Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy.
Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy.
Eur J Phys Rehabil Med. 2017 Oct;53(5):676-684. doi: 10.23736/S1973-9087.17.04591-9. Epub 2017 Jan 24.
Recovery of therapeutic or functional ambulatory capacity in post-stroke patients is a primary goal of rehabilitation. Wearable powered exoskeletons allow patients with gait dysfunctions to perform over-ground gait training, even immediately after the acute event.
To investigate the feasibility and the clinical effects of an over-ground walking training with a wearable powered exoskeleton in sub-acute and chronic stroke patients.
Prospective, pilot pre-post, open label, non-randomized experimental study.
A single neurological rehabilitation center for inpatients and outpatients.
Twenty-three post-stroke patients were enrolled: 12 sub-acute (mean age: 43.8±13.3 years, 5 male and 7 female, 7 right hemiparesis and 5 left hemiparesis) and 11 chronic (mean age: 55.5±15.9 years, 7 male and 4 female, 4 right hemiparesis and 7 left hemiparesis) patients.
Patients underwent 12 sessions (60 min/session, 3 times/week) of walking rehabilitation training using Ekso™, a wearable bionic suit that enables individuals with lower extremity disabilities and minimal forearm strength to stand up, sit down and walk over a flat hard surface with a full weight-bearing reciprocal gait. Clinical evaluations were performed at the beginning of the training period (t0), after 6 sessions (t1) and after 12 sessions (t2) and were based on the Ashworth scale, Motricity Index, Trunk Control Test, Functional Ambulation Scale, 10-Meter Walking Test, 6-Minute Walking Test, and Walking Handicap Scale. Wilcoxon's test (P<0.05) was used to detect significant changes.
Statistically significant improvements were observed at the three assessment periods for both groups in Motricity Index, Functional Ambulation Scale, 10-meter walking test, and 6-minute walking test. Sub-acute patients achieved statistically significant improvement in Trunk Control Test and Walking Handicap Scale at t0-t2. Sub-acute and chronic patient did not achieve significant improvement in Ashworth scale at t0-t2.
Twelve sessions of over-ground gait training using a powered wearable robotic exoskeleton improved ambulatory functions in sub-acute and chronic post-stroke patients. Large, randomized multicenter studies are needed to confirm these preliminary data.
To plan a completely new individual tailored robotic rehabilitation strategy after stroke, including task-oriented over-ground gait training.
在脑卒中患者中，恢复治疗或功能性步行能力是康复的主要目标。穿戴式动力外骨骼允许步态障碍患者进行地面步行训练，即使是在急性事件后立即进行。
研究穿戴式动力外骨骼在亚急性期和慢性期脑卒中患者中的地面步行训练的可行性和临床效果。
前瞻性、先导性、前后自身对照、开放标签、非随机实验研究。
一家单神经病学康复中心，用于住院和门诊患者。
共纳入 23 例脑卒中患者：12 例亚急性期（平均年龄：43.8±13.3 岁，5 例男性，7 例女性，7 例右侧偏瘫，5 例左侧偏瘫）和 11 例慢性期（平均年龄：55.5±15.9 岁，7 例男性，4 例女性，4 例右侧偏瘫，7 例左侧偏瘫）。
患者使用 Ekso ™进行 12 次（每次 60 分钟/次，每周 3 次）步行康复训练，Ekso ™是一种可穿戴仿生服，可使下肢残疾和最小前臂力量的个体能够在平坦坚硬的表面上站立、坐下和行走，实现全负重的交互步态。临床评估在训练期开始时（t0）、6 次治疗后（t1）和 12 次治疗后（t2）进行，评估基于 Ashworth 量表、运动指数、躯干控制测试、功能性步行量表、10 米步行测试、6 分钟步行测试和步行障碍量表。Wilcoxon 检验（P<0.05）用于检测显著变化。
两组患者在运动指数、功能性步行量表、10 米步行测试和 6 分钟步行测试的三个评估期均观察到统计学显著改善。亚急性期患者在 t0-t2 时躯干控制测试和步行障碍量表的改善具有统计学意义。亚急性期和慢性期患者在 t0-t2 时 Ashworth 量表无显著改善。
12 次地面步态训练使用动力可穿戴机器人外骨骼改善了亚急性期和慢性期脑卒中患者的步行功能。需要进行更大规模、多中心的随机研究来证实这些初步数据。
为脑卒中后制定全新的个体化机器人康复策略，包括以任务为导向的地面步行训练。
