IRCCS Centro Neurolesi "Bonino-Pulejo", S.S. 113, Contrada Casazza, 98124, Messina, Italy.
Fondazione Centri di Riabilitazione, P. Pio - Onlus, Lecce, Italy.
J Neuroeng Rehabil. 2018 Apr 25;15(1):35. doi: 10.1186/s12984-018-0377-8.
The use of neurorobotic devices may improve gait recovery by entraining specific brain plasticity mechanisms, which may be a key issue for successful rehabilitation using such approach. We assessed whether the wearable exoskeleton, Ekso™, could get higher gait performance than conventional overground gait training (OGT) in patients with hemiparesis due to stroke in a chronic phase, and foster the recovery of specific brain plasticity mechanisms.
We enrolled forty patients in a prospective, pre-post, randomized clinical study. Twenty patients underwent Ekso™ gait training (EGT) (45-min/session, five times/week), in addition to overground gait therapy, whilst 20 patients practiced an OGT of the same duration. All individuals were evaluated about gait performance (10 m walking test), gait cycle, muscle activation pattern (by recording surface electromyography from lower limb muscles), frontoparietal effective connectivity (FPEC) by using EEG, cortico-spinal excitability (CSE), and sensory-motor integration (SMI) from both primary motor areas by using Transcranial Magnetic Stimulation paradigm before and after the gait training.
A significant effect size was found in the EGT-induced improvement in the 10 m walking test (d = 0.9, p < 0.001), CSE in the affected side (d = 0.7, p = 0.001), SMI in the affected side (d = 0.5, p = 0.03), overall gait quality (d = 0.8, p = 0.001), hip and knee muscle activation (d = 0.8, p = 0.001), and FPEC (d = 0.8, p = 0.001). The strengthening of FPEC (r = 0.601, p < 0.001), the increase of SMI in the affected side (r = 0.554, p < 0.001), and the decrease of SMI in the unaffected side (r = - 0.540, p < 0.001) were the most important factors correlated with the clinical improvement.
Ekso™ gait training seems promising in gait rehabilitation for post-stroke patients, besides OGT. Our study proposes a putative neurophysiological basis supporting Ekso™ after-effects. This knowledge may be useful to plan highly patient-tailored gait rehabilitation protocols.
ClinicalTrials.gov , NCT03162263 .
使用神经机器人设备可以通过引出特定的大脑可塑性机制来改善步态恢复，这可能是使用这种方法进行成功康复的关键问题。我们评估了可穿戴式外骨骼 Ekso™ 是否可以在慢性期因中风导致偏瘫的患者中比传统的地面步态训练（OGT）获得更高的步态表现，并促进特定大脑可塑性机制的恢复。
我们前瞻性地纳入了 40 名患者进行预-后、随机的临床研究。20 名患者接受 Ekso™ 步态训练（EGT）（45 分钟/次，每周 5 次），同时进行地面步态治疗，而 20 名患者接受相同时长的 OGT。所有患者在步态训练前和后分别进行步态表现（10 米步行测试）、步态周期、下肢肌肉肌电图记录的肌肉激活模式、脑电的额顶有效连通性（FPEC）、使用经颅磁刺激范式的初级运动区的皮质脊髓兴奋性（CSE）和感觉运动整合（SMI）评估。
在 EGT 诱导的 10 米步行测试（d=0.9，p<0.001）、患侧的 CSE（d=0.7，p=0.001）、患侧的 SMI（d=0.5，p=0.03）、整体步态质量（d=0.8，p=0.001）、髋关节和膝关节肌肉激活（d=0.8，p=0.001）和 FPEC（d=0.8，p=0.001）方面，我们发现 EGT 有显著的效果量。FPEC 的增强（r=0.601，p<0.001）、患侧 SMI 的增加（r=0.554，p<0.001）和健侧 SMI 的减少（r=-0.540，p<0.001）是与临床改善最相关的最重要因素。
Ekso™ 步态训练除了 OGT 外，对中风后患者的步态康复似乎很有前景。我们的研究提出了支持 Ekso™ 后效的神经生理学基础。这些知识可能有助于制定高度针对患者的步态康复方案。
ClinicalTrials.gov，NCT03162263。
