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Clinical non-superiority of technology-assisted gait training with body weight support in patients with subacute stroke: A meta-analysis / Chih-Yang Hsu in Annals of physical and rehabilitation medicine, Vol. 63 n° 6 (November 2020)
[article] Clinical non-superiority of technology-assisted gait training with body weight support in patients with subacute stroke: A meta-analysis [texte imprimé] / Chih-Yang Hsu, Auteur ; Yu-Hsuan Cheng, Auteur ; Chien-Hung Lai, Auteur . - 2020 . - p. 535-542.
Langues : Anglais (eng) Français (fre)
in Annals of physical and rehabilitation medicine > Vol. 63 n° 6 (November 2020) . - p. 535-542
Catégories : PATHOLOGIE
Tags : Stroke rehabilitation Robotics Body-weight-support Treadmill Gait Résumé : Background: Technology-assisted gait training (TAGT) with body weight support (BWS) has been designed to provide high numbers of repetitions during stepping practice, but its benefits have been inconclusive.
Objective: We evaluated the superiority of TAGT over conventional overground training (COT) to judge the clinical benefits.
Methods: We searched PubMed, Embase and Web of Science databases from their earliest record to July 1, 2019 and included randomized controlled trials of TAGT with BWS, such as robot-assisted gait training and body weight-supported treadmill training, for treating walking disability in patients within 6months after stroke. We conducted a meta-analysis of the outcomes motor impairment, mobility capacity, walking speed, endurance and fitness, balance, and activities of daily living as well as subgroup analyses of initial ambulatory ability and stroke duration.
Results: Among 14robotics and 10body weight-supported treadmill studies included for review, 23studies involving 1452participants contributed to the meta-analysis. We found no significant standardized mean differences between TAGT and COT (P >0.05) across all outcome categories in the robotics subgroup, the body weight-supported treadmill subgroup, or both subgroups combined, for both the short and long term. Further subgroup analyses also revealed non-significant standardized mean differences (P >0.05) across all outcomes in the subgroups initially ambulatory, non-ambulatory, or stroke duration less than 3 months.
Conclusions: TAGT with BWS was not superior to COT in improving post-stroke recovery in patients with subacute stroke. Strategies other than simply increasing the repetitions by external assistance may be considered to augment the treatment effects of TAGT.
En ligne : http://www.em-consulte.com/produit/rehab Permalink : [article]Clinical effects of robot-assisted gait training and treadmill training for Parkinson's disease. A randomized controlled trial / Marianna Capecci in Annals of physical and rehabilitation medicine, Vol. 62 n° 5 (September 2019)
[article] Clinical effects of robot-assisted gait training and treadmill training for Parkinson's disease. A randomized controlled trial [texte imprimé] / Marianna Capecci, Auteur ; Sanaz Pournajaf, Auteur . - 2019 . - p. 303-312.
Langues : Anglais (eng) Français (fre)
in Annals of physical and rehabilitation medicine > Vol. 62 n° 5 (September 2019) . - p. 303-312
Catégories : PHYSIOLOGIE
RandomisationUtilisation du hasard dans la constitution d'un échantillon pour une étude ou une enquête.
Tags : Gait Robotics Parkinson disease Rehabilitation Freezing Résumé : Background: Although gait disorders strongly contribute to perceived disability in people with Parkinson's disease, clinical trials have failed to identify which task-oriented gait training method can provide the best benefit. Freezing of gait remains one of the least investigated and most troublesome symptoms.
Objective: We aimed to compare the effects of robot-assisted gait training and treadmill training on endurance and gait capacity in people with Parkinson disease; the secondary aim was to compare the effect of the treatments in people with freezing and/or severe gait disability and assess changes in overall disease-related disability and quality of life.
Methods: Outpatients with Parkinson disease (Hoehn and Yahr stage≥2) were randomly assigned to receive 20 sessions of 45-min gait training assisted by an end-effector robotic device (G-EO System) or treadmill training. Outcome assessments were the 6-min walk test, Timed Up and Go test, Freezing of Gait Questionnaire, Unified Parkinson's Disease Rating Scales and Parkinson's Disease Quality of Life Questionnaire-39 administered before (T0) and after treatment (T1).
Results: We included 96 individuals with Parkinson disease: 48 with robot-assisted gait training and 48 treadmill training. Both groups showed significant improvement in all outcomes. As compared with baseline, with robot-assisted gait training and treadmill training, endurance and gait capacity were enhanced by 18% and 12%, respectively, and motor symptoms and quality of life were improved by 17% and 15%. The maximum advantage was observed with the Freezing of Gait Questionnaire score, which decreased by 20% after either treatment. On post-hoc analysis, dependent walkers benefited more than independent walkers from any gait training, whereas freezers gained more from robot-assisted than treadmill training in terms of freezing reduction.
Conclusions: Repetitive intensive gait training is an effective treatment for people with Parkinson disease and can increase endurance and gait velocity, especially for those with severe walking disability. Advantages are greater with robot-assisted gait training than treadmill training for individuals with freezing of gait related disability.
En ligne : http://www.em-consulte.com/produit/rehab Permalink : [article]Effectiveness of upper-limb robotic-assisted therapy in the early rehabilitation phase after stroke: A single-blind, randomised, controlled trial / Stéphanie Dehem in Annals of physical and rehabilitation medicine, Vol. 62 n° 5 (September 2019)
[article] Effectiveness of upper-limb robotic-assisted therapy in the early rehabilitation phase after stroke: A single-blind, randomised, controlled trial [texte imprimé] / Stéphanie Dehem, Auteur ; Maxime Gilliaux, Auteur ; Gaëtan Stoquart, Auteur . - 2019 . - p. 312-320.
Langues : Anglais (eng) Français (fre)
in Annals of physical and rehabilitation medicine > Vol. 62 n° 5 (September 2019) . - p. 312-320
Catégories : ANATOMIE
Tags : Stroke Upper extremity Robotics Rehabilitation Recovery of function Résumé : Background: Upper-limb robotic-assisted therapy (RAT) is promising for stroke rehabilitation, particularly in the early phase. When RAT is provided as partial substitution of conventional therapy, it is expected to be at least as effective or might be more effective than conventional therapy. Assessments have usually been restricted to the first 2 domains of the International classification of functioning, disability and health (ICF).
Objective: This was a pragmatic, multicentric, single-blind, randomized controlled trial to evaluate the effectiveness of upper-limb RAT used as partial substitution to conventional therapy in the early phase of stroke rehabilitation, following the 3 ICF domains.
Methods: We randomized 45 patients with acute stroke into 2 groups (conventional therapy, n =22, and RAT, n =23). Both interventions were dose-matched regarding treatment duration and lasted 9 weeks. The conventional therapy group followed a standard rehabilitation. In the RAT group, 4 sessions of conventional therapy (25%) were substituted by RAT each week. RAT consisted of moving the paretic upper limb along a reference trajectory while the robot provided assistance as needed. A blinded assessor evaluated participants before, just after the intervention and 6 months post-stroke, according to the ICF domains UL motor impairments, activity limitations, and social participation restriction.
Results: In total, 28 individuals were assessed after the intervention. The following were more improved in the RAT than conventional therapy group at 6 months post-stroke: gross manual dexterity (Box and Block test +7.7 blocks; P =0.02), upper-limb ability during functional tasks (Wolf Motor Function test +12%; P =0.02) and patient social participation (Stroke Impact Scale +18%; P =0.01). Participants abilities to perform manual activities and activities of daily living improved similarly in both groups.
Conclusion: For the same duration of daily rehabilitation, RAT combined with conventional therapy during the early rehabilitation phase after stroke is more effective than conventional therapy alone to improve gross manual dexterity, upper-limb ability during functional tasks and patient social participation.
En ligne : http://www.em-consulte.com/produit/rehab Permalink : [article]