Esquenazi Alberto, Lee Stella, Wikoff Amanda, Packel Andrew, Toczylowski Theresa, Feeley John
MossRehab Gait and Motion Analysis Laboratory, 60 Township Line Rd, Elkins Park, PA 19027(∗).
MossRehab Gait and Motion Analysis Laboratory, Elkins Park, PA(†).
PM R. 2017 Sep;9(9):839-846. doi: 10.1016/j.pmrj.2016.12.010. Epub 2017 Jan 16.
Literature in the application of gait training techniques in persons with traumatic brain injury (TBI) is limited. Current techniques require multiple staff and are physically demanding. The use of a robotic locomotor training may provide improved training capacity for this population.
To examine the impact of 3 different modes of locomotor therapy on gait velocity and spatiotemporal symmetry using an end effector robot (G-EO); a robotic exoskeleton (Lokomat), and manual assisted partial-body weight-supported treadmill training (PBWSTT) in participants with traumatic brain injury.
Randomized, prospective study.
Tertiary rehabilitation hospital.
A total of 22 individuals with ≥12 months chronic TBI with hemiparetic pattern able to walk overground without assistance at velocities between 0.2 and 0.6 m/s.
Eighteen sessions of 45 minutes of assigned locomotor training.
Overground walking self-selected velocity (SSV), maximal velocity (MV), spatiotemporal asymmetry ratio, 6-Minute Walk Test (6MWT), and mobility domain of Stroke Impact Scale (MSIS).
Severity in walking dysfunction was similar across groups as determined by walking velocity data. At baseline, participants in the Lokomat group had a baseline velocity that was slightly slower compared with the other groups. Training elicited a statistically significant median increase in SSV for all groups compared with pretraining (Lokomat, P = .04; G-EO, P = .03; and PBWSTT, P = .02) and MV excluding the G-EO group (Lokomat, P = .04; PBWSTT, P = .03 and G-EO, P = .15). There were no pre-post significant differences in swing time, stance time, and step length asymmetry ratios at SSV or MV for any of the interventions. Mean rank in the change of SSV and MV was not statistically significantly different between groups. Participants in the G-EO and PBWSTT groups significantly improved their 6MWT posttraining (P = .04 and .03, respectively). The MSIS significantly improved only for the Lokomat group (P = .04 and .03). The data did not elicit between-groups significant differences for 6MWT and MSIS. There was less use of staff for Lokomat than G-EO.
Locomotor therapy using G-EO, Lokomat, or PBWSTT in individuals with chronic TBI increased SSV and MV without significant changes in gait symmetry. Staffing needed for therapy provision was the least for the Lokomat. A larger study may further elucidate changes in gait symmetry and other training parameters.
II.
关于步态训练技术在创伤性脑损伤（TBI）患者中的应用的文献有限。当前技术需要多名工作人员，且对体力要求较高。使用机器人运动训练可能会为这一人群提供更好的训练能力。
使用末端执行器机器人（G-EO）、机器人外骨骼（Lokomat）和手动辅助部分体重支撑跑步机训练（PBWSTT），研究三种不同运动疗法模式对创伤性脑损伤患者步态速度和时空对称性的影响。
随机、前瞻性研究。
三级康复医院。
总共22名患有慢性TBI且病程≥12个月、有偏瘫模式、能够在地面上以0.2至0.6米/秒的速度独立行走的个体。
进行18节，每节45分钟的指定运动训练。
地面行走自选速度（SSV）、最大速度（MV）、时空不对称率、6分钟步行试验（6MWT）以及卒中影响量表的活动领域（MSIS）。
根据步行速度数据确定，各组间步行功能障碍的严重程度相似。在基线时，Lokomat组参与者的基线速度比其他组略慢。与训练前相比，所有组的训练均使SSV出现统计学上显著的中位数增加（Lokomat组，P = 0.04；G-EO组，P = 0.03；PBWSTT组，P = 0.02），MV除G-EO组外也有增加（Lokomat组，P = 0.04；PBWSTT组，P = 0.03；G-EO组，P = 0.15）。对于任何一种干预措施，在SSV或MV时，摆动时间、站立时间和步长不对称率在训练前后均无显著差异。各组间SSV和MV变化的平均秩无统计学显著差异。G-EO组和PBWSTT组的参与者在训练后6MWT有显著改善（分别为P = 0.04和0.03）。仅Lokomat组的MSIS有显著改善（P = 0.04和0.03）。6MWT和MSIS的数据在组间未显示出显著差异。Lokomat组所需的工作人员比G-EO组少。
在慢性TBI患者中使用G-EO、Lokomat或PBWSTT进行运动疗法可提高SSV和MV，且步态对称性无显著变化。提供治疗所需的工作人员中，Lokomat组最少。一项更大规模的研究可能会进一步阐明步态对称性和其他训练参数的变化。
II级。
