Lee Seung Yeol, Seo Jisu, Seo Cheong Hoon, Cho Yoon Soo, Joo So Young
Department of Physical Medicine and Rehabilitation, College of Medicine, Soonchunhyang University Hospital, Bucheon 14584, Republic of Korea.
Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 01000, Republic of Korea.
J Clin Med. 2024 Aug 16;13(16):4838. doi: 10.3390/jcm13164838.
Patients with lower extremity burn injuries have decreased gait function. Gait dysfunctions are compensated by activation of executive areas such as the prefrontal cortex (PFC). Although robot-assisted gait training (RAGT) can improve gait function, the training mechanisms of RAGT are unknown. We aimed to determine the clinical effects of RAGT in patients with burns and investigate their underlying mechanisms. This single-blind, randomized controlled trial involved 54 patients with lower extremity burns. The RAGT group underwent RAGT using SUBAR and conventional training. The control (CON) group underwent only conventional training. The primary outcome was cortical activity measured using a functional near-infrared spectroscopy device before and after 8 weeks of training to confirm the compensatory effect of gait dysfunction. The secondary outcomes were the functional ambulation category (FAC) to evaluate gait performance, 6-min walking test (6 MWT) distance to measure gait speed, isometric force and range of motion (ROM) of lower extremities to evaluate physical function, and the visual analog scale (VAS) score to evaluate subjective pain during gait. PFC activation during the gait phase in the RAGT group decreased significantly compared with that of the CON. The VAS score decreased and FAC score improved after 8 weeks of training in both groups. The 6 MWT scores, isometric strengths (the left knee flexor and bilateral ankle plantar flexors), and the ROMs (the extensions of bilateral hip and bilateral knee) of the RAGT group were significantly improved compared with those of the CON. RAGT improved gait speed, lower extremity ROMs, and lower extremity muscles strengths in patients with burns. The improvement in gait speed and cerebral blood flow evaluation results suggests that the automatization of gait is related to the treatment mechanism during RAGT.
下肢烧伤患者的步态功能会下降。步态功能障碍可通过前额叶皮层（PFC）等执行区域的激活来代偿。尽管机器人辅助步态训练（RAGT）可以改善步态功能，但其训练机制尚不清楚。我们旨在确定RAGT对烧伤患者的临床效果，并研究其潜在机制。这项单盲随机对照试验纳入了54例下肢烧伤患者。RAGT组使用SUBAR进行RAGT并结合传统训练。对照组仅接受传统训练。主要结局是在训练8周前后使用功能近红外光谱设备测量的皮层活动，以确认步态功能障碍的代偿效果。次要结局包括用于评估步态表现的功能步行分类（FAC）、用于测量步态速度的6分钟步行试验（6MWT）距离、用于评估身体功能的下肢等长肌力和关节活动范围（ROM），以及用于评估步态期间主观疼痛的视觉模拟量表（VAS）评分。与对照组相比，RAGT组在步态阶段的PFC激活显著降低。两组在训练8周后VAS评分降低，FAC评分提高。与对照组相比，RAGT组的6MWT评分、等长肌力（左膝屈肌和双侧踝跖屈肌）以及ROM（双侧髋关节和双侧膝关节的伸展）均有显著改善。RAGT改善了烧伤患者的步态速度、下肢ROM和下肢肌肉力量。步态速度和脑血流评估结果的改善表明，步态自动化与RAGT期间的治疗机制有关。
