Hwang Jongseok, Shin Yongil, Park Ji-Ho, Cha Young Joo, You Joshua Sung H
Department of Physical Therapy, Sports Movement Artificial Robotics Technology (SMART) Institute, Yonsei University, Wonju, Republic of Korea.
Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan, Republic of Korea.
NeuroRehabilitation. 2018;42(4):481-489. doi: 10.3233/NRE-172226.
The robotic-assisted gait training (RAGT) system has gained recognition as an innovative, effective paradigm to improve functional ambulation and activities of daily living in spinal cord injury and stroke. However, the effects of the Walkbot robotic-assisted gait training system with a specialized hip-knee-ankle actuator have never been examined in the paraplegia and quadriplegia population.
The aim of this study was to determine the long-term effects of Walkbot training on clinical for hips and knee stiffness in individuals with paraplegia or quadriplegia.
Nine adults with subacute or chronic paraplegia resulting from spinal cord injury or quadriplegia resulting from cerebral vascular accident (CVA) and/or hypoxia underwent progressive conventional gait retraining combined with the Walkbot RAGT for 5 days/week over an average of 43 sessions for 8 weeks. Clinical outcomes were measured with the Functional Ambulation Category (FAC), Modified Rankin Scale (MRS), Korean version of the Modified Barthel Index (K-MBI), Modified Ashworth Scale (MAS). Kinetic and kinematic data were collected via a built-in Walkbot program.
Wilcoxon signed-rank tests showed significant positive intervention effects on K-MBI, maximal hip flexion and extension, maximal knee flexion, active torque in the knee joint, resistive torque, and stiffness in the hip joint (P < 0.05). These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. These improvements were associated with functional recovery in gait, balance, mobility and daily activities.
These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. This is the first clinical evidence for intensive, long-term effects of the Walkbot RAGT on active or resistive moments and stiffness associated with spasticity and functional mobility in individuals with subacute or chronic paraplegia or quadriplegia who had reached a plateau in motor recovery after conventional therapy.
机器人辅助步态训练（RAGT）系统已被公认为是一种创新、有效的模式，可改善脊髓损伤和中风患者的功能性步行及日常生活活动能力。然而，具有专门髋-膝-踝驱动装置的Walkbot机器人辅助步态训练系统对截瘫和四肢瘫患者的影响尚未得到研究。
本研究旨在确定Walkbot训练对截瘫或四肢瘫患者髋部和膝部僵硬临床症状的长期影响。
9名因脊髓损伤导致亚急性或慢性截瘫或因脑血管意外（CVA）和/或缺氧导致四肢瘫的成年人，接受了渐进性传统步态再训练，并结合Walkbot RAGT，每周训练5天，平均训练43节，共8周。临床结局采用功能性步行分类（FAC）、改良Rankin量表（MRS）、韩国版改良Barthel指数（K-MBI）、改良Ashworth量表（MAS）进行测量。动力学和运动学数据通过内置的Walkbot程序收集。
Wilcoxon符号秩检验显示，对K-MBI、最大髋部屈伸、最大膝部屈伸、膝关节主动扭矩、阻力扭矩和髋关节僵硬有显著的正向干预效果（P < 0.05）。这些发现表明，Walkbot RAGT可有效改善膝部和髋部运动学以及膝关节主动力矩，同时降低髋部阻力。这些改善与步态、平衡、移动性和日常活动的功能恢复相关。
这些发现表明，Walkbot RAGT可有效改善膝部和髋部运动学以及膝关节主动力矩，同时降低髋部阻力。这是Walkbot RAGT对亚急性或慢性截瘫或四肢瘫患者的主动或阻力力矩以及与痉挛和功能移动性相关的僵硬产生强化、长期影响的首个临床证据，这些患者在传统治疗后运动恢复已达到平台期。
