Romanato M, Spolaor F, Beretta C, Fichera F, Bertoldo A, Volpe D, Sawacha Z
Department of Information Engineering, University of Padua, Padua, Italy.
Fresco Parkinson Center, Villa Margherita, S. Stefano, Vicenza, Italy.
Contemp Clin Trials Commun. 2022 May 25;28:100926. doi: 10.1016/j.conctc.2022.100926. eCollection 2022 Aug.
Gait alterations are among the most disabling motor-symptoms associated with Parkinson's Disease (PD): reduced stride length, stride velocity and lower limb joint range of motion are hallmarks of parkinsonian gait. Research focusing on optimal functional rehabilitation methods has been directed towards powered lower-limb exoskeletons which combines the advantages delivered from the grounded robotic devices with the ability to train the patient in a real-world environment As gait involves both central (CNS) and peripheral nervous systems (PNS), targeted rehabilitation must restore not only mechanics but also neurophysiological gait patterns.
Two cohorts of subjects will be enrolled and equally distributed between one group (n = 25) who will undergo a functional kinematic therapy, and one group (n = 25) who will undergo an overground wearable-exoskeleton training. Participants are evaluated at three time points: before the therapy (T0), after the therapy (T1), 4-weeks after T1 (T2). Comprehensive gait analysis and surface electromyography will be combined into neuromusculoskeletal modelling to determine modifications at the PNS level. Functional magnetic resonance imaging coupled with electroencephalography will be used to determine modifications at the CNS level.
The findings of the proposed trial will likely give substantial solutions for the management of gait and postural disorders in PD where valid interventions are lacking. The coupling of movement evaluation, which assesses neuromuscular and biomechanical features, with neurological data, will better define the impact of the therapy on the relationship between PD motor alterations and brain activity. This will provide an active treatment that is personalized and shared to large populations.
步态改变是帕金森病（PD）最致残的运动症状之一：步幅缩短、步速减慢以及下肢关节活动范围减小是帕金森步态的特征。针对最佳功能康复方法的研究一直致力于动力下肢外骨骼，这种外骨骼结合了地面机器人设备的优势以及在现实环境中训练患者的能力。由于步态涉及中枢神经系统（CNS）和外周神经系统（PNS），有针对性的康复不仅必须恢复力学，还必须恢复神经生理步态模式。
将招募两组受试者，并平均分配到一组（n = 25）接受功能运动疗法，以及一组（n = 25）接受地面可穿戴外骨骼训练。在三个时间点对参与者进行评估：治疗前（T0）、治疗后（T1）、T1后4周（T2）。综合步态分析和表面肌电图将结合到神经肌肉骨骼建模中，以确定PNS水平的变化。功能磁共振成像与脑电图相结合将用于确定CNS水平的变化。
拟议试验的结果可能会为缺乏有效干预措施的PD步态和姿势障碍管理提供实质性解决方案。将评估神经肌肉和生物力学特征的运动评估与神经学数据相结合，将更好地界定治疗对PD运动改变与脑活动之间关系的影响。这将提供一种个性化且适用于大量人群的积极治疗方法。
