[논문]Robotic-assisted gait training applied with guidance force for balance and gait performance in persons with subacute hemiparetic stroke

Son, Dong-Wook; Hwang, Sujin

doi:10.14474/ptrs.2017.6.3.106

Robotic-assisted gait training applied with guidance force for balance and gait performance in persons with subacute hemiparetic stroke 원문보기

Physical therapy rehabilitation science, v.6 no.3, 2017년, pp.106 - 112

Son, Dong-Wook (Department of Physical Therapy, Graduate School of Health and Welfare, Baekseok University) , Hwang, Sujin (Department of Physical Therapy, Division of Health Science, Baekseok University)

Abstract ▼ AI-Helper

Objective: Robot assisted gait training is implemented as part of therapy for the recovery of gait patterns in recent clinical fields, and the scope of implications are continuously increasing. However clear therapy protocols of robot assisted gait training are insufficent. The purpose of this study was to investigate the effects of robot-assisted gait training applied with guidance force on balance and gait performance in persons with hemiparetic stroke. Design: Two group pre-test post-test design. Methods: Nineteen persons were diagnosed with hemiparesis following stroke participated in this study. The participants were randomly assigned to the unilateral guidance group or bilateral guidance group to conduct robot-assisted gait training. All participants underwent robot-assisted gait training for twelve sessions (30 min/d, 3 d/wk for 4 weeks). They were assessed with gait parameters (gait velocity, cadence, step length, stance phase, and swing phase) using Optogait. This study also measured the dynamic gait index (DGI), the Berg balance scale (BBS) score, and timed up and go (TUG). Results: After training, BBS scores were was significantly increased in the bilateral training group than in the unilateral guidance group (p<0.05). Spatiotemporal parameters were significantly changed in the bilateral training group (gait speed, swing phase ratio, and stance phase ratio) compared to the unilateral training group (p<0.05). Conclusions: The results of this study suggest that robot-assisted gait training show feasibility in facilitating improvements in balance and gait performance for subacute hemiparetic stroke patients.

주제어

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문제 정의

Therefore, this study aims to investigate the effects of different types of robot assistance on gait, balance, and symmetry in hemiplegic patients due to stroke.
This study demonstrated gait training based on motor learning theory using robot-assisted gait equipment. As a result of gait training for 4 weeks by both groups, significant results for both balance and gait ability were able to be derived, and the difference between the two methods were discovered.
This study was the pretest and posttest with control group design. Twenty participants who conducted on the inclusion criteria were corrected from local rehabilitation center in Seoul.
Robot-assisted gait training increases a tolerance of weight bearing on the more-affected side and muscle activation to promote enhanced gait ability [12]. This study was to investigate the effects of types of manual guidance in ro-bot-assisted gait training on balance and gait performance for subacute hemiparetic stroke. The robot-assisted gait training was applying both weight tolerance and shifting of the more-affected side to train long term with normal patterns [27].

제안 방법

BUIRB-201511-HR-028). The inclusion criteria were as follows: (1) persons diagnosed with hemiplegia due to stroke where the onset is more than 3 months and less than 6 months, (2) persons who are able to perform gait for 10 meters or more regardless of the usage of assistive devices, (3) persons without any neurological pathology except for stroke, (4) persons who do not have any trauma or osteoarthritic pathological issues, or a history of such in either lower extremities, and (5) persons who scored 24 or higher in Korean mini mental state examination and are able to follow the instructions of the researcher (Table 1).
The index for balance of the participants were derived from TUG and BBS scores, and gait ability used DGI scores, gait velocity, stride length, cadence, and step length from the gait analysis. Independent t-test was done in order to determine the differences in variables of participant’s properties, age, height, weight, and diagnosis date.
The participants of this study conducted robot-assisted three times per week, for four weeks. The postural stability shows improvement after robot-assisted gait training in both types of manual guidance, although the postural stability show more increase in the bilateral training group by facilitated bilateral movements.
Berg. The tool is composed of 14 tasks that require maintaining of balance or the increase in level of difficulty of tasks in order to assess static and dynamic balance performance and fall risks. Each items range from 0 (none) to 4 (maximum) points and the total score is 56 [18].
The participant performs with a marked distance of 20 feet and can be performed with or without an assistance device. The tool is composed of 8 items such as steady state walking, walking with changing speeds, walking with head turns both horizontally and vertically, walking while stepping over and around obstacles, pivoting while walking, and stair climbing. The scores of the DGI are based on a 4-point scale from 0 (severe impairment) to 3 (no gait dysfunction), and highest possible score is 24 points.
Twenty participants who conducted on the inclusion criteria were corrected from local rehabilitation center in Seoul. They were assigned to either unilateral or bilateral training group, and conducted robot-assisted gait training for 4 weeks (30 min a day, 3 times for week). To analyze the therapeutic effects after training, this study measured three clinical measures including timed up and go test (TUG), Berg balance scale (BBS), and dynamic gait index (DGI) and also measured spatiotemporal parameters including gait velocity, stride length, cadence, step length, gait symmetry, and single support period and double support period at one day before and after the interventions.
This study analyzed the spatiotemporal parameter during gait performance each paretic side respectively. In less-affected side, spatiotemporal parameters were not significantly different between pre-test and post-test in unilateral training group, while stance phase and swing phase only were significantly different between pre-test and post-test in bilateral training group.
The normal range of the recorded time is less than 10 seconds, so the participants has abnormal dynamic balance and are dependent in physical mobility, if the time exceeds more than 20 seconds. This study measured three times and then used the mean value for analyzing. Inter-rater (r=0.
They were assigned to either unilateral or bilateral training group, and conducted robot-assisted gait training for 4 weeks (30 min a day, 3 times for week). To analyze the therapeutic effects after training, this study measured three clinical measures including timed up and go test (TUG), Berg balance scale (BBS), and dynamic gait index (DGI) and also measured spatiotemporal parameters including gait velocity, stride length, cadence, step length, gait symmetry, and single support period and double support period at one day before and after the interventions.

대상 데이터

This study was conducted with 19 participants, where the number is not big enough to generalize all hemiplegia in stroke. In addition, not doing follow up observations after 4 weeks of intervention is a limitation, which do not reflect the differences of long term intervene.
This study was conducted with 20 patients who were admitted to local rehabilitation hospital with the diagnosis of hemiplegia due to stroke. Ten participants were randomly assigned to hemiplegia focused training group and 10 were assigned to bilateral training group using the table of random sampling numbers.
This study was the pretest and posttest with control group design. Twenty participants who conducted on the inclusion criteria were corrected from local rehabilitation center in Seoul. They were assigned to either unilateral or bilateral training group, and conducted robot-assisted gait training for 4 weeks (30 min a day, 3 times for week).

데이터처리

Independent t-tests were used to examine the effects of robot-assisted gait training, and matching sample t-test for each group were made to see the effects of robot-assisted training on balance and gait performance. Before and after intervention discrepancies were compared, and independent t-test was done in order to check for the differences. Statistically significant level was set to α=0.
Independent t-test was done in order to determine the differences in variables of participant’s properties, age, height, weight, and diagnosis date.

성능/효과

This study demonstrated gait training based on motor learning theory using robot-assisted gait equipment. As a result of gait training for 4 weeks by both groups, significant results for both balance and gait ability were able to be derived, and the difference between the two methods were discovered. Robot-assisted gait training promotes intensive repetitive learning and normal patterns, making it an approach method for the improvement of balance and gait ability for patients with stroke.
The BBS score was significantly increase between pre-test and post-test in both groups, but the BBS score of bilateral training group was not significantly increase after training compared with that of unilateral training group (p<0.05).

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