Effect of Robotic Assisted Gait Training on functional and psychological improvement in patients with Incomplete Spinal Cord Injury

of 4
All materials on our website are shared by users. If you have any questions about copyright issues, please report us to resolve them. We are always happy to assist you.
Information Report
Category:

Automobiles

Published:

Views: 16 | Pages: 4

Extension: PDF | Download: 0

Share
Description
Background: Several studies provide evidence that Robotic-assisted gait training (RAGT) promotes motor recovery and functional improvement in patients with spinal cord injuries. Context and purpose of the study: The present study was conducted to
Tags
Transcript
  v Citation:  Jardim N, Santos S (2016) Effects of a Psychomotor Intervention on Water in the Quality of Life of Adults with Intellectual and Developmental Disabilities. J Nov Physiother Phys Rehabil 3(1): 053-086. DOI: 10.17352/2455-5487.000053  Journal of Novel Physiotherapy and Physical Rehabilitation   ISSN: 2455-5487DOICC By 083 Medical Group Citation:  Shahin AA, Shawky SA, Rady HM, Effat DA, Abdelrahman SK, et al. (2017) Effect of Robotic Assisted Gait Training on functional and psychological improvement in patients with Incomplete Spinal Cord Injury. J Nov Physiother Phys Rehabil 4(3): 083-086. DOI: http://doi.org/10.17352/2455-5487.000053 Abstract Background:   Several studies provide evidence that Robotic-assisted gait training (RAGT) promotes motor recovery and functional improvement in patients with spinal cord injuries. Context and purpose of the study:   The present study was conducted to assess the effect of RAGT on functional and psychological improvement in patients with incomplete spinal cord injury as compared to conventional methods. Forty patients with incomplete spinal cord injury were recruited to this study. They all received conventional rehabilitation program. Twenty patients received RAGT in addition. Baseline measurements of outcome variables were taken before and at week 12 after treatment. Posture control and balance were assessed by Berg Balance Scale [BBS].Functional ambulation was assessed by Functional ambulation category scale [FAC]. Depression was assessed by the Beck depression inventory [BDI]. World Health Organization Quality of Life Questionnaire-BREF (WHOQOL-BREF) was used. Results: The BBS was signi fi cantly improved in both groups, while FAC improved signi fi cantly in RAGT group and non-signi fi cantly in conventional group. WHOQOL-BREF improved signi fi cantly in RAGT group only. The results of BDI and HOQOL-BREF showed a signi fi cant difference between both groups in week 12. Conclusion: RAGT can lead to better improvement in ambulatory function as well as psychological condition and quality of life compared to conventional treatment in incomplete SCI patients. Research Article Effect of Robotic Assisted Gait Training on functional and psychological improvement in patients  with Incomplete Spinal Cord Injury  Amira A Shahin 1 *, Sherif A Shawky 2 , Hanaa M Rady 1 , Dina A Effat 1 , Sherry K Abdelrahman 3 , Essam Mohamed 2  and Reda Awad 2 1 Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Egypt 2 Agouza rheumatology & rehabilitation military centre, Giza, Egypt 3 Rheumatology and Rehabilitation department, Benha teaching hospital, Benha, Egypt Dates: Received:  22 July, 2017; Accepted:  21 August, 2017; Published:  23 August, 2017 *Corresponding author:  Amira A Shahin, MD Rheu-matology and Rehabilitation Department, Faculty of Medicine, Cairo University, Egypt, E-mail: https://www.peertechz.com  body weight support (BWS) system over a motorized treadmill [8]. The patient’s legs are guided on the treadmill according to a pre-programmed physiological gait pattern [4]. It has the advantage of repeatedly conducting a pre-programmed gait pattern. Previous studies provide evidence that RAGT promotes motor recovery and functional improvement [9,10]. However, other study showed that there was no signi fi cant difference  between RAGT and conventional therapy [3]. The present study  was conducted to assess the effect of RAGT on functional and psychological improvement in patient with incomplete spinal cord injury as compared to conventional method.  Materials and Methods Forty patients were recruited to this study from those admitted to Agouza rheumatology & rehabilitation military centre, Giza, Egypt with incomplete spinal cord injury. Patients Introduction Improvement of walking ability is the main target of rehabilitation programs of patients after spinal cord injury (SCI), a factor associated with quality of life and psychological wellbeing [1]. The main limitations of over-ground walking ability for patients with SCI are reduced sensory motor coordination, spasticity, decreased muscle strength and impaired balance [2]. Different treatments have  been attempted to facilitate walking ability, such as manually assisted over-ground training and manually assisted treadmill training. However, the techniques are cumbersome and highly demanding in terms of staf  fi ng and time [3]. Robotic-assisted gait training (RAGT) was introduced in the late1990s. Different systems are commercially available, including the “Lokomat” [4-7]. The Lokomat is a motor-driven gait orthotic secured to a patient’s legs while the patient him/herself is supported by a  084Citation:  Shahin AA, Shawky SA, Rady HM, Effat DA, Abdelrahman SK, et al. (2017) Effect of Robotic Assisted Gait Training on functional and psychological improvement in patients with Incomplete Spinal Cord Injury. J Nov Physiother Phys Rehabil 4(3): 083-086. DOI: http://doi.org/10.17352/2455-5487.000053  were both military and civilian. Inclusion criteria were onset less than 6 month and age 20 to 60 years old. Exclusion criteria  were patients with pressure ulcers, contractures of the hips and knee joints, severe cognitive impairment and patients having lower motor neuron lesion. No previous local anti-spastic measures had been used for any of the recruited patients. Twenty patients were assigned to the RAGT group [gr A]: Received RAGT in addition to the rehabilitation program (mean age 32.4±11.8 years and mean injury duration 4.7±4.6months), and 20 patients to the conventional group [gr B]: received rehabilitation program only (mean age 32.7±10.5 years and mean injury duration 3.7±3.1 months). The RAGT group received RAGT with regular physiotherapy in the following schedule: 3 days with RAGT and 2 days with regular treatment a week. The lokomat system of Hocoma, Switzerland was used .Each session lasted for 60 minutes. The body weight support was adjusted to the minimum without knee buckling or toe dragging. The walking speed was gradually increased up to 1.5 km/hr. Sessions of the conventional therapy group were performed 30 minutes each, 5 sessions a week, included functional exercises according to the muscle grading, slow prolonged stretching of the spastic muscles, and strengthening exercises to the anti-spastic muscles. The conventional therapy included active or assisted active exercises. Baseline measurements of outcome  variables were taken before they underwent intervention (W0) and at week 12 after treatment (W12). Patient’s impairment  was identi fi ed according to Asia impairment scale [ASIA] [11]. Posture control and balance were assessed by Berg Balance Scale [BBS] [12]. Functional ambulation was assessed by Functional ambulation category scale [FAC] which has six categories (0-5) that distinguish level of physical support irrespective of technical aids used [13].Depression was assessed by the Beck depression inventory [BDI], a 21-questionmultiple-choice self-report inventory,  which is one of the most commonly used instruments to measure the presence and severity of depression [14]. The cutoff-scores according Kendal let al., are 0-9 indicating normal, 10-19 indicating mild depression, 20-30 indicating moderate depression, and 31-63 indicating severe depression [15] . World Health Organization Quality of Life Questionnaire-BREF (WHOQOL-BREF) was used to assess the four domains de fi ning the QOL: physical, psychological, social, and environmental. The higher the QOL score the higher the life satisfaction [16]. Statistical analysis The data were analyzed using the statistical program SPSS version 15. Results were expressed as mean ± standard deviation (SD). The Kruskal Wallis test with exact method was used for comparing the RAGT group and the conventional group concerning the BBS, FAC, BDI and WHOQOL-BREF in W0 and in  W12. The Friedman test, which is a non-parametric alternative to the one-way ANOVA, was used with exact method for the repeated measures of the BBS, FAC, BDI and WHOQOL-BREF in the follow up visits within the same group. The level of statistical signi fi cance was <0.05 (2-tailed). Results  All patients in RAGT group and in the conventional group  were ASIA B and C. Six patients had tetraplegia (3 in each group)  while 34 patients had paraplegia (17 in each group). At the  beginning of the study (W0), in RAGT group; 17 patients were not be able to walk, 3 patients could walk by walker, and one patient could walk by using long leg brace (LLB). While at the end of the study (W12), 3 patients still can’t walk, 3 could walk  by walker, 3 could walk by LLB, and 11 patients were able to  walk. Although the conventional group had the same features in W0; 17 patients were not be able to walk, 3 patients could  walk by walker, and one patient could walk by using long leg  brace (LLB). The outcome was slightly worse compared to the RAGT group; 5 patients still can’t walk, 3 patients could walk  by walker, and 2 patients could walk by LLB, and 10 patients  were able to walk.The BBS was signi fi cantly improved in both groups in W12,  while FAC improved signi fi cantly in RAGT group in W12 and non-signi fi cantly in conventional group. The comparison  between W0 and W12 concerning FAC and BBS in both groups is shown in table 1. The BDI and WHOQOL-BREF were signi fi cantly improved in RAGT group, while showed less improvement in conventional group in W12. The comparison between W0 and W12 concerning BDI and WHOQOL-BREF in both groups is shown in table 2. No signi fi cant difference was detected between the results of BBS and FAC either in W0 nor W12 in both groups (Table 3). While the results of BDI and WHOQOL-BREF showed a signi fi cant difference in W12 in both groups (Table 4). Discussion In the present study, both patient groups showed improvement in the functional ambulation category scale by the end of the study but the change was statistically signi fi cant only in the RAGT group. These results are in agreement with previous studies by Alcobendas-Maestro et al., 2012 and Shin et al., 2014 which found that RAGT groups improved signi fi cantly from baseline to follow-up compared to conventional therapy Table 1 : BBS and FAC scale in RAGT & conventional group in W0 & W12. RAGT group N=20Sig.conventional group N=20Sig.BBS W07.7±5.20.001*9.1±60.001W1222±15.222±14 FAC W00.4±0.50.02*0.4±0.50.114W122.5±2.12.1±1.9 Table 2:  BDI& WHOQOL-BREF in RAGT & conventional group in W0 & W12. RAGTgroup N=20Sig.conventional group N=20SigBDI W025.1±11.60.001*28.4±10.90.05*W1211.2±13.321.9±12.9 WHOQOL-BREF W061.2±13.20.001*56.7±10.10.06W1284.9±18.360.1±8.8  085Citation:  Shahin AA, Shawky SA, Rady HM, Effat DA, Abdelrahman SK, et al. (2017) Effect of Robotic Assisted Gait Training on functional and psychological improvement in patients with Incomplete Spinal Cord Injury. J Nov Physiother Phys Rehabil 4(3): 083-086. DOI: http://doi.org/10.17352/2455-5487.000053 groups [9,17]. This is in contrast to the study of Labruyère and van Hede, 2014 who found that there were no signi fi cant differences in changes in scores between the 2 interventions, except for maximal walking speed (10MWT), which improved signi fi cantly more after strength training than after RAGT but sample size was small (9 patients) [18]. The BBS signi fi cantly improved in both patient groups by the end of the study .This is in agreement with the study by Labruyère and van Hede, 2014 [18], where there were no statistical differences between the changes in scores due to RAGT and strength training for  balance measures.Depressive disorders are the most common psychological problems in spinal cord injury (SCI) patients [19]. In our study  both patient groups completed the BDI and WHOQOL-BREF questionnaires for assessment of depression and quality of life at entry and after completion of the program. All patients studied had some degree of depression at entry. A study by  JiCheol Shin et al., 2012 found that the patients within six months after SCI injury had higher rate of depression [17]. Previous studies have shown that participating in gait training  without support has a signi fi cant potential to improve self-image and positive change of emotion [20, 21]. In our study there was a statistically signi fi cant improvement in the BDI score in the RAGT group and improved less signi fi cantly in the other group. The WHOQOL-BREF was signi fi cantly improved only in RAGT group.A previous case report has shown signi fi cant improvement in function, psychological and cognitive status after intensive Lokomat training in a chronic stroke patient which was related to the task oriented exercises and computerized visual feedback which increases patient output and motivation [22]. By comparing the results of both groups in the recent study, a signi fi cant difference  was recorded between the improvement of BDI and WHOQOL-BREF in both groups. Our results show that RAGT was better than conventional therapy in improving ambulatory function, depression scores as well as quality of life questionnaire.The limitations of the present study were the relatively small number of patients in both groups (twenty each) and the relatively short follow up period which was twelve weeks. Conclusion  RAGT lead to better improvement in ambulatory function as well as psychological condition and quality of life compared to conventional treatment in studied patients. Future studies are required on larger scale and for longer follow up periods. References 1. Van Middendorp JJ, Hosman AJ, van de Meent H (2009) Whowants to walk? Preferences for recovery after SCI: a longitudinal and cross-sectional study. Spinal Cord 47: 268- 269. Link:  https://goo.gl/vRL3dX 2. Dietz V, Colombo G, Jensen L, Baumgartner L (1995) Locomotor capacity of spinal cord in paraplegic patients. Ann Neurol 37: 574-582. Link:  https://goo.gl/3qMq1j 3. Field-Fote EC, Roach KE (2011) In fl uence of a locomotor training approach on walking speed and distance in people with chronic spinal cord injury: a randomized clinical trial. Phys Ther 91: 48-60. Link:  https://goo.gl/eH16rX 4. Hocoma (2009) Lokomat® – functional locomotion therapy with augmented feedback. Link:  https://goo.gl/kY5ufZ 5. Colombo G, Hostettler P (2000) De rLokomat – eineangetriebenegehorthose. Med Orth Tech 120: 178–181.6. Colombo G, Joerg M, Schreier R, Dietz V (2000) Treadmill training of paraplegic patients using a robotic orthosis. J Rehabil Res Dev 37: 693–700. Link: https://goo.gl/7aTJ7N 7. Colombo G, Wirz M, Dietz V (2001) Driven gait orthosis for improvement of locomotor training in paraplegic patients. Spinal Cord 39: 252–255. Link:  https://goo.gl/KR7d9C 8. Hornby TG, Zemon DH, Campbell D (2005) Robotic-assisted, bodyweight-supported treadmill training in individuals following motorincomplete spinal cord injury. Phys Ther 85: 52–66. Link:  https://goo.gl/G1HDJq 9. Alcobendas-Maestro M, Esclarin-Ruz A, Casado-Lopez RM, Munoz-Gonzalez A, Perez-Mateos G, et al. (2012) Lokomat robotic-assisted versus overground training within 3 to 6 months of incomplete spinal cord lesion: randomized controlled trial. Neurorehabil Neural Repair 26: 1058-1063. Link:  https://goo.gl/ymCK5R 10. Schwartz I, Sajina A, Neeb M, Fisher I, Katz-Luerer M, et al. (2011) Locomotor training using a robotic device in patients with subacute spinal cord injury. SpinalCord 49: 1062-1067. Link:  https://goo.gl/etGmXQ 11. (2009) American Spinal Injury Association. Standard neurological classi fi cation of spinal cord injury. Link:  https://goo.gl/hDWyuz 12. Berg KO, Wood-Dauphinee SL, Williams JI, Maki B (1992) Measuring balance in the elderly: validation of an instrument. Can J Public Health 83: 7–11. Link:  https://goo.gl/EY3pzf 13. Holden MK, Gill KM, Marie RM (1986) Gait assessment for neurologically impaired patients. Standards for outcome assessment. Phys Ther 66: 1530-1539. Link:  https://goo.gl/sMj4wo 14. Joe S, Woolley ME, Brown GK, Ghahramanlou-Holloway M, Beck AT (2008) Psychometric properties of the Beck Depression Inventory-II in low-income, African American suicide attempters. J Pers Assess 90: 521-523. Link:  https://goo.gl/YXCHSc 15. Kendall PC, Hollon SD, Beck AT, Hammen CL, Ingram RE (1987) Issues and recommendation regarding use of theBeck Depression Inventory. Cognitive Therapy and Research 3: 289-299. Link:  https://goo.gl/DHReiC 16. Skevington SM, Lotfy M, O’Connell KA (2004) The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and Table 3:  The comparison between RAGT group and conventional group concerning BBS and FAC in W0 and W12. Chi-SquareExact Sig.BBS W01.3690.242W120.0180.892 FAC W00.0011.000W120.1650.961 Table 4:  The comparison between RAGT group and conventionsl group canserning BDI and WHOQOL-BREF in W0 and W12. Chi-SquareExact Sig.BDI W01.4510.228W1213.2690.001* WHOQOL-BREF W03.4600.07W1215.4220.001*  086Citation:  Shahin AA, Shawky SA, Rady HM, Effat DA, Abdelrahman SK, et al. (2017) Effect of Robotic Assisted Gait Training on functional and psychological improvement in patients with Incomplete Spinal Cord Injury. J Nov Physiother Phys Rehabil 4(3): 083-086. DOI: http://doi.org/10.17352/2455-5487.000053 Copyright: © 2017 Shahin AA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the srcinal author and source are credited.results of the international fi eld trial. A report from the WHOQOL group. Qual Life Res 13: 299-310. Link:  https://goo.gl/x9BquK 17. JiCheol Shin, Ji Yong Kim, HanKyul Park, Na Young Kim (2014) Effect of Robotic-Assisted Gait Training in patients with incomplete spinal cord injury. Ann Rehabil Med 38: 719-725. Link:  https://goo.gl/TMghkN 18. Labruyère R, van Hedel HJA (2014) Strength training versus robot-assisted gait training after incomplete spinal cord injury: a randomized pilot study in patients depending on walking assistance. Journal of NeuroEngineering and Rehabilitation. Link:  https://goo.gl/MKjEUg 19. Elliott TR, Frank RG (1996) Depression following spinal cord injury. Arch Phys Med Rehabil 77: 816-823. Link:  https://goo.gl/pYHFnh 20. Semerjian TZ, Montague SM, Dominguez JF, Davidian AM, de Leon RD (2005) Enhancement of quality of life and body satisfaction through the use of adapted exercise devices for individuals with spinal cord injuries. Top Spinal Cord InjRehabil 11: 95-108. Link:  https://goo.gl/tDcGeZ 21. Martin Ginis KA, Latimer AE (2007) The effects of single bouts of body-weight supported treadmill training on the feeling states of people with spinal cord injury.Spinal Cord 45:112-115. Link:  https://goo.gl/6nnH8a 22. Calabro RS, Melegari C, Reltano S, Leo A, De Luca R, et al. (2014) Can robot assisted movement training(lokomat) improve fundtional recovery and psychological wellbeing in chronic stoke?.Functional neurology 29: 139-141. Link:  https://goo.gl/2mb5Jq
Recommended
View more...
We Need Your Support
Thank you for visiting our website and your interest in our free products and services. We are nonprofit website to share and download documents. To the running of this website, we need your help to support us.

Thanks to everyone for your continued support.

No, Thanks
SAVE OUR EARTH

We need your sign to support Project to invent "SMART AND CONTROLLABLE REFLECTIVE BALLOONS" to cover the Sun and Save Our Earth.

More details...

Sign Now!

We are very appreciated for your Prompt Action!

x