Robot-assisted gait training is not superior to balance training for improving postural instability in patients with mild to moderate Parkinson's disease: a single-blind randomized controlled trial.

OBJECTIVE: The main aim was to compare robotic gait training vs. balance training for reducing postural instability in patients with Parkinson's disease. The secondary aim was to compare their effects on the level of confidence during activities of daily living requiring balance, functional mobility and severity of disease. DESIGN: Randomized controlled trial. SETTING: University hospital. SUBJECTS: A total of 66 patients with Parkinson's disease at Hoehn and Yahr Stage 3. INTERVENTION: After balanced randomization, all patients received 12, 45-minute treatment sessions, three days a week, for four consecutive weeks. A group underwent robot-assisted gait training with progressive gait speed increasing and body-weight support decreasing. The other group underwent balance training aimed at improving postural reactions (self and externally induced destabilization, coordination, locomotor dexterity exercises). MAIN MEASURES: Patients were evaluated before, after and one month posttreatment. MAIN OUTCOME MEASURE: Berg Balance Scale. SECONDARY OUTCOMES: Activities-Specific Balance Confidence Scale; Timed Up and Go Test; Unified Parkinson's Disease Rating Scale. RESULTS: No significant differences were found between the groups for the Berg Balance Scale either immediately after intervention (mean score in the robotic training group 51.58 ±3.94; mean score in the balance training group 51.15 ±3.46), or one-month follow-up (mean score in the robotic training group 51.03 ±4.63; mean score in the balance training group 50.97 ±4.28). Similar results were found for all the secondary outcome measures. CONCLUSIONS: Our findings indicate that robotic gait training is not superior to balance training for improving postural instability in patients with mild to moderate Parkinson's disease.

Robot-assisted gait training versus equal intensity treadmill training in patients with mild to moderate Parkinson's disease: a randomized controlled trial.

BACKGROUND: There is a lack of evidence about the most effective strategy for training gait in mild to moderate Parkinson's disease. The aim of this study was to compare the effects of robotic gait training versus equal intensity treadmill training and conventional physiotherapy on walking ability in patients with mild to moderate Parkinson's disease. METHODS: Sixty patients with mild to moderate Parkinson's disease (Hoehn & Yahr stage 3) were randomly assigned into three groups. All patients received twelve, 45-min treatment sessions, three days a week, for four consecutive weeks. The Robotic Gait Training group (n = 20) underwent robot-assisted gait training. The Treadmill Training group (n = 20) performed equal intensity treadmill training without body-weight support. The Physical Therapy group (n = 20) underwent conventional gait therapy according to the proprioceptive neuromuscular facilitation concept. Patients were evaluated before, after and 3 months post-treatment. Primary outcomes were the following timed tasks: 10-m walking test, 6-min walking test. RESULTS: No statistically significant difference was found on the primary outcome measures between the Robotic Gait Training group and the Treadmill Training group at the after treatment evaluation. A statistically significant improvement was found after treatment on the primary outcomes in favor of the Robotic Gait Training group and Treadmill Training group compared to the Physical Therapy group. Findings were confirmed at the 3-month follow-up evaluation. CONCLUSIONS: Our findings support the hypothesis that robotic gait training is not superior to equal intensity treadmill training for improving walking ability in patients with mild to moderate Parkinson's disease.

Does robotic gait training improve balance in Parkinson's disease? A randomized controlled trial.

BACKGROUND: Treadmill training (with or without robotic assistance) has been reported to improve balance skills in patients with Parkinson's disease (PD). However, its effectiveness on postural instability has been evaluated mainly in patients with mild to moderate PD (Hoehn & Yahr stage ≤3). Patients with more severe disease may benefit from robot-assisted gait training performed by the Gait-Trainer GT1, as a harness supports them with their feet placed on motor-driven footplates. The aim of this study was to determine whether robot-assisted gait training could have a positive influence on postural stability in patients with PD at Hoehn & Yahr stage 3-4. METHODS: Thirty-four patients with PD at Hoehn & Yahr stage 3-4 were randomly assigned into two groups. All patients received twelve, 40-min treatment sessions, three days/week, for four consecutive weeks. The Robotic Training group (n = 17) underwent robot-assisted gait training, while the Physical Therapy group (n = 17) underwent a training program not specifically aimed at improving postural stability. Patients were evaluated before, immediately after and 1-month post-treatment. Primary outcomes were: Berg Balance scale; Nutt's rating. RESULTS: A significant improvement was found after treatment on the Berg Balance Scale and the Nutt's rating in favor of the Robotic Training group (Berg: 43.44 ± 2.73; Nutt: 1.38 ± 0.50) compared to the Physical Therapy group (Berg: 37.27 ± 5.68; Nutt: 2.07 ± 0.59). All improvements were maintained at the 1-month follow-up evaluation. CONCLUSIONS: Robot-assisted gait training may improve postural instability in patients with PD at Hoehn & Yahr stage 3-4.

Robot-assisted gait training in patients with Parkinson disease: a randomized controlled trial.

BACKGROUND: . Gait impairment is a common cause of disability in Parkinson disease (PD). Electromechanical devices to assist stepping have been suggested as a potential intervention. OBJECTIVE: . To evaluate whether a rehabilitation program of robot-assisted gait training (RAGT) is more effective than conventional physiotherapy to improve walking. METHODS: . A total of 41 patients with PD were randomly assigned to 45-minute treatment sessions (12 in all), 3 days a week, for 4 consecutive weeks of either robotic stepper training (RST; n = 21) using the Gait Trainer or physiotherapy (PT; n = 20) with active joint mobilization and a modest amount of conventional gait training. Participants were evaluated before, immediately after, and 1 month after treatment. Primary outcomes were 10-m walking speed and distance walked in 6 minutes. RESULTS: . Baseline measures revealed no statistical differences between groups, but the PT group walked 0.12 m/s slower; 5 patients withdrew. A statistically significant improvement was found in favor of the RST group (walking speed 1.22 ± 0.19 m/s [P = .035]; distance 366.06 ± 78.54 m [P < .001]) compared with the PT group (0.98 ± 0.32 m/s; 280.11 ± 106.61 m). The RAGT mean speed increased by 0.13 m/s, which is probably not clinically important. Improvements were maintained 1 month later. CONCLUSIONS: . RAGT may improve aspects of walking ability in patients with PD. Future trials should compare robotic assistive training with treadmill or equal amounts of overground walking practice.