Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital.
Department of Rehabilitation Medicine, Konkuk University Medical Center.
Medicine (Baltimore). 2021 Feb 5;100(5):e24348. doi: 10.1097/MD.0000000000024348.
Gait automaticity is reduced in patients with Parkinson disease (PD) due to impaired habitual control. The aim of this study was to investigate the effect of robot-assisted gait training (RAGT) on gait automaticity as well as gait speed and balance in patients with PD.This study was a prospective, open-label, single-arm, pilot study. We planned to recruit 12 patients with idiopathic PD. Participants received 12 sessions of RAGT using exoskeleton-type robotic device. Sessions were 45-minute each, 3 days a week, for 4 consecutive weeks using an exoskeleton-type gait robot. The primary outcome was the percentage of dual-task interference measured by the 10-Meter Walk Test (10MWT) under single and dual-task (cognitive and physical) conditions. Secondary outcomes were the Berg Balance Scale and Korean version of the Falls Efficacy Scale-International. All measures were evaluated before treatment (T0), after treatment (T1), and 1-month post-treatment (T2).Twelve patients were enrolled and 1 dropped out. Finally, 11 patients with idiopathic PD were analyzed. The mean age of 11 patients (5 males) was 66.46 ± 5.66 years, and disease duration was 112.91 ± 50.19 months. The Hoehn and Yahr stages were 2.5 in 8 patients and 3 in 3 patients. Linear mixed-effect model analysis showed a significant change over time only in single-task gait speed of the 10MWT (P = .007), but not in dual-task gait speed, dual-task interferences, and Korean version of the Falls Efficacy Scale-International. Cognitive dual-task interference significantly increased (P = .026) at T1, but not at T2 (P = .203). No significant changes were observed for physical dual-task interference at T1 and T2. Single-task gait speed of the 10MWT was significantly increased at T1 (P = .041), but not at T2 (P = .445). There were no significant changes in the dual-task gait speed of 10MWT. A significant improvement was observed in Berg Balance Scale score at T1 and T2 (P = .004 and P = .024, respectively).In this pilot study, despite improvement in walking speed and balance, gait automaticity in patients with PD was not improved by RAGT using an exoskeleton-type robot. Additional therapeutic components may be needed to improve gait automaticity using RAGT in patients with PD.
步态自动性在帕金森病（PD）患者中降低，这是由于习惯性控制受损。本研究旨在探讨机器人辅助步态训练（RAGT）对 PD 患者步态自动性以及步态速度和平衡的影响。
本研究为前瞻性、开放标签、单臂、试点研究。我们计划招募 12 名特发性 PD 患者。参与者使用外骨骼式机器人接受 12 次 RAGT。每个疗程为 45 分钟，每周 3 天，连续 4 周使用外骨骼式步态机器人。主要结局指标是在单任务和双任务（认知和体力）条件下通过 10 米步行测试（10MWT）测量的双重任务干扰的百分比。次要结局指标是 Berg 平衡量表和韩国版跌倒效能量表-国际版。所有测量均在治疗前（T0）、治疗后（T1）和治疗后 1 个月（T2）进行评估。
12 名患者入组，1 名脱落。最终，11 名特发性 PD 患者进行了分析。11 名患者（5 名男性）的平均年龄为 66.46±5.66 岁，病程为 112.91±50.19 个月。Hoehn 和 Yahr 分期为 8 例 2.5 期，3 例 3 期。线性混合效应模型分析显示，仅在 10MWT 的单任务步态速度上随时间有显著变化（P=0.007），而在双任务步态速度、双任务干扰和韩国版跌倒效能量表-国际版上没有变化。认知双重任务干扰在 T1 时显著增加（P=0.026），但在 T2 时没有（P=0.203）。T1 和 T2 时物理双重任务干扰无明显变化。10MWT 的单任务步态速度在 T1 时显著增加（P=0.041），但在 T2 时没有（P=0.445）。10MWT 的双任务步态速度无明显变化。Berg 平衡量表评分在 T1 和 T2 时均有显著改善（P=0.004 和 P=0.024）。
在这项试点研究中，尽管步行速度和平衡有所改善，但使用外骨骼式机器人的 RAGT 并未改善 PD 患者的步态自动性。可能需要额外的治疗成分来改善 PD 患者使用 RAGT 的步态自动性。
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