{"title":"Gait Training with Robotic Exoskeleton: A Case Report on the Treatment of Neurological Patients with Ataxia","authors":"Monnivon Morrow, Alivia Thorn, Monnivon Morrow","doi":"10.1016/j.apmr.2025.01.069","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>To assess treatment of gait instability in the subacute and chronic phase after a cerebral infarction as well as chronic brain injury after tumor removal, by focusing on postural impairment and gait ataxia, with the use of robotic overground ambulation. Treatments such as virtual reality, biofeedback, and postural stability training have shown some promise to treat ataxia, but specific efficacy needs to be further investigated (Marquer, 2014). Santos et al looked at therapist-assisted gait training versus bodyweight supported robotic-assisted gait training, which concluded that one was not better than the other (Santos 2018). No current studies have looked at the efficacy of robotic-assisted overground gait training without body weight support when not done in the intensive (5d/wk) setting.</div></div><div><h3>Design</h3><div>This is a 2-subject qualitative case study. There was no follow-up after discharge.</div></div><div><h3>Setting</h3><div>Outpatient neurological physical therapy.</div></div><div><h3>Participants</h3><div>Two patients with subacute cerebral infarction and chronic brain injury participated in this observational study.</div></div><div><h3>Interventions</h3><div>Both patients participated in outpatient neurological physical therapy. Over the span of 12 weeks, patients underwent an Ekso training program that included 10 sessions walking with decreasing assistance levels followed by overground ambulation between 100 and 200 feet each session.</div></div><div><h3>Main Outcome Measures</h3><div>Ataxia deficits were quantified by ataxia scores on the scale for the assessment and rating of ataxia (SARA), performed at every 8th to 10th visit. Standing balance and gait were also assessed through the Berg Balance Scale (BBS), Six-Minute Walk Test (6MWT), and the Ten Meter Walk Test (10MWT).</div></div><div><h3>Results</h3><div>In the subacute and chronic phase, patients showed severe ataxia through the use of the SARA. Subject 2 was formally assessed and scored 21 of 50. Both subjects were initially nonambulatory, or required maximum assistance to stand and walk. After 12-weeks between the start of treatment with the exoskeleton and the re-evaluation of patients, the patients demonstrated meaningful improvement on the BBS, 6MWT, and 10MWT. Subject 1 improved his BBS from 16 of 56 to 23 of 56, meeting MDC of 4 points. Subject 2 did not meet MDC for the BBS (3-point improvement). However, subject 2 did increase 6MWT distance from 0 feet at initial evaluation to 198 feet. Both subjects discharged as household ambulators. SARA scores remained unchanged.</div></div><div><h3>Conclusions</h3><div>Although gait training with robotics for ataxia has promising preliminary results to decrease fall risk, future studies are needed to investigate efficacy of this treatment.</div></div><div><h3>Disclosures</h3><div>none.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"106 4","pages":"Page e27"},"PeriodicalIF":3.6000,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of physical medicine and rehabilitation","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0003999325000954","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"REHABILITATION","Score":null,"Total":0}
引用次数: 0
Abstract
Objectives
To assess treatment of gait instability in the subacute and chronic phase after a cerebral infarction as well as chronic brain injury after tumor removal, by focusing on postural impairment and gait ataxia, with the use of robotic overground ambulation. Treatments such as virtual reality, biofeedback, and postural stability training have shown some promise to treat ataxia, but specific efficacy needs to be further investigated (Marquer, 2014). Santos et al looked at therapist-assisted gait training versus bodyweight supported robotic-assisted gait training, which concluded that one was not better than the other (Santos 2018). No current studies have looked at the efficacy of robotic-assisted overground gait training without body weight support when not done in the intensive (5d/wk) setting.
Design
This is a 2-subject qualitative case study. There was no follow-up after discharge.
Setting
Outpatient neurological physical therapy.
Participants
Two patients with subacute cerebral infarction and chronic brain injury participated in this observational study.
Interventions
Both patients participated in outpatient neurological physical therapy. Over the span of 12 weeks, patients underwent an Ekso training program that included 10 sessions walking with decreasing assistance levels followed by overground ambulation between 100 and 200 feet each session.
Main Outcome Measures
Ataxia deficits were quantified by ataxia scores on the scale for the assessment and rating of ataxia (SARA), performed at every 8th to 10th visit. Standing balance and gait were also assessed through the Berg Balance Scale (BBS), Six-Minute Walk Test (6MWT), and the Ten Meter Walk Test (10MWT).
Results
In the subacute and chronic phase, patients showed severe ataxia through the use of the SARA. Subject 2 was formally assessed and scored 21 of 50. Both subjects were initially nonambulatory, or required maximum assistance to stand and walk. After 12-weeks between the start of treatment with the exoskeleton and the re-evaluation of patients, the patients demonstrated meaningful improvement on the BBS, 6MWT, and 10MWT. Subject 1 improved his BBS from 16 of 56 to 23 of 56, meeting MDC of 4 points. Subject 2 did not meet MDC for the BBS (3-point improvement). However, subject 2 did increase 6MWT distance from 0 feet at initial evaluation to 198 feet. Both subjects discharged as household ambulators. SARA scores remained unchanged.
Conclusions
Although gait training with robotics for ataxia has promising preliminary results to decrease fall risk, future studies are needed to investigate efficacy of this treatment.
期刊介绍:
The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields. This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and pharmaceutical agents in providing comprehensive care for individuals with chronic illness and disabilities.
Archives began publication in 1920, publishes monthly, and is the official journal of the American Congress of Rehabilitation Medicine. Its papers are cited more often than any other rehabilitation journal.