The Effectiveness of Robotic Assisted Gait Training (Exoskeleton Devices: Lokomat) in Stroke Patients: A Systematic Review
Keywords:Lokomat, Stroke, Robotic assisted gait training
Background: Walking disability is a main problem of stroke patients. Regaining one’s ability to walk is important for stroke survivors, and is a major goal of all rehabilitation programs. The advance technologies for gait training were developed and studies. There are Body Weight Support Treadmill Training; BWSTT, Gait Trainer and Robotic assisted gait training; RAGT were developed to improve walking ability in patient after stroke. However, the effects of the training were found variations among the trials regarding onset of stroke, duration and frequency of treatment as well as differences in the ambulatory status of the patients and outcome measurements. Purpose: This study was a systematic review to assess the effectiveness of robotic assisted gait training (Exoskeleton devices: Lokomat) in stroke patients. Methods: We searched MEDLINE via PubMed with randomized controlled trials (RCTs) and found 150 records. 145 records were excluded because of no study about Lokomat and no walking ability outcome measurements. We assessed the quality of 5 studies. Results: The results showed that the subjects were included an different onset, duration and frequency of treatment. Different outcome measurements had effects on training performance which cannot be performed meta - analysis. Conclusion: From the systematic review, it is concluded that insufficient data were variable to make meta-analysis. For more clinical benefits, it should be carried out randomized controlled trials (RCTs) to investigate the effectiveness of robotic assisted gait training (Exoskeleton devices: Lokomat) and the long term effect of the training in stroke patients.
Wade DT, Wood VA, Heller AA, Maggs J, Langton HR. Walking after stroke. Measurement and recovery over the first 3 months. Scand J Rehabil Med 1987; 19:25-30.
Ratanananachai J. Physical therapy in nervous system patients. 2nd edition, Chiang Mai: Department of Physical Therapy Faculty of Medicine Chiang Mai University; 1998. p. 107-10.
Hidler J, Nichols D, Pelliccio M, Brady K, Campbell DD, Kahn JH, et al. Multicenter randomized clinical trial evaluating the effectiveness of the Lokomat in subacute stroke. Neurorehabil Neural Repair 2009; 23:5-13.
Nuannett N. Principles of physical therapy For neurological patients. 3rdedition. Khon Kaen: Nana Wittaya; 2007. p. 154-94.
Westlake KP, Patten C. Pilot study of Lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke. J Neuroeng Rehabil 2009;6:18.
Borggraefe I, Schaefer JS, Klaiber M, Dabrowski E, Ammann-Reiffer C, Knecht B, et al. Robotic-assisted treadmill therapy improves walking and standing performance in children and adolescents with cerebral palsy. Eur J Pediatr Neurol 2010;14:496-502.
Lo AC, Triche EW. Improving gait in multiple sclerosis using robot-assisted, body weight supported treadmill training. Neurorehabil Neural Repair 2008;22:661-71.
Mehrholz J, Werner C, Kugler J, Pohl M. Electromechanicalassisted training for walking after stroke. Cochrane Database Syst Rev 2007;17:CDOO6185.
Colombo G, Joerg M, Schreier R, Dietz V. Treadmill training of paraplegic patients using a robotic orthosis. J Rehabil Res Dev 2000;37:693-700.
Miyai I, Yagura H, Hatakenaka M, Oda I, Konishi I, Kubota K. Longitudinal optical imaging study for locomotor recovery after stroke. Stroke 2003;34:2866-70.
Dietz V. Body weight supported gait training: from laboratory to clinical setting. Brain Res Bull 2008; 76:459-63.
Colombo G, Wirz M, Dietz V. Driven gait orthosis for improvement of locomotor training in paraplegic patients. Spinal Cord 2001; 39:252-5.
Ada L, Dean CM, Hall JM, Bampton J, Crompton S. A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo- controlled, randomized trial. Arch Phys Med Rehabil 2003;84:1486-91.
Patterson SL, Rodgers MM, Macko RF, Forrester LW. Effect of treadmill exercise training on spatial and temporal gait parameters in subjects with chronic stroke: a preliminary report. J Rehabil Res Dev 2008;45:221-8.
Macko RF, Smith GV, Dobrovolny CL, Sorkin JD, Goldberg AP, Silver KH. Treadmill training improves fitness reserve in chronic stroke patients. Arch Phys Med Rehabil 2001;82:879-84.
Mayr A, Kofler M, Quirbach E, Matzak H, Frohlich K, Saltuari L. Prospective, blinded, randomized crossover study of gait rehabilitation in stroke patients using the Lokomat gait orthosis. Neurorehabil Neural Repair 2007;21:307-14.
Takami A, Wakayama S. Effects of partial body weight support while training acute stroke patients to walk backwards on a treadmill. A controlled clinical trial using randomized allocation. Journal of Physical Therapy Science 2010;22:177-87.
Husemann B, Muller F, Krewer C, Heller S, Koenig E. Effects of locomotion training with assistance of a robot-driven gait orthosis in hemiparetic patients after stroke: a randomized controlled pilot study. Stroke 2007;38:349-54.
Uçar DE, Paker N, Bugdayci D. Lokomat: a therapeutic chance for patients with chronic hemiplegia. NeuroRehabilitation 2014;34:447–53.
Kelley CP, Childress J, Boake C, Noser EA. Over-ground and robotic-assisted locomotor training in adults with chronic stroke: a blinded randomized clinical trial. Disabil Rehabil Assist Technol 2013;8:161–8.
Schwartz I, Sajin A, Fisher I, Neeb M, Shochina M, KatzLeurer M, et al. The effectiveness of locomotor therapy using robotic-assisted gait training in subacute stroke patients: a randomized controlled trial. PM R 2009;1:516-23.
Hornby TG, Campbell DD, Kahn JH, Demott T, Moore JL, Roth HR. Enhanced gait-related improvements after therapist- versus robotic-assisted locomotor training in subjects with chronic stroke. Stroke 2008;39:1786-92.
Hassid E, Rose D, Commisarow J, Guttry M, Dobkin BH. Improved gait symmetry in hemiparetic stroke patients induced during body weightsupported treadmill stepping. J Neurol Rehabil 1997;11:21–26.
Taub E, Miller NE, Novack TA, Cook EW 3rd, Fleming WC, Nepomuceon CS, et al. Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil 1993;74:347–54.
How to Cite
ข้อความและข้อคิดเห็นต่างๆ เป็นของผู้เขียนบทความ ไม่ใช่ความเห็นของกองบรรณาธิการหรือของวารสารกรมการแพทย์