Park Ji-Ho, Shin Yong-Il, You Joshua Sung H, Park Min Su
Department of Physical Therapy, Dynamic Movement Institute and Technology, College of Health Science, Yonsei University, Wonju, Republic of Korea.
Brain Korea 21 PLUS Project for Physical Therapy, Yonsei University, Wonju, Republic of Korea.
NeuroRehabilitation. 2018;42(2):181-190. doi: 10.3233/NRE-172234.
Robotic-assisted gait training (RAGT) has been proposed as a novel, promising intervention paradigm to improve gait function in subacute or chronic stroke neurorehabilitation. However, the benefits of RAGT combined with conventional physical therapy for gait recovery in patients with subacute and chronic hemiparetic stroke remain unclear.
The aim of the present study was to compare the effect of RAGT combine with conventional physical therapy on hip joint kinetics, kinematics, and clinical function characteristics between subacute and chronic hemiparetic stroke.
Seventeen patients with hemiparetic stroke (nine subacute and eight chronic patients) performed progressive RAGT (session 1, 40 min) combined with conventional physical therapy (session 1, 40 min) 5 days per week, for an average of 86 sessions over 8 weeks. The clinical outcomes included the Functional Ambulation Category (FAC), modified Rankin scale (mRS), Korean version of the modified Barthel index (K-MBI), and modified Ashworth scale, in addition to hip joint kinetics and kinematics before and after intervention.
The mean change in active torque, resistive torque, and stiffness in the paretic hip joint did not differ significantly between the two groups. However, Cohen's effect size suggested a moderate difference between the groups in the hip flexion phase (d = 0.58, d = 0.70, and d = 0.70). The mean change in maximal hip flexion kinematics in the chronic group was significantly greater than that in the subacute group (p = 0.04, d = -0.70). The mean change in the clinical function test results between the groups was not statistically significant. However, both groups showed significantly improved FAC, mRS, and K-MBI scores.
RAGT combine with conventional physical therapy may be useful when selecting therapeutic interventions to improve the active torque, resistive torque, and stiffness in the paretic hip flexion phase in patients with chronic hemiparetic stroke who reached a plateau in the maximum locomotor recovery after conventional locomotor training.
机器人辅助步态训练（RAGT）已被提出作为一种新型的、有前景的干预模式，用于改善亚急性或慢性卒中神经康复中的步态功能。然而，RAGT联合传统物理治疗对亚急性和慢性偏瘫性卒中患者步态恢复的益处仍不明确。
本研究旨在比较RAGT联合传统物理治疗对亚急性和慢性偏瘫性卒中患者髋关节动力学、运动学及临床功能特征的影响。
17例偏瘫性卒中患者（9例亚急性患者和8例慢性患者）每周5天进行渐进式RAGT（第1阶段，40分钟）联合传统物理治疗（第1阶段，40分钟），平均8周进行86次治疗。临床结局包括功能步行分类（FAC）、改良Rankin量表（mRS）、韩国版改良Barthel指数（K-MBI）和改良Ashworth量表，以及干预前后的髋关节动力学和运动学。
两组患者患侧髋关节主动扭矩、阻力扭矩和刚度的平均变化无显著差异。然而，Cohen效应量表明两组在髋关节屈曲阶段存在中度差异（d = 0.58、d = 0.70和d = 0.70）。慢性组最大髋关节屈曲运动学的平均变化显著大于亚急性组（p = 0.04，d = -0.70）。两组间临床功能测试结果的平均变化无统计学意义。然而，两组的FAC、mRS和K-MBI评分均显著改善。
对于在传统运动训练后最大运动恢复达到平台期的慢性偏瘫性卒中患者，在选择治疗干预措施以改善患侧髋关节屈曲阶段的主动扭矩、阻力扭矩和刚度时，RAGT联合传统物理治疗可能是有用的。
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