Yokota Chiaki, Tanaka Kenta, Omae Katsuhiro, Kamada Masatoshi, Nishikawa Hiroyasu, Koga Masatoshi, Ihara Masafumi, Fujimoto Yasuyuki, Sankai Yoshiyuki, Nakajima Takashi, Minami Manabu
Department of Stroke Rehabilitation, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan.
Department of Data Science, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan.
J Stroke Cerebrovasc Dis. 2023 Apr;32(4):107020. doi: 10.1016/j.jstrokecerebrovasdis.2023.107020. Epub 2023 Jan 24.
To investigate whether early gait training using Hybrid Assistive Limb (HAL) is feasible and improves walking and independency compared with conventional physical therapy (CPT) in patients with severe walking disability after stroke.
We conducted a single-center, randomized controlled study. Patients with first-ever stroke who had severe walking disability were included. All patients started gait training within 10 days post-stroke onset. Twenty-four patients were randomly assigned into HAL or CPT groups. Outcome measures were collected at three time points, at baseline, completion of 20 sessions of gait training (second assessment), and 3 months after the initiation of gait training. The primary outcomes were changes in motor sub-scores of the Functional Independence Measure or Functional Ambulation Category at the completion of the second assessment from baseline.
Twenty-two patients (median age, 68 years; 12 patients in the HAL group and 10 patients in the CPT group) completed the study. There were no significant differences in primary outcomes. Apathy scale, one of the secondary outcomes, showed a decreasing trend in the HAL group (mean change of -3.8, 95% CI -8.14 to 0.475), and a slight increasing trend in the CPT group (mean change of 1.2, 95% CI -2.66 to 5.06) at the second assessment. Patients in the HAL group experienced no adverse events.
Early gait training in patients with severe walking disability after stroke using HAL was feasible. Walking ability and independency were not improved at the completion of 20 sessions of gait training.
探讨对于中风后严重行走障碍患者,使用混合辅助肢体(HAL)进行早期步态训练与传统物理治疗(CPT)相比是否可行,以及能否改善行走能力和独立性。
我们开展了一项单中心随机对照研究。纳入首次中风且有严重行走障碍的患者。所有患者在中风发作后10天内开始步态训练。24名患者被随机分为HAL组或CPT组。在三个时间点收集结果指标,即基线、完成20次步态训练时(第二次评估)以及开始步态训练3个月后。主要结局指标为第二次评估完成时功能独立性测量或功能性步行分类的运动子评分相对于基线的变化。
22名患者(中位年龄68岁;HAL组12名患者,CPT组10名患者)完成了研究。主要结局指标无显著差异。次要结局指标之一的冷漠量表在第二次评估时,HAL组呈下降趋势(平均变化为-3.8,95%CI为-8.14至0.475),CPT组呈轻微上升趋势(平均变化为1.2,95%CI为-2.66至5.06)。HAL组患者未发生不良事件。
对于中风后严重行走障碍患者,使用HAL进行早期步态训练是可行的。在完成20次步态训练时,行走能力和独立性并未得到改善。