In this case report, we investigated the effects of robot-assisted gait therapy in a chronic stroke patient using motor assessment and gait analysis. A patient who suffered from the right hemiparesis following the left corona radiata and basal ganglia infarction received 30 minutes of robot-assisted...
In this case report, we investigated the effects of robot-assisted gait therapy in a chronic stroke patient using motor assessment and gait analysis. A patient who suffered from the right hemiparesis following the left corona radiata and basal ganglia infarction received 30 minutes of robot-assisted gait therapy, 3 times a week for 4 weeks. Outcome was measured using Motoricity index(MI), Fugl-Meyer assessment(FMA), modified motor assessment scale(MMAS), isometric torque, body tissue composition, 10-meter gait speed and gait analysis. After robot-assisted gait therapy, the patient showed improvement in motor functions measured by MI, FMA, MMAS, isometric torque, skeletal muscle mass, 10-meter gait speed. In gait analysis, cadence, single support time, double support time, step length, walking speed improvement in after robot-assisted gait therapy. The results of this study showed that robot-assisted gait therapy is considered to facilitate locomotor recovery of the chronic hemiparetic stroke patient.
In this case report, we investigated the effects of robot-assisted gait therapy in a chronic stroke patient using motor assessment and gait analysis. A patient who suffered from the right hemiparesis following the left corona radiata and basal ganglia infarction received 30 minutes of robot-assisted gait therapy, 3 times a week for 4 weeks. Outcome was measured using Motoricity index(MI), Fugl-Meyer assessment(FMA), modified motor assessment scale(MMAS), isometric torque, body tissue composition, 10-meter gait speed and gait analysis. After robot-assisted gait therapy, the patient showed improvement in motor functions measured by MI, FMA, MMAS, isometric torque, skeletal muscle mass, 10-meter gait speed. In gait analysis, cadence, single support time, double support time, step length, walking speed improvement in after robot-assisted gait therapy. The results of this study showed that robot-assisted gait therapy is considered to facilitate locomotor recovery of the chronic hemiparetic stroke patient.
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문제 정의
This case report aimed to identify improvement of locomotor functions after providing robot-assisted gait therapy to chronic stroke patients with gait problems. When comparison took place before and after robot-assisted gait therapy, improvement in motor functions of legs as well as gait patterns was observed after training.
제안 방법
A 10-meter gait on the flat land took place for speed measurement and Vicon 612 motion analysis systemⓇ(Oxford Metrics Ltd, Oxford, UK) with five infrared cameras was applied for gait analysis and measurement of gait indexes.
All the indexes were gradually adjusted based on the improvement of the patient's muscular strength and gait capacity.
In the first week, manual gait training was applied to help the patient to adapt to the robot-driven gait orthosis and to learn normal gait patterns. From the second week, resistance training and active normal gait patterns were provided. As for biofeedback, in the first and second weeks, patterns of hip and knee joints of both legs were shown for comparison.
In the first week, manual gait training was applied to help the patient to adapt to the robot-driven gait orthosis and to learn normal gait patterns. From the second week, resistance training and active normal gait patterns were provided.
With robot-assisted gait therapy, gait variables such as step length and gait speed may be adjusted according to a patient's gait performance. It was programmed to repeat and reproduce symmetrical physiological gait patterns by extending the support of the paralyzed leg in the stable upright position from the weight support. Husemann et al.
The test items consisted of motoricity index(MI)(14) applying manual muscle testing of leg muscles and assessing between 1-100 marks, Fugl-Meyer Assessment(FMA)(15) assessing between 0-34 marks according to the recovery level of leg muscles, modified motor assessment scale(MMAS)(16) assessing motor functions of parts except for arms between 0-36 marks, skeletal body mass produced through Inbody720Ⓡ(Bio-space Co. Ltd, Seoul, Korea), and isometric torque measuring with test programs of the LokomatⓇ driven gait orthosis(Hocoma AG, Zurich, Switzerland).
This case report aimed to identify how robot-assisted gait therapy can contribute to recovery of leg movement and gait functions as an assistive method of physical therapy for neurological patients by applying a robot-driven gait orthosis to chronic stroke patients and analyzing motor and gait functions before and after the treatment.
For this patient, palliative motor treatment took place from April 10. While the patient visited S Hospital in Seoul, gait training using a robot-driven gait orthosis was provided 12 times for four weeks, three times a week from April 2, 2008. While robot-assisted gait therapy took place, palliative rehabilitation treatment except for gait training was provided and the onset duration was 24 months.
대상 데이터
Before and after the implementation of gait training using a robot-driven gait orthosis, motor functions were tested for each case after four weeks. All the tests were conducted one skilled physical therapist(7 years of experience).
This patient, aged 46, was diagnosed on April 8, 2006 of infarction in corona radiata and basal ganglia, resulting in motor disturbances from right hemiplegia(Fig. 2). For this patient, palliative motor treatment took place from April 10.
성능/효과
In addition, step length of both legs, cadence, and gait speed improved. Also the maximum flexion movement of hip joints as well as the maximum/minimum flexion movement of knee joints and maximum dorsiflexion of ankle joints became better. Also in the 10-meter gait speed among all other clinical gait indexes, there was improvement after robot-assisted gait therapy.
reported that the robot-assisted gait therapy provided more significant improvement than traditional training when Rivermead motor assessment scale evaluating motor functions and muscle strength of five leg muscles were measured in their study which implemented gait therapy by using the LokomatⓇ driven gait orthosis for 16 stroke patients(22). Also, in this case report, in terms of MI, FMA, MMAS, and isometric torque of hip and knee joints, there was great improvement after the robot-assisted gait therapy. This means that robot-assisted gait therapy is effective for muscle strength recovery.
Based on changes in temporal gait parameters, double support time and cadence of paralyzed and non-paralyzed legs decreased after training while single support time of the paralyzed leg, step length, and gait speed improved after treatment(Table 2).
In the 10-meter gait speed test, the speed improved after the robot-assisted gait therapy. In the follow-up test after four weeks, it was found that the improved speed was maintained(Table 3).
In this study, 100% application took place at the early stage of training and the guidance force was reduced to 60% according to the patient's adaptation and gait patterns.
참고문헌 (23)
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