Exo-rehabilitation of patients with spastic hemiparesis: high technology

Abstract

AIM: Walking disorders are a frequent consequence of stroke. New technologies, such as the use of robotic exoskeletons, can help with recovery, but their effectiveness has not yet been sufficiently proven.

MATERIALS AND METHODS: Forty-two patients with spasticity and walking disorders (stroke duration from 1.5 to 4 years) were included in the study. The Tardieu Scale, Modified Ashworth scale, Medical Research Council Scale, 10 Meter Walk Test, Rivermead Mobility Index, Berg Balance Test, Rankin scale, and a Visual Analog Scale (to assess patient satisfaction with treatment) were used in assessments. The patients were randomized into 2 groups (n = 22 & 20): the first group received exoskeleton walk training with the powered exoskeleton, ExoAtlet, and the second group received physical therapy sessions, each for 1 hour daily over 10 days. Clinical evaluations of patients were performed at 3 timepoints: baseline (Day 1), and 12.

RESULTS: Comparison of both groups at the second timepoint showed significantly better results (p < 0.05) in the first group vs the second group. Walking speed increased due to balance training, correction of postural disorders, spastic muscle stretching, and stretch reflex suppression.

CONCLUSION: The wearable powered ExoAtlet exoskeleton is a promising technology for improving walking (2 tables, bibliography: 13 refs).

Keywords

Exorehabilitation / Exoskeleton ExoAtlet / Post-stroke rehabilitation / Spasticity / Walking disorder

References

[1] Bushkov FA, Kleshchunov SS, Kosiaeva SV, et al. Clinical trial applications of the locomotion exoskeleton “exoatlet” in spinal patients. Bulletin of Rehabilitation Medicine. 2017;2(78):54–59. (In Russ.)

[2] Бушков Ф.А., Клещунов С.С., Косяева С.В., и др. Клиническое исследование применения экзоскелета «Exoatlet» у спинальных пациентов // Вестник восстановительной медицины. 2017. № 2 (78). С. 54–59.

[3] Tkachenko PV, Daminov VD, Karpov OE. Application of exoskeleton exoatlet in complex rehabilitation of the spinal cord injury patients. Bulletin of Rehabilitation Medicine. 2017;2(78):126–132. (In Russ.)

[4] Ткаченко П.В., Даминов В.Д., Карпов О.Э. Использование экзоскелета в комплексной реабилитации пациентов с позвоночно-спинномозговой травмой // Вестник восстановительной медицины. 2017. № 2 (78). С. 126–132.

[5] Klochkov AS. Robotic systems in the restoration of walking skills in patients who have suffered a stroke [dissertation]. Moscow; 2012. (In Russ.)

[6] Клочков А.С. Роботизированные системы в восстановлении навыка ходьбы у пациентов, перенесших инсульт. Автореф. дис. … канд. мед. наук. М., 2012. 26 с.

[7] Kotov SV, Lijdvoy VY, Sekirin AB, et al. The efficacy of the exoskeleton exoatlet to restore walking in patients with multiple sclerosis. Neuroscience and Behavioral Physiology. 2017;117(10–2):41–47. (In Russ.)

[8] Котов С.В., Лиждвой В.Ю., Секирин А.Б. Эффективность применения экзоскелета exoatlet для восстановления функции ходьбы у больных рассеянным склерозом // Журнал неврологии и психиатрии им. C.C. Корсакова. 2017. Т. 117, № 10–2. С. 41–47.

[9] Makarova MR, Liadov KV, Turova EA, Kochetkov AV. Possibilities of modern mechanical therapy in the correction of motor disorders of neurological patients. Bulletin of Rehabilitation Medicine. 2014;1(59):54–62. (In Russ.)

[10] Макарова М.Р., Лядов К.В., Турова Е.А., Кочетков А.В. Возможности современной механотерапии в коррекции двигательных нарушений неврологических больных // Вестник восстановительной медицины. 2014. № 1 (59). С. 54–62.

[11] Cruciger O, Schildhauer TA, Meindl RC, et al. Impact of locomotion training with a neurologic controlled hybrid assistive limb (HAL) exoskeleton on neuropathic pain and health related quality of life (HRQoL) in chronic SCI: a case study. Disabil Rehabil Assist Technol. 2016;11(6):529–534. DOI: 10.3109/17483107.2014.981875

[12] Cruciger O., Schildhauer T.A., Meindl R.C., et al. Impact of locomotion training with a neurologic controlled hybrid assistive limb (HAL) exoskeleton on neuropathic pain and health related quality of life (HRQoL) in chronic SCI: a case study // Disabil. Rehabil. Assist. Technol. 2016. Vol. 11, No. 6. P. 529–534. DOI: 10.3109/17483107.2014.981875

[13] Hartigan C, Kandilakis C, Dalley S, et al. Mobility Outcomes Following Five Training Sessions with a Powered Exoskeleton. Spring. 2015;21(2):93–99. DOI: 10.1310/sci2102-93

[14] Hartigan C., Kandilakis C., Dalley S., et al. Mobility Outcomes Following Five Training Sessions with a Powered Exoskeleton // Spring. 2015. Vol. 21, No. 2. P. 93–99. DOI: 10.1310/sci2102-93

[15] Kasai R, Takeda S. The effect of a hybrid assistive limb on sit-to-stand and standing patterns of stroke patients. J Phys Ther Sci. 2016;28(6):1786–1790. DOI: 10.1589/jpts.2016.1786

[16] Kasai R., Takeda S. The effect of a hybrid assistive limb on sit-to-stand and standing patterns of stroke patients // J. Phys. Ther. Sci. 2016. Vol. 28, No. 6. P. 1786–1790. DOI: 10.1589/jpts.2016.1786

[17] Mehrholz J, Thomas S, Werner C, et al. Electromechanical-assisted training for walking after stroke. Cochrane Database Syst Rev. 2017;5(5):CD006185. DOI: 10.1002/14651858.CD006185.pub4

[18] Mehrholz J., Thomas S., Werner C., et al. Electromechanical-assisted training for walking after stroke. Cochrane Database Syst. Rev. 2017. Vol. 5, No. 5. CD006185. DOI: 10.1002/14651858.CD006185.pub4

[19] Kovalenko AP, Kamaeva OV, Misikov VK, et al. Scales and tests in the rehabilitation and treatment of patients with spasticity of the lower limbs. Neuroscience and Behavioral Physiology. 2018;118(5):120–128. (In Russ.) DOI: 10.17116/jneuro201811851120

[20] Коваленко А.П., Камаева О.В., Мисиков В.К., и др. Шкалы и тесты для оценки эффективности лечебно-реабилитационных мероприятий у пациентов со спастичностью нижней конечности // Журнал неврологии и психиатрии им. С.С. Корсакова. 2018. T. 118, № 5. 120–128. DOI: 10.17116/jneuro201811851120

[21] Kovalenko AP, Misikov VK, Iskra DA. Tardue scales in the diagnostic of spasticity. Neuroscience and Behavioral Physiology. 2019;119(9):70–77. (In Russ.) DOI: 10.17116/jnevro201911909183

[22] Коваленко А.П., Мисиков В.К., Искра Д.А., и др. Шкала Тардье в диагностике спастичности // Журнал неврологии и психиатрии им. С.С. Корсакова. 2019. Т. 119, № 9. С. 70–77. DOI: 10.17116/jnevro201911909183

[23] Iskra DA, Kovalenko AP, Koshkarev MA, Dyskin DE. Spasticity: from pathophysiology to treatment. Neuroscience and Behavioral Physiology. 2018;118(10):108–114. (In Russ.) DOI:10.17116/jnevro2018118101108

[24] Искра Д.А., Коваленко А.П., Кошкарев М.А., Дыскин Д.Е. Спастичность: от патофизиологии к лечению // Журнал неврологии и психиатрии им. С.С. Корсакова. 2018. T. 118, № 10. C. 108–114. DOI:10.17116/jnevro2018118101108

[25] Kovalenko AP, Misikov VK. Botulinum toxin in treatment of lower limb spasticity in patients with brain damage. Neuroscience and Behavioral Physiology. 2018;118(9):113–119. (In Russ.) DOI: 10.17116/jnevro201811809128

[26] Коваленко А.П., Мисиков В.К. Ботулинический токсин в лечении спастичности нижней конечности при повреждениях головного мозга // Журнал неврологии и психиатрии им. С.С. Корсакова. 2018. T. 118, № 9. C. 113–119. DOI: 10.17116/jnevro201811809128

RIGHTS & PERMISSIONS

Rodionov A.S., Kovalenko A.P., Kremlуоv D.I., Averkiуev D.V.