From the Schoen Klinik Bad Aibling; and German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University of Munich, Germany.
Neurology. 2018 Oct 2;91(14):e1319-e1327. doi: 10.1212/WNL.0000000000006276. Epub 2018 Aug 31.
To determine the effects of 2 weeks of intensive robot-assisted gait training (RAGT) on pusher behavior compared to nonrobotic physiotherapy (nR-PT).
In a single-blind, randomized, controlled trial with 2 parallel arms, we compared 2 weeks of daily RAGT (intervention group) with the same amount of nR-PT (control group). Patients with subacute stroke who had pusher behavior according to the Scale for Contraversive Pushing (SCP) were included. The primary research questions were whether changes in pusher behavior would differ between groups post intervention, and at a follow-up 2 weeks afterward (SCP and Burke Lateropulsion Scale, Class II evidence). Secondary outcomes included the Performance-Oriented Mobility Assessment, the Functional Ambulation Classification, and the Subjective Visual Vertical.
Thirty-eight patients were randomized. Thereof, 30 patients received the allocated intervention and were included in the analyses. RAGT led to a larger reduction of pusher behavior than nR-PT at post test (SCP: = 69.00, = -0.33, = 0.037; Burke Lateropulsion Scale: = 47.500, = -0.50, = 0.003) and at follow-up (SCP: = 54.00, = -0.44, = 0.008). Pusher behavior had ceased in 6 of 15 participants in the intervention group and 1 of 15 participants in the control group at post test. At follow-up, 9 of 15 and 5 of 15 participants, respectively, no longer exhibited the behavior.
Two weeks of RAGT seems to persistently reduce pusher behavior, possibly by recalibrating the disturbed inner reference of verticality. The potential benefits of RAGT on pusher behavior and verticality perception require further investigation.
German Clinical Trials Register (registration number: DRKS00003444).
This study provides Class II evidence that RAGT is beneficial to reduce pusher behavior in patients with stroke.
比较 2 周强化机器人辅助步态训练（RAGT）与非机器人物理治疗（nR-PT）对推挤行为的影响。
在一项单盲、随机、对照的双臂平行试验中，我们比较了 2 周的每日 RAGT（干预组）与相同数量的 nR-PT（对照组）。纳入了根据推挤量表（SCP）有推挤行为的亚急性脑卒中患者。主要研究问题是干预后两组间的推挤行为变化是否不同，以及 2 周后随访时（SCP 和 Burke 侧方推动量表，II 级证据）是否不同。次要结局包括作业性移动评估、功能性步行分类和主观视觉垂直。
38 名患者被随机分配。其中，30 名患者接受了分配的干预并纳入了分析。与 nR-PT 相比，RAGT 导致推挤行为的减少更大，无论是在测试后（SCP： = 69.00， = -0.33， = 0.037；Burke 侧方推动量表： = 47.500， = -0.50， = 0.003）还是在随访时（SCP： = 54.00， = -0.44， = 0.008）。干预组 15 名参与者中有 6 名和对照组 15 名参与者中有 1 名在测试后停止了推挤行为。在随访时，分别有 9 名和 5 名参与者不再表现出这种行为。
2 周的 RAGT 似乎持续地减少了推挤行为，可能是通过重新校准了垂直感的紊乱的内在参考。RAGT 对推挤行为和垂直感的潜在益处需要进一步研究。
德国临床试验注册处（注册号：DRKS00003444）。
本研究提供了 II 级证据，表明 RAGT 有利于减少脑卒中患者的推挤行为。
