Calabrò Rocco S, De Cola Maria C, Leo Antonino, Reitano Simone, Balletta Tina, Trombetta Giovanni, Naro Antonino, Russo Margherita, Bertè Francesco, De Luca Rosaria, Bramanti Placido
IRCCS Centro Neurolesi 'Bonino Pulejo', Messina, Italy.
Int J Rehabil Res. 2015 Sep;38(3):219-25. doi: 10.1097/MRR.0000000000000114.
Although gait abnormality is one of the most disabling events following stroke, cognitive, and psychological impairments can be devastating. The Lokomat is a robotic that has been used widely for gait rehabilitation in several movement disorders, especially in the acute and subacute phases. The aim of this study was to evaluate the effectiveness of gait robotic rehabilitation in patients affected by chronic stroke. Psychological impact was also taken into consideration. Thirty patients (13 women and 17 men) affected by chronic stroke entered the study. All participants underwent neurological examination with respect to ambulation, Ashworth, Functional Independence Measure, and Tinetti scales to assess their physical status, and Hamilton Rating Scale for Depression, Psychological General Well-being Index, and Coping Orientation to Problem Experienced to evaluate the Lokomat-related psychological impact before and after either a conventional treatment or the robotic training. During each rehabilitation period (separated by a no-treatment period), patients underwent a total of 40 1 h training sessions (i.e. five times a week for 8 weeks). After the conventional treatment, the patients did not achieve a significant improvement in the functional status, except balance (P<0.001) and walking ability (P<0.01), as per the Tinetti scale. Indeed, after the robotic rehabilitation, significant improvements were detected in almost all the motor and psychological scales that we investigated, particularly for Psychological General Well-being Index and Coping Orientation to Problem Experienced. Manual and robotic-assisted body weight-supported treadmill training optimizes the sensory inputs relevant to step training, repeated practice, as well as neuroplasticity. Several controlled trials have shown a superior effect of Lokomat treatment in stroke patients' walking ability and velocity in particular. Therefore, our preliminary results proved that active robotic training not only facilitates gait and physical function but also the psychological status, even in patients affected by chronic stroke.
尽管步态异常是中风后最致残的情况之一，但认知和心理障碍可能更具破坏性。Lokomat是一种机器人设备，已广泛应用于多种运动障碍的步态康复，尤其是在急性和亚急性期。本研究的目的是评估步态机器人康复对慢性中风患者的有效性。同时也考虑了其心理影响。30例慢性中风患者（13名女性和17名男性）进入本研究。所有参与者均接受了关于步行、Ashworth量表、功能独立性测量和Tinetti量表的神经学检查，以评估其身体状况，并使用汉密尔顿抑郁量表、心理总体幸福感指数和应对问题的定向方式来评估传统治疗或机器人训练前后与Lokomat相关的心理影响。在每个康复阶段（中间有一个无治疗期），患者总共接受40次1小时的训练课程（即每周5次，共8周）。根据Tinetti量表，传统治疗后，除平衡能力（P<0.001）和步行能力（P<0.01）外，患者的功能状态未取得显著改善。事实上，机器人康复后，我们所研究的几乎所有运动和心理量表都有显著改善，特别是心理总体幸福感指数和应对问题的定向方式。手动和机器人辅助的体重支持跑步机训练优化了与步幅训练、重复练习以及神经可塑性相关的感觉输入。多项对照试验表明，Lokomat治疗对中风患者的步行能力和速度尤其有显著效果。因此，我们的初步结果证明，主动机器人训练不仅有助于改善步态和身体功能，还能改善心理状态，即使是慢性中风患者。
