Effect of home-based, overground robotic-assisted gait training on vascular health in people with chronic stroke.

Overground robotic-assisted gait training (O-RAGT) has been shown to improve clinical functional outcomes in people living with stroke. The purpose of this study was to identify whether a home-based O-RAGT program, in combination with usual care physiotherapy, would demonstrate improvements in vascular health in individuals with chronic stroke, and, whether any changes in vascular outcomes would be sustained 3 months after completing the program. Thirty-four participants with chronic stroke (between 3 months and 5 years post-stroke) were randomized to either a 10-week O-RAGT program in combination with usual care physiotherapy, or to a usual care physiotherapy only control group. Participants' (n = 31) pulse wave analysis (PWA), and regional [carotid-femoral pulse wave analysis (cfPWV)] and local (carotid) measures of arterial stiffness were assessed at baseline, post-intervention, and 3-month post-intervention. Analysis of covariance demonstrated a significant reduction (improvement) in cfPWV between BL and PI for O-RAGT (8.81 ± 2.51 vs. 7.92 ± 2.17 m/s, respectively), whilst the control group remained unchanged (9.87 ± 2.46 vs. 9.84 ± 1.76 m/s, respectively; p < 0.05; ηp2 = 0.14). The improvement in cfPWV was maintained 3 months after completing the O-RAGT program. There were no significant Condition by Time interactions for all PWA and carotid arterial stiffness measures (p > 0.05). A significant increase in physical activity, as determined by the time spent stepping, was observed for O-RAGT between baseline and post-intervention assessments (3.2 ± 3.0-5.2 ± 3.3%, respectively) but not for CON (p < 0.05). The improvement in cfPWV, in combination with an increase in physical activity whilst wearing the O-RAGT and concomitant reduction in sedentary behavior, are important positive findings when considering the application of this technology for "at home" rehabilitation therapy for stroke survivors. Further research is needed to determine whether implementing "at home" O-RAGT programs should be a part of the stroke treatment pathway. Clinical trial registration: https://clinicaltrials.gov, identifier NCT03104127.

Effect of combined home-based, overground robotic-assisted gait training and usual physiotherapy on clinical functional outcomes in people with chronic stroke: A randomized controlled trial.

OBJECTIVES: To assess the effect of a home-based over-ground robotic-assisted gait training program using the AlterG Bionic Leg orthosis on clinical functional outcomes in people with chronic stroke. DESIGN: Randomized controlled trial. SETTING: Home. PARTICIPANTS: Thirty-four ambulatory chronic stroke patients who recieve usual physiotherapy. INTERVENTION: Usual physiotherapy plus either (1)10-week over-ground robotic-assisted gait training program (n = 16), using the device for ⩾30 minutes per day, or (2) control group (n = 18), 30 minutes of physical activity per day. MEASUREMENTS: The primary outcome was the Six-Minute Walk Test. Secondary outcomes included: Timed-Up-and-Go, Functional Ambulation Categories, Dynamic Gait Index and Berg Balance Scale. Physical activity and sedentary time were assessed using accelerometry. All measurements were completed at baseline, 10 and 22 weeks after baseline. RESULTS: Significant increases in walking distance were observed for the Six-Minute Walk Test between baseline and 10 weeks for over-ground robotic-assisted gait training (135 ± 81 m vs 158 ± 93 m, respectively; P ⩽ 0.001) but not for control (122 ± 92 m vs 119 ± 84 m, respectively). Findings were similar for Functional Ambulation Categories, Dynamic Gait Index and Berg Balance Scale (all P ⩽ 0.01). For over-ground robotic-assisted gait training, there were increases in time spent stepping, number of steps taken, number of sit-to-stand transitions, and reductions in time spent sitting/supine between baseline and 10 weeks (all P < 0.05). The differences observed in all of the aforementioned outcome measures were maintained at 22 weeks, 12 weeks after completing the intervention (all P > 0.05). CONCLUSION: Over-ground robotic-assisted gait training combined with physiotherapy in chronic stroke patients led to significant improvements in clinical functional outcomes and physical activity compared to the control group. Improvements were maintained at 22 weeks.

Effects of robotic-assisted gait training on the central vascular health of individuals with spinal cord injury: A pilot study.

Objective: To investigate the effect of a short-term, robotic-assisted (exoskeleton) gait training (RGT) program on central and peripheral hemodynamic measures in patients with spinal cord injury (SCI).Design: Parallel group, non-randomized trial with before (baseline) and after (follow-up) assessments.Setting: Single-center, community-based neuro-physiotherapy practice.Participants: Twelve individuals with SCI (ASI A to C).Interventions: Participants completed either a 5-day RGT program plus physiotherapy (n = 6), or a usual care physiotherapy only program (control group; n = 6). The RGT program consisted of daily 60-min physiotherapy and 90-min of RGT. Outcome measures were measured before and after the rehabilitation program.Main outcome measure(s): The primary outcome measure was arterial wave reflection (Augmentation index [AIx]), with central and peripheral blood pressures also reported. Data are presented as mean (SD) and effect sizes (partial eta squared; η2p).Results: There was a significant reduction in AIx (30 ± 18-21 ± 15%; η2p=0.75) and mean arterial pressure (89 ± 11-82 ± 10 mmHg; η2p=0.47) following completion of the RGT program (both P < 0.05). There were no changes in these measures for the control group. Although not significantly different, medium to large effects were observed in favor of RGT for all other central and peripheral measures (η2p=0.06-0.21), except for heart rate and pulse pressure (η2p<0.04).Conclusions: RGT using an exoskeleton is a promising therapy for improving cardiovascular health in patients with SCI. Specifically, this study indicates decreased arterial wave reflection and supports the need for larger randomized controlled trials.Trial Registration: Clinical trials Registry (https://clinicaltrials.gov/; NCT03611803).

Psychometric properties of 3 functional mobility tests for people with Parkinson disease.

BACKGROUND: Standardized outcome measures with high clinical utility are of paramount importance for clinical practice. OBJECTIVE: The purpose of this study was to examine interrater and intrarater reliability, construct validity, discriminant ability, and smallest detectable differences of the sit-to-stand test (STS), Timed "Up & Go" Test (TUG), and bed mobility test for people with Parkinson disease (PD). DESIGN: A cross-sectional, psychometric evaluation study was conducted. METHODS: A group of individuals with PD (PD group) and a group of individuals who were healthy (control group) were recruited through local PD groups and assessed in a movement laboratory in their "on" phase. Measurements of time to perform one STS, TUG, and bed mobility test were collected based on video recordings of that single performance. RESULTS: Thirty-eight individuals with PD (Hoehn and Yahr stages I-IV) and 19 age-matched control participants were recruited. Intraclass correlation coefficients for interrater and intrarater reliability for the PD group ranged from .95 to .99. Bland-Altman plots showed mean differences close to zero and narrow confidence intervals. Construct validity was established by means of moderate to good Spearman rho correlation coefficients with part III of the Unified Parkinson's Disease Rating Scale and the Hoehn and Yahr stage (range=.51-.63). Timings of all tests discriminated participants in the PD group from those in the control group and participants in the PD group in Hoehn and Yahr stages I and II from those in Hoehn and Yahr stages III and IV but did not discriminate "nonfallers" or those with single falls from repeat "fallers" or "nonfreezers" from "freezers." Applicable smallest detectable differences were established. LIMITATIONS: The results are not generalizable to people in the late stage of PD (Hoehn and Yahr stage IV: n=3). CONCLUSIONS: Timings of video recordings of 3 functional mobility tests with high clinical utility showed good psychometric properties for community-dwelling, ambulatory people with PD.