The effects of robot-assisted gait training in progressive multiple sclerosis: A randomized controlled trial

2015 ◽  
Vol 22 (3) ◽  
pp. 373-384 ◽  
Author(s):  
Sofia Straudi ◽  
Chiara Fanciullacci ◽  
Carlotta Martinuzzi ◽  
Claudia Pavarelli ◽  
Bruno Rossi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Short Form ◽  
Gait Training ◽  
Progressive Multiple Sclerosis ◽  
Controlled Study ◽  
Walking Ability ◽  
Walk Test ◽  
Robot Assisted ◽  
Positive Effects ◽  
Randomized Controlled

Background: Gait and mobility impairments are common in progressive multiple sclerosis (MS), leading to reduced quality of life (QoL). Objective: In this randomized controlled study, we tested the effects of robot-assisted gait training (RAGT) and compared it to conventional physiotherapy, measuring walking ability, depression, fatigue, and QoL in patients with progressive MS and severe gait disability. Methods: Fifty-two participants (Expanded Disability Status Scale score 6–7) completed the study protocol. They received two sessions/week over 6 weeks of RAGT or conventional walking therapy. Outcome measures were Six-Minute Walk Test, Ten-Meter Walk Test, Timed Up and Go Test, Berg Balance Scale, Fatigue Severity Scale, Patient Health Questionnaire, and Short Form 36. They were performed pre-treatment, post-treatment, and at 3 months. Results: Walking endurance ( p < 0.01) and balance ( p < 0.01) were improved among those in the RAGT group. Positive effects on depression in both treatment groups were highlighted. However, only among those in the RAGT group was perceived physical functioning QoL increased. No significant effects on fatigue were found. Conclusion: RAGT is a treatment option in progressive MS patients with severe gait impairments to induce short-lasting effects on mobility and QoL.

scholarly journals Robot-Assisted Gait Training in Patients with Multiple Sclerosis: A Randomized Controlled Crossover Trial

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 713
Author(s):  
Cristiano Sconza ◽  
Francesco Negrini ◽  
Berardo Di Matteo ◽  
Alberto Borboni ◽  
Gennaro Boccia ◽  
...  
Keyword(s):  
Crossover Trial ◽  
Gait Training ◽  
Treatment Session ◽  
Control Group ◽  
Walk Test ◽  
Robot Assisted ◽  
Randomized Controlled ◽  
Gait Parameters ◽  
Before And After

Background and Objectives: Gait disorders represent one of the most disabling aspects in multiple sclerosis (MS) that strongly influence patient quality of life. The improvement of walking ability is a primary goal for rehabilitation treatment. The aim of this study is to evaluate the effectiveness of robot-assisted gait training (RAGT) in association with physiotherapy treatment in patients affected by MS in comparison with ground conventional gait training. Study design: Randomized controlled crossover trial. Materials and Methods: Twenty-seven participants affected by MS with EDSS scores between 3.5 and 7 were enrolled, of whom seventeen completed the study. They received five training sessions per week over five weeks of conventional gait training with (experimental group) or without (control group) the inclusion of RAGT. The patients were prospectively evaluated before and after the first treatment session and, after the crossover phase, before and after the second treatment session. The evaluation was based on the 25-foot walk test (25FW, main outcome), 6 min walk test (6MWT), Tinetti Test, Modified Ashworth Scale, and modified Motricity Index for lower limbs. We also measured disability parameters using Functional Independence Measure and Quality of Life Index, and instrumental kinematic and gait parameters: knee extensor strength, double-time support, step length ratio; 17 patients reached the final evaluation. Results: Both groups significantly improved on gait parameters, motor abilities, and autonomy recovery in daily living activities with generally better results of RAGT over control treatment. In particular, the RAGT group improved more than control group in the 25FW (p = 0.004) and the 6MWT (p = 0.022). Conclusions: RAGT is a valid treatment option that in association with physiotherapy could induce positive effects in MS-correlated gait disorders. Our results showed greater effectiveness in recovering gait speed and resistance than conventional gait training.

scholarly journals Effects of Robot-Assisted Gait Training in Individuals with Spinal Cord Injury: A Meta-analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-13 ◽  
Author(s):  
Chia-Ying Fang ◽  
Jia-Ling Tsai ◽  
Guo-Sheng Li ◽  
Angela Shin-Yu Lien ◽  
Ya-Ju Chang
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Lower Extremity ◽  
Gait Training ◽  
Controlled Trials ◽  
Walking Ability ◽  
Walk Test ◽  
Robot Assisted ◽  
Cord Injury ◽  
Ashworth Scale

Background. To investigate the effects of robot-assisted gait training (RAGT) on spasticity and pain in people with spinal cord injury (SCI). Material and methods. Four electronic databases (PubMed, Scopus, Medline, and Cochrane Central Register of Controlled Trials) were searched for studies published up to November 2019. Only human trials and of English language were included. The searched studies were reviewed and extracted independently by two authors. Randomized controlled trials (RCTs) and non-RCTs were pooled separately for analyses. Primary outcome measures included spasticity assessed by Ashworth scale (AS) or modified Ashworth scale (MAS) and pain assessed by VAS. Secondary outcome measures included lower extremity motor score (LEMS) and walking ability (i.e., 6-minute walk test, 10-meter walk test). Results. A total of 225 studies were identified. Eighteen studies (7 RCTs and 11 non-RCTs) including 301 subjects met inclusion criteria. The outcome measure of spasticity significantly improved in favor of RAGT group in non-RCTs (AS: 95%CI=−0.202 to -0.068, p≤0.001; MAS: 95%CI=−2.886 to -1.412, p≤0.001). The results on pain did not show significant change after RAGT in either RCTs or non-RCTs. LEMS and walking ability significantly increased in favor of RAGT. Conclusions. RAGT can improve spasticity and walking ability in people with SCI. The probable reason for no significant change in pain after RAGT is floor effect. RAGT is beneficial for normalizing muscle tone and for improving lower extremity function in people with SCI without causing extra pain.

Robot-assisted gait training is not superior to intensive overground walking in multiple sclerosis with severe disability (the RAGTIME study): A randomized controlled trial

2019 ◽  
Vol 26 (6) ◽  
pp. 716-724 ◽  
Author(s):  
Sofia Straudi ◽  
Fabio Manfredini ◽  
Nicola Lamberti ◽  
Carlotta Martinuzzi ◽  
Elisa Maietti ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Randomized Controlled Trial ◽  
Gait Speed ◽  
Controlled Trial ◽  
Gait Training ◽  
Overground Walking ◽  
Robot Assisted ◽  
Randomized Controlled ◽  
End Of Treatment

Background: Rehabilitation may attenuate the impact on mobility of patients with progressive multiple sclerosis (MS) and severe gait disabilities. Objective: In this randomized controlled trial, we compared robot-assisted gait training (RAGT) with conventional therapy (CT) in terms of gait speed, mobility, balance, fatigue and quality of life (QoL). Methods: Seventy-two patients with MS (expanded disability status scale score 6.0–7.0) were randomized to receive 12 training sessions over a 4-week period of RAGT ( n = 36) or overground walking therapy ( n = 36). The primary outcome was gait speed, assessed by the timed 25-foot walk test. Secondary outcome measures were walking endurance, balance, depression, fatigue and QoL. Tests were performed at baseline, intermediate, at the end of treatment and at a 3-month follow-up. Results: Sixty-six patients completed the treatments. At the end of treatment with respect to baseline, both groups significantly improved gait speed ( p < 0.001) and most secondary outcomes without between-group differences. Outcome values returned to baseline at follow-up. Conclusions: RAGT was not superior to CT in improving gait speed in patients with progressive MS and severe gait disabilities where a positive, even transitory, effect of rehabilitation was observed.

scholarly journals Dalfampridine in the treatment of multiple sclerosis: a meta-analysis of randomised controlled trials

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Enyao Zhang ◽  
Xin Tian ◽  
Ruoming Li ◽  
Chaoyang Chen ◽  
Min Li ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Test Score ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Walking Ability ◽  
Walk Test ◽  
Weighted Mean ◽  
Positive Effects ◽  
The Central Nervous System ◽  
Randomised Controlled

Abstract Background Multiple sclerosis (MS) is a chronic illness involving the central nervous system (CNS) that is characterised by inflammation, demyelination, and degenerative changes. Dalfampridine is one of the available treatments for MS symptoms and comorbidities. This meta-analysis aimed to assess the safety and benefits of dalfampridine versus placebo in MS by summarising data deriving from previously published clinical randomised controlled studies (RCTs). Results A total of 9 RCTs were included in this meta-analysis, involving 1691 participants. There were significant differences between dalfampridine and placebo in terms of decreased 12-item Multiple Sclerosis Walking Scale score (weighted mean difference [WMD] =  − 3.68, 95% confidence interval [CI] [− 5.55, − 1.80], p = 0.0001), improved response to the timed 25-foot walk test (relative risk [RR] = 2.57, 95% CI [1.04, 6.33], p = 0.04), increased 6-min walk test (WMD = 18.40, 95% CI [1.30, 35.51], p = 0.03), increased 9-Hole Peg Test score (WMD = 1.33, 95% CI [0.60, 2.05], p = 0.0004), and increased Symbol Digit Modalities Test score (WMD = 4.47, 95% CI [3.91, 5.02], p < 0.00001). Significant differences in the incidence of side effects were also observed (RR = 1.12, 95% CI [1.04, 1.21], p = 0.002). Conclusion Dalfampridine exerts positive effects on walking ability, finger dexterity, and cognitive function. Treatment should be administered under the guidance of a physician or pharmacist given the higher incidence of adverse events.

A double-blind, randomized, controlled study of oral pirfenidone for treatment of secondary progressive multiple sclerosis

2005 ◽  
Vol 11 (2) ◽  
pp. 149-158 ◽  
Author(s):  
Jonathan E Walker ◽  
Shri N Giri ◽  
Solomon B Margolin
Keyword(s):  
Multiple Sclerosis ◽  
Rating Scale ◽  
Progressive Multiple Sclerosis ◽  
Secondary Progressive Multiple Sclerosis ◽  
Bladder Function ◽  
Controlled Study ◽  
Controlled Clinical Trial ◽  
Double Blind ◽  
Secondary Progressive ◽  
Randomized Controlled

Currently, there are no approved treatments for secondary progressive multiple sclerosis (MS) that stabilize or reverse the neurological disabilities associated with this disease. Oral pirfenidone was found to stabilize and overcome the disabilities in two published independent open-label studies in secondary progressive MS. This led us to study pirfenidone in a phase II double-blind, randomized and controlled, clinical trial in patients with advanced secondary progressive MS for 12 months. Forty-three patients met the eligibility criteria approved by the IRB and accepted by the FDA. Of these patients, 18 were randomly assigned to placebo and 25 patients to oral pirfenidone groups. All eligible patients were included in the statistical analysis of the data according to intention-to-treat principles. Some patients on oral pirfenidone manifested mild drug-related adverse effects, but it was well tolerated overall. By one month, pirfenidone significantly (P<0.05) improved the Scripps Neurological Rating Scale (SNRS) scores, and scores remained significantly improved for 3, 6 and 12 months when compared to the baseline SNRS scores. In contrast, the SNRS scores of patients on oral placebo were not significantly improved at 1, 3, 6 or 12 months of the study, when compared with baseline scores. Oral pirfenidone significantly (P<0.04) reduced the incidence of relapses (27.8% on placebo versus 8.0% on pirfenidone). Furthermore, oral pirfenidone treatment was associated with a marked improvement in bladder dysfunction (40.0% on pirfenidone versus 16.7% on placebo). Expanded Disability Status Scale scores and MRI lesion count were not significantly different in the placebo and pirfenidone groups. These findings indicate a significant effect of pirfenidone on clinical disability and bladder function for secondary progressive MS patients. A major multicentre, double-blind, randomized, controlled trial is justified.

scholarly journals Web-based physiotherapy for people affected by multiple sclerosis: a single blind, randomized controlled feasibility study

2018 ◽  
Vol 33 (3) ◽  
pp. 473-484 ◽  
Author(s):  
Lorna Paul ◽  
Linda Renfrew ◽  
Jennifer Freeman ◽  
Heather Murray ◽  
Belinda Weller ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Outcome Measures ◽  
Exercise Programme ◽  
Home Exercise ◽  
Walk Test ◽  
Web Based ◽  
Randomized Controlled ◽  
Home Exercise Programme ◽  
Minute Walk ◽  
Over Time

Objective: To examine the feasibility of a trial to evaluate web-based physiotherapy compared to a standard home exercise programme in people with multiple sclerosis. Design: Multi-centre, randomized controlled, feasibility study. Setting: Three multiple sclerosis out-patient centres. Participants: A total of 90 people with multiple sclerosis (Expanded Disability Status Scale 4–6.5). Interventions: Participants were randomized to a six-month individualized, home exercise programme delivered via web-based physiotherapy ( n = 45; intervention) or a sheet of exercises ( n = 45; active comparator). Outcome measures: Outcome measures (0, three, six and nine months) included adherence, two-minute walk test, 25 foot walk, Berg Balance Scale, physical activity and healthcare resource use. Interviews were undertaken with 24 participants and 3 physiotherapists. Results: Almost 25% of people approached agreed to take part. No intervention-related adverse events were recorded. Adherence was 40%–63% and 53%–71% in the intervention and comparator groups. There was no difference in the two-minute walk test between groups at baseline (Intervention-80.4(33.91)m, Comparator-70.6(31.20)m) and no change over time (at six-month Intervention-81.6(32.75)m, Comparator-74.8(36.16)m. There were no significant changes over time in other outcome measures except the EuroQol-5 Dimension at six months which decreased in the active comparator group. For a difference of 8(17.4)m in two-minute walk test between groups, 76 participants/group would be required (80% power, P > 0.05) for a future randomized controlled trial. Conclusion: No changes were found in the majority of outcome measures over time. This study was acceptable and feasible by participants and physiotherapists. An adequately powered study needs 160 participants.

scholarly journals Efficacy Of Robot-assisted Physiotherapy For Pain Management In Neurological Disorders-A Systematic Review

2021 ◽  
Vol 29 (03) ◽  
pp. 126-131
Author(s):  
Okasha Anjum ◽  
Hajra Ameer Shaikh ◽  
Nida Waheed ◽  
Syeda Wajeeha Raza Zaidi
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Neurological Disorders ◽  
Spinal Cord Injuries ◽  
Large Body ◽  
Treatment Strategies ◽  
Gait Training ◽  
Training System ◽  
Robot Assisted ◽  
Randomized Controlled

Efficacy Of Robot-assisted Physiotherapy For Pain Management In Neurological Disorders-A Systematic Review Abstract Background: Neurological disorders (ND) are ranked as the leading cause of death and disability around the globe and the escalating burden summons the advancements in the treatment strategies hence this systematic review aimed to fill the knowledge gap regarding the efficacy of robot-assisted physiotherapy (RAPT) for pain management in ND. Methodology: Scientific trials were sought by an extensive search via electronic databases mainly PubMed, PEDro, and Scopus. Randomized controlled trials published from the year 2014 to April 2021, evaluating the potential effects of RAPT for pain management in ND were included in the review. The quality appraisal of the RCTs was analyzed via Cochrane tool for assessing risk of bias. Results: The Majority of the trials reported the effectiveness of RAPT using PARO robot, Armeo spring, Gloreha robot, and robotic Lokomat gait training system in significantly improving pain of ND such as stroke, dementia, phantom syndrome, and spinal cord injuries. Conclusions: Large body of evidence suggested RAPT as a potential solution in improving pain of various ND however further rigorous trials are necessary to draw conclusive recommendations. Keywords: Neurological disorders, pain, physiotherapy management, rehabilitation, robot-assisted physiotherapy, robotics

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