Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, University Hospital of Ancona, "Politecnica delle Marche" University, Ancona, Italy.
Rehabilitation Department IRCCS San Raffaele-Pisana, Rome, Italy.
Ann Phys Rehabil Med. 2019 Sep;62(5):303-312. doi: 10.1016/j.rehab.2019.06.016. Epub 2019 Aug 1.
Although gait disorders strongly contribute to perceived disability in people with Parkinson's disease, clinical trials have failed to identify which task-oriented gait training method can provide the best benefit. Freezing of gait remains one of the least investigated and most troublesome symptoms.
We aimed to compare the effects of robot-assisted gait training and treadmill training on endurance and gait capacity in people with Parkinson disease; the secondary aim was to compare the effect of the treatments in people with freezing and/or severe gait disability and assess changes in overall disease-related disability and quality of life.
Outpatients with Parkinson disease (Hoehn and Yahr stage≥2) were randomly assigned to receive 20 sessions of 45-min gait training assisted by an end-effector robotic device (G-EO System) or treadmill training. Outcome assessments were the 6-min walk test, Timed Up and Go test, Freezing of Gait Questionnaire, Unified Parkinson's Disease Rating Scales and Parkinson's Disease Quality of Life Questionnaire-39 administered before (T0) and after treatment (T1).
We included 96 individuals with Parkinson disease: 48 with robot-assisted gait training and 48 treadmill training. Both groups showed significant improvement in all outcomes. As compared with baseline, with robot-assisted gait training and treadmill training, endurance and gait capacity were enhanced by 18% and 12%, respectively, and motor symptoms and quality of life were improved by 17% and 15%. The maximum advantage was observed with the Freezing of Gait Questionnaire score, which decreased by 20% after either treatment. On post-hoc analysis, dependent walkers benefited more than independent walkers from any gait training, whereas freezers gained more from robot-assisted than treadmill training in terms of freezing reduction.
Repetitive intensive gait training is an effective treatment for people with Parkinson disease and can increase endurance and gait velocity, especially for those with severe walking disability. Advantages are greater with robot-assisted gait training than treadmill training for individuals with freezing of gait - related disability.
尽管步态障碍严重影响帕金森病患者的自理能力，但临床试验未能确定哪种以任务为导向的步态训练方法能带来最佳效果。冻结步态仍然是研究最少、最麻烦的症状之一。
我们旨在比较机器人辅助步态训练和跑步机训练对帕金森病患者耐力和步态能力的影响；次要目的是比较两种治疗方法对冻结步态和/或严重步态障碍患者的效果，并评估整体与疾病相关的残疾和生活质量的变化。
门诊帕金森病患者（Hoehn 和 Yahr 分期≥2 期）被随机分配接受 20 次 45 分钟的步态训练，由末端执行器机器人设备（G-EO 系统）或跑步机辅助。在治疗前（T0）和治疗后（T1），使用 6 分钟步行测试、计时起立行走测试、冻结步态问卷、统一帕金森病评定量表和帕金森病生活质量问卷-39 进行评估。
我们纳入了 96 名帕金森病患者：48 名接受机器人辅助步态训练，48 名接受跑步机训练。两组在所有结果上均显示出显著改善。与基线相比，机器人辅助步态训练和跑步机训练后，耐力和步态能力分别提高了 18%和 12%，运动症状和生活质量分别提高了 17%和 15%。最大的优势出现在冻结步态问卷评分上，两种治疗后评分均下降了 20%。事后分析显示，依赖步行者比独立步行者从任何步态训练中获益更多，而对于与冻结步态相关的残疾，冻结步态患者从机器人辅助步态训练中获益比跑步机训练更多。
重复强化步态训练是治疗帕金森病患者的有效方法，可以提高耐力和步态速度，特别是对严重步行障碍的患者。对于与冻结步态相关的残疾患者，机器人辅助步态训练比跑步机训练具有更大的优势。
