Picelli Alessandro, Bacciga Marco, Melotti Camilla, LA Marchina Elisabetta, Verzini Elisabetta, Ferrari Federico, Pontillo Angelo, Corradi Jessica, Tamburin Stefano, Saltuari Leopold, Corradini Claudio, Waldner Andreas, Smania Nicola
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy -
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
Eur J Phys Rehabil Med. 2016 Dec;52(6):759-766. Epub 2016 Apr 21.
Despite the growing evidence about the use of robotic gait training in neurorehabilitation, there is a scant literature about the combined effects of this innovative technological approach and a first‑line treatment for focal spasticity as botulinum toxin type A. In particular, to the best of our knowledge, no previous study evaluated if robotic gait training may enhance the antispastic effect of botulinum toxin type A.
To evaluate the combined effects of robot‑assisted gait training and botulinum toxin type A on spastic equinus foot in patients with chronic stroke.
Pilot, single blind, randomized controlled trial.
University hospital.
Twenty‑two adult outpatients with spastic equinus due to chronic stroke.
Participants were randomly assigned to two groups: patients allocated to the group 1 received robot‑assisted gait training (30 minutes a day for five consecutive days) after AbobotulinumtoxinA injection into the spastic calf muscles as well as patients allocated to the group 2 were only injected with AbobotulinumtoxinA into the same muscles. All patients were evaluated immediately before and one month after injection. The following outcome measures were considered: the modified Ashworth scale, the Tardieu scale and the 6-minute walking test.
No difference was found between groups as to the modified Ashworth scale and the Tardieu scale measured at the affected ankle one month after botulinum toxin injection. A significant difference in the 6-minute walking test was noted between groups at the post‑treatment evaluation (P=0.045).
Our preliminary findings support the hypothesis that robot‑assisted gait training does not enhance the effect of botulinum toxin type A on spastic equinus foot in patients with chronic stroke.
Our observations should be taken into account in daily clinical rehabilitation practice in order to develop effective treatment protocols based on the enhancement of antispastic drugs effect.
尽管关于机器人步态训练在神经康复中的应用证据越来越多，但关于这种创新技术方法与一线局灶性痉挛治疗药物A型肉毒毒素联合使用效果的文献却很少。特别是，据我们所知，以前没有研究评估机器人步态训练是否可以增强A型肉毒毒素的抗痉挛效果。
评估机器人辅助步态训练和A型肉毒毒素对慢性中风患者痉挛性马蹄足的联合效果。
前瞻性、单盲、随机对照试验。
大学医院。
22名因慢性中风导致痉挛性马蹄足的成年门诊患者。
参与者被随机分为两组：第1组患者在向痉挛性小腿肌肉注射阿柏西普肉毒毒素A后接受机器人辅助步态训练（每天30分钟，连续五天），第2组患者仅在相同肌肉注射阿柏西普肉毒毒素A。所有患者在注射前和注射后1个月立即进行评估。考虑以下结果指标：改良Ashworth量表、Tardieu量表和6分钟步行试验。
在肉毒毒素注射后1个月，两组在受影响踝关节处测量的改良Ashworth量表和Tardieu量表方面没有差异。在治疗后评估中，两组在6分钟步行试验中存在显著差异（P = 0.045）。
我们的初步研究结果支持以下假设：机器人辅助步态训练不会增强A型肉毒毒素对慢性中风患者痉挛性马蹄足的治疗效果。
在日常临床康复实践中应考虑我们的观察结果，以便制定基于增强抗痉挛药物效果的有效治疗方案。
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