Wall Anneli, Palmcrantz Susanne, Borg Jörgen, Gutierrez-Farewik Elena M
Department of Rehabilitation Medicine Stockholm, Danderyd Hospital, Stockholm, Sweden.
Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
Front Neurol. 2023 Oct 11;14:1244287. doi: 10.3389/fneur.2023.1244287. eCollection 2023.
Electromechanically-assisted gait training has been introduced in stroke rehabilitation as a means to enable gait training with a large number of reproducible and symmetrical task repetitions, i.e. steps. However, few studies have evaluated its impact on gait pattern functions. This study includes persons with no independent ambulation function at the start of a 4-week neurorehabilitation period in the sub-acute phase after stroke. The primary aim of the study was to evaluate whether the addition of electromechanically-assisted gait training to conventional training resulted in better gait pattern function than conventional training alone. The secondary aim was to identify correlations between overall gait quality and standardized clinical assessments.
Seventeen patients with no independent ambulation function who participated in a Prospective Randomized Open Blinded End-point study in the sub-acute phase after stroke were randomized into two groups; one group ( = 7) to undergo conventional training only (CONV group) and the other group ( = 10) to undergo conventional training with additional electromechanically-assisted gait training (HAL group). All patients were assessed with 3D gait analysis and clinical assessments after the 4-week intervention period. Overall gait quality as per the Gait Profile Score (GPS), as well as kinematic, and kinetic and other spatiotemporal metrics were collected and compared between intervention groups. Correlations between biomechanical and clinical outcomes were evaluated.
Both the CONV and HAL groups exhibited similar gait patterns with no significant differences between groups in any kinematic, kinetic parameters or other spatiotemporal metrics. The GPS for the paretic limb had a median (IQR) of 12.9° (7.8°) and 13.4° (4.3°) for the CONV and HAL groups, respectively ( = 0.887). Overall gait quality was correlated with independence in walking, walking speed, movement function and balance. We found no added benefit in gait pattern function from the electromechanically-assisted gait training compared to the conventional training alone.
This finding raises new questions about how to best design effective and optimal post-stroke rehabilitation programs in patients with moderate to severe gait impairments to achieve both independent walking and optimal gait pattern function, and about which patients should be in focus in further studies on the efficacy of electromechanically-assisted gait training.
The study was retrospectively registered at ClinicalTrials.gov, identifier (NCT02410915) on April 2015.
机电辅助步态训练已被引入中风康复领域，作为一种能够进行大量可重复且对称的任务重复（即步数）的步态训练方法。然而，很少有研究评估其对步态模式功能的影响。本研究纳入了中风亚急性期为期4周的神经康复治疗开始时无独立行走功能的患者。该研究的主要目的是评估在传统训练基础上增加机电辅助步态训练是否比单纯传统训练能带来更好的步态模式功能。次要目的是确定整体步态质量与标准化临床评估之间的相关性。
17例中风亚急性期无独立行走功能且参与前瞻性随机开放盲终点研究的患者被随机分为两组；一组（n = 7）仅接受传统训练（CONV组），另一组（n = 10）接受传统训练并附加机电辅助步态训练（HAL组）。在为期4周的干预期结束后，所有患者均接受三维步态分析和临床评估。收集并比较干预组之间根据步态轮廓评分（GPS）得出的整体步态质量，以及运动学、动力学和其他时空指标。评估生物力学和临床结果之间的相关性。
CONV组和HAL组均表现出相似的步态模式，两组在任何运动学、动力学参数或其他时空指标上均无显著差异。CONV组和HAL组患侧肢体的GPS中位数（IQR）分别为12.9°（7.8°）和13.4°（4.3°）（P = 0.887）。整体步态质量与行走独立性、步行速度、运动功能和平衡相关。与单纯传统训练相比，我们发现机电辅助步态训练在步态模式功能方面没有额外益处。
这一发现引发了关于如何为中度至重度步态障碍患者最佳设计有效且优化的中风后康复方案以实现独立行走和最佳步态模式功能的新问题，以及在进一步研究机电辅助步态训练疗效时应关注哪些患者的新问题。
该研究于2015年4月在ClinicalTrials.gov上进行回顾性注册，标识符为（NCT02410915）。
