Savonia Article: The Effect of Robotic and Electromechanical Gait Training in Patients with Stroke
In 20 – 25. 2 . 2023, Blended Intensive program in Neurological rehabilitation ran. More than 30 physiotherapy students and teachers from three universities (Savonia University of Applied Sciences, Finland, Third Faculty of Medicine, Charles University, Czech Republic and University of Thessaly, Greece) actively participated. Students worked together and wrote articles devoted to on the following themes: stroke and rehabilitation, multiple sclerosis and rehabilitation, Parkinson’s disease and rehabilitation, children with neurological disorders and rehabilitation, spinal cord injury and rehabilitation and virtual reality and exergames in rehabilitation of neurological patients. We are going to present their great work here. (Äijö et al 2022.)
Stroke is a condition that occurs due to low perfusion in the brain tissue, which leads to hypoxia and eventually necrosis in the affected area. It happens when blood flow in the brain is blocked and it’s called ischemic stroke. Ischemic stroke can occur either due to a thrombotic or thromboembolic episode. The other mechanism of stroke is hemorrhagic and it occurs if there is a rupture of the vessel then it is. There are 15.000.000 cases per year, 1/3 dies, 1/3 will have permanent consequences, 1/3 will go back to normal life (World Health Organization, 2020). Potential risk factors for the development of stroke include hypertension, atrial fibrillation, diabetes, hypercholesterolemia, smoking, alcohol consumption and, in general, an unhealthy lifestyle.
Symptoms of stroke may include weakness of the arms or legs, numbness, difficulty in speaking, dizziness and vertigo, reduced vision or double vision, headache, vomiting and difficulty walking (instability in walking). In addition, depending on the vascular area of the brain that is damaged, there may be some differences in the patient’s symptomatology.
Finland, Greece, and Czech Republic have no big differences, because they used robotic devices in stroke rehabilitation and also, neurorehabilitation methods and techniques, such as Neurodevelopmental Treatment (Bobath), Vojta’s method and Proprioceptive Neuromuscular Facilitation patterns (PNF).
The suitability of different robotic devices for a certain stage of rehabilitation and the degree of severity of the injury can be defined, but according to the study, there are considerable differences in the amount of training and methods of rehabilitation.
The use of robotics as an additional treatment is common. Furthermore, it has been found that higher intensity walking training using repetitive task-specific methods can lead to improved walking in poststroke patients (Morone etal 2022). One another study shows that traditional walking training and A3 robot- assisted walking training can both improve the walking ability of stroke patients during a two-week intensive period (Yu etal 2021).
Morning Walk robot was found to significantly improve walking ability, lower limb function and balance and specifically, increase the activity of the cerebral cortex, especially on the injured side. The obtained results can contribute to explaining the mechanisms of recovery from stroke. (Song etal 2021).
The stationary robot-assisted training improved walking ability (gait speed and endurance) better than the conventional overground gait training in subacute stroke survivors (Pournajaf et al. 2023). An intervention form of end-effector gait rehabilitation and balance in a robotic platform has been shown improved muscle strength and muscle tone with significant results in trunk oscillators and displacement than patients that followed only gait training (Aprile et al. 2022).
Furthermore, assist-as-needed approach with multiple degrees of freedom robotic training was not superior to conventional training for gait parameters in subacute stroke survivors, but both groups improved their gait efficiency (Alingh et al. 2021).
A meta-analysis comparing electromechanical and robotic assisted therapies with standard physiotherapy care found that physiotherapy in combination with electromechanical support increase the independency and the velocity of walking, mostly in the first three months, but the capacity didn’t improve. Furthermore, the analysis showed that people who are non- ambulatory have bigger chance to benefit from the robotic assisted therapy than those who are ambulatory (Mehrloz et al. 2020).
For every eight people treated with these devices plus physiotherapy, there is one person who could walk independently at the end of the treatment. We need more research to find out how often and for how long should be these devices used to get positive response (Mehrloz et al. 2020).
Alamoodi Fares, Physiotherapy students, Third Faculty of Medicine, Charles University, Czech Republic
Kyriakatis Georgios Marios, Physiotherapy students, Department School of Health Sciences, University of Thessaly, Greece
Rentola Helmi, Physiotherapy students, Savonia University of Applied Sciences, Kuopio, Finland
Solarova Valentyna Physiotherapy students, Third Faculty of Medicine, Charles University, Czech Republic
Syrjäniemi Kaisa Physiotherapy students, Savonia University of Applied Sciences, Kuopio, Finland
Dr. Marja Äijö, PhD, Principal lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences, Kuopio, Finland
Dr. Kamila Řasová, Ph.D., Associative professor of Physiotherapy, Third Faculty of Medicine, Charles University, Czech Republic
Dr. Thomas Besios, Assistant Professor, Department School of Health Sciences, University of Thessaly, Greece,
Alingh JF, Fleerkotte BM, Groen BE, Rietman JS, Weerdesteyn V, van Asseldonk EHF, Geurts ACH, Buurke JH. 2021. Effect of assist-as-needed robotic gait training on the gait pattern post stroke: a randomized controlled trial. J Neuroeng Rehabil. 5;18(1):26. doi: 10.1186/s12984-020-00800-4.
Aprile I, Conte C, Cruciani A, Pecchioli C, Castelli L, Insalaco S, Germanotta M, Iacovelli C. 2022. Efficacy of Robot-Assisted Gait Training Combined with Robotic Balance Training in Subacute Stroke Patients: A Randomized Clinical Trial. Journal of Clinical Medicine. 11(17):5162. https://doi.org/10.3390/jcm11175162
Mehrholz J, Thomas S, Kugler J, Pohl M, Elsner B. 2020. Electromechanical-assisted training for walking after stroke. Cochrane Database Syst Rev. 2020 Oct 22;10(10):CD006185. doi: 10.1002/14651858.CD006185.pub5.
Morone G, Riener R, Mazzoleni S. 2022. Integrating robot-assisted therapy into neurorehabilitation clinical practice: Where are we now? Where are we heading? NeuroRehabilitation. 51(4):537-539. doi: 10.3233/NRE-228025.
Pournajaf S, Calabrò RS, Naro A, Goffredo M, Aprile I, Tamburella F, Filoni S, Waldner A, Mazzoleni S, Focacci A, Ferraro F, Bonaiuti D, Franceschini M, TreadStroke Group. 2023. Robotic versus Conventional Overground Gait Training in Subacute Stroke Survivors: A Multicenter Controlled Clinical Trial. Journal of Clinical Medicine. 12(2):439. https://doi.org/10.3390/jcm12020439
Song KJ, Chun MH, Lee J, Lee C. 2021. The effect of robot-assisted gait training on cortical activation in stroke patients: A functional near-infrared spectroscopy study. NeuroRehabilitation. 49(1):65-73. doi: 10.3233/NRE-210034. PMID: 33998555.
Yu D, Yang Z, Lei L, Chaoming N, Ming W. 2021. Robot-Assisted Gait Training Plan for Patients in Poststroke Recovery Period: A Single Blind Randomized Controlled Trial. Biomed Res Int. 29;2021:5820304. doi: 10.1155/2021/5820304. PMID: 34497851; PMCID: PMC8419501.
World Health Organization. 2020. Stroke, Cerebrovascular accident. In available. https://www.emro.who.int/health-topics/stroke-cerebrovascular-accident/index.html
Äijö M, Řasová K & Besios T. 2022. Neurological rehabilitation, Blended Intensive program has started. Savonia Article, Savonia-ammattikorkeakoulu. In available: https://www.savonia.fi/en/articles/savonia-article-neurological-rehabilitation-blended-intensive-program-has-started/