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Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2021.tde-11112021-142058
Document
Author
Full name
Mariana Vita Milazzotto Neves
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2021
Supervisor
Committee
Simis, Marcel (President)
Alfieri, Fabio Marcon
Brito, Christina May Moran de
Imamura, Marta
Title in Portuguese
Treinamento de marcha assistida por robô na reabilitação de AVC: um estudo piloto
Keywords in Portuguese
Acidente vascular cerebral
Caminhada
Exoesqueleto energizado
Marcha
Reabilitação
Robótica
Abstract in Portuguese
O treinamento de marcha assistida por robô, quando associado à fisioterapia convencional, melhora a caminhada após o AVC em termos de velocidade e qualidade de marcha. Dois tipos principais destes dispositivos foram investigados: exoesqueletos e efetores finais. No entanto, as diferenças entre eles ainda não foram totalmente definidas. Portanto, é importante compreender os efeitos desses dois tipos de intervenção para planejar futuros estudos comparativos. Com o objetivo de descrever o desempenho de dois dispositivos (Lokomat® e o G-EO System) em termos de sua capacidade de melhorar os padrões funcionais da marcha, realizamos uma análise retrospectiva de uma coorte de 24 pacientes com AVC crônico que receberam o treino robótico de marcha com os dois diferentes equipamentos. A intervenção foi realizada 3 vezes por semana (total de 36 sessões). Os seguintes testes/escalas foram empregados antes e depois do treino robótico: Functional Ambulation Categories (FAC), Timed Up and Go (TUG), Teste de Caminhada de 10 Metros (10 MWT), Teste de Caminhada de 6 Minutos (TC6), Escala de Deficiência de Tronco (EDT), Índice de Marcha Dinâmica (DGI), Berg Balance Scale (BBS) e Habilidade de Subir Escadas (tempo para subir seis degraus de 15 cm cada; HSE). Houve 5 desistências, todas do grupo G-EO System. Finalizaram o estudo, 10 participantes do grupo Lokomat® e 9 do grupo G-EO System. Do pré ao pós treino robótico assistido de marcha, os pacientes do grupo G-EO System melhoraram em todos os testes/escalas funcionais, enquanto os pacientes do grupo Lokomat® melhoraram apenas no TUG, DGI e BBS. A maioria dos pacientes de ambos os grupos apresentou melhoras acima da menor diferença real relativa (SRD%) no TUG, 10 MWT e TC6. No geral, nossos resultados mostram que tanto os efetores finais quanto os exoesqueletos melhoram aspectos clinicamente relevantes da função de andar, conforme avaliado por meio dos testes/escalas TUG, DGI e BBS. Estudos futuros são necessários para investigar possíveis diferenças nos resultados clínicos, efeitos colaterais, contraindicações e relação custo-benefício entre esses dois tipos de dispositivos robóticos de assistência à marcha
Title in English
Robotic-assisted gait training (RAGT) in stroke rehabilitation: a pilot study
Keywords in English
Exoskeleton device
Gait
Rehabilitation
Robotics
Stroke
Walking
Abstract in English
Robotic-assisted gait training (RAGT), when combined with conventional physical therapy, improves walking after stroke in terms of gait speed and quality. Two main types of RAGT devices have been investigated: exoskeletons and endeffectors. However, the differences between them have not yet been fully defined. Therefore, it is important to understand the effects of these two types of intervention to plan future comparative studies. To describe the performance of these two devices (Lokomat® and the G-EO System) in terms of their ability to improve functional gait patterns, we performed a retrospective analysis of a cohort of 24 chronic stroke patients who received the robotic training with the two different equipment. The intervention was delivered 3 times per week (36 sessions total). The following tests/scales were employed before and after RAGT: Functional Ambulation Categories (FAC), Timed Up and Go (TUG), 10-Metre Walk Test (10MWT), 6-Minute Walk Test (6MWT), Trunk Impairment Scale (TIS), Dynamic Gait Index (DGI), Berg Balance Scale (BBS) and ability to climb stairs (time to climb six steps of 15cm each; ACS). There were 5 dropouts, all from the G-EO group. At the end, 10 participants in the Lokomat and 9 in the G-EO group completed the intervention. From pre- to post-RAGT, G-EO patients improved on all functional tests/scales, whereas Lokomat patients improved only on the TUG, DGI and BBS. Most patients from both groups showed improvements above the relative smallest real difference (SRD%) in the TUG, 10MWT and 6MWT. Overall, our results show that both end-effectors and exoskeletons improve clinically relevant aspects of walking function, as assessed through the tests/scales TUG, DGI and BBS. Future studies are needed for investigating potential differences in clinical results, side effects, contraindications and cost effectiveness between these two different types of RAGT
 
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Publishing Date
2021-11-11
 
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