The Journal of Korean Physical Therapy

The Korean Society of Physical Therapy (대한물리치료학회)
권호 표지
DOI QR코드

DOI QR Code

Effects of Gait Training Using a Robot for Balance in Total Hip Arthroplasty Patients after Bilateral Avascular Necrosis: A Case Study

  • Kim, So-Yeong (Department of Physical Therapy, Graduate School, Nambu University) ;
  • Kim, Byeong-Geun (Department of Physical Therapy, Nambu University) ;
  • Cho, Woon-Su (Department of Physical Therapy, Nambu University) ;
  • Park, Chi-Bok (Department of Physical Therapy, Nambu University)
  • Received : 2021.09.15
  • Accepted : 2021.10.30
  • Published : 2021.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study sought to investigate the effects of robot-assisted gait training on balance in total hip arthroplasty (THA) patients after bilateral avascular necrosis (AVN). Methods: This case study in two patients utilized an 'A-B-A' single-subject experimental design that included five days of pre-intervention, followed by five days of intervention, and five days of post-intervention. The intervention involved the use of a standing inclined robot (R-bot) for 15 minutes. The outcome measures were evaluated using the Functional Reaching Test (FRT), Time Up to Go (TUG), and the Modified One Leg Standing Test (OLST). Results: Patient 1 showed improvement based on data gathered from baseline A to intervention period B, with results as follows: FRT improved from 27.7 cm to 41.28 cm, OLST LT from 14.03 seconds to 67.37 seconds, OLST RT from 2.94 seconds to 35.97 seconds, and TUG from 12.96 seconds to 7.82 seconds. Patient 2 also showed improvement from baseline A to intervention period B, with results as follows: FRT improved from 17.18 cm to 24.3 cm, OLST LT from 11.53 seconds to 52.01 seconds, OLST RT from 12.99 seconds to 62.19 seconds, and TUG from 27.31 seconds to 12.99 seconds. Conclusion: Based on the results of this study, robotic rehabilitation during the early stages after surgery is effective for promoting balance in patients who have undergone THA due to bilateral AVN.

Keywords

Acknowledgement

이 논문은 2021년도 남부대학교 학술연구비의 지원을 받아 연구되었음.

References

  1. Moya-Angeler J, Gianakos A, Villa J et al. Current concepts on osteonecrosis of the femoral head. World J Orthop. 2015;6(8):590-601. https://doi.org/10.5312/wjo.v6.i8.590
  2. Kaushik AP, Das A, Cui Q. Osteonecrosis of the femoral head: an update in year 2012. World J Orthop. 2012;3(5):49-57. https://doi.org/10.5312/wjo.v3.i5.49
  3. Malizos KN, Karantanas AH, Varitimidis SE et al. Osteonecrosis of the femoral head: etiology, imaging and treatment. Eur J Radiol. 2007;63(1):16-28. https://doi.org/10.1016/j.ejrad.2007.03.019
  4. Jang JD. Etiology and pathophysiology of osteonecrosis of the femoral head. J Korean Hip Soc. 2006;18(4):362-9.
  5. Ancelin D, Rei na N, Cavaignac E et al. Total hip arthroplasty survival in femoral head avascular necrosis versus primary hip osteoarthritis: case-control study with a mean 10-year follow-up after anatomical cement-less metal-on-metal 28-mm replacement. Orthop Traumatol Surg Res. 2016;102(8):1029-34. https://doi.org/10.1016/j.otsr.2016.08.021
  6. Min K, Beom J, Kim BR et al. Clinical practice guideline for postoperative rehabilitation in older patients with hip fractures. Ann Rehabil Med. 2021;45(3):225-59. https://doi.org/10.5535/arm.21110
  7. Kim GB, Lee HS, Lee YJ et al. Case study of patients who underwent total hip arthroplasty. The Korean Nurse. 1997;36(4):34-50.
  8. Cho SH, Lee SH, Kim KH et al. Gait analysis before and after total hip arthroplasty in hip dysplasia and osteonecrosis of the femoral head. J Korean Orthop Assoc. 2004;39(5):82.
  9. Warenczak A, Lisinski P. Does total hip replacement impact on postural stability? BMC Musculoskelet Disord. 2019;17:20(1):229. https://doi.org/10.1186/s12891-019-2598-9
  10. Piscitelli P, Iolascon G, Di Tanna G et al. Socioeconomic burden of total joint arthroplasty for symptomatic hip and knee osteoarthritis in the Italian population: a 5-year analysis based on hospitalization records. Arthritis Care Res (Hoboken). 2012;64(9):1320-7. https://doi.org/10.1002/acr.21706
  11. ROOS, Ewa M. Effectiveness and practice variation of rehabilitation after joint replacement. Curr opin Rheumatol. 2003;2:160-2. https://doi.org/10.1097/00002281-199002010-00028
  12. Lee, GS, Lee SH, Park SH et al. Effect of postoperative intensive rehabilitation on ankle function recovery in patients with chronic ankle instability. Korean J Sports Med. 2020;38(1):20-7. https://doi.org/10.5763/kjsm.2020.38.1.20
  13. Nankaku M, Ikeguchi R, Goto K et al. Hip external rotator exercise contributes to improving physical functions in the early stage after total hip arthroplasty using an anterolateral approach: a randomized controlled trial. Disabil Rehabil. 2016;38(22):2178-83. https://doi.org/10.3109/09638288.2015.1129453
  14. Austin MS, Urbani BT, Fleischman AN et al. Formal physical therapy after total hip arthroplasty is not required: a randomized controlled trial. J Bone Joint Surg Am. 2017;99(8):648-55. https://doi.org/10.2106/JBJS.16.00674
  15. Smedes F, Heidmann M, Keogh J. PNF-based gait rehabilitation-training after a total hip arthroplasty in congenital pelvic malformation; a case report. Physiother Theory Pract. 2021:1-10.
  16. Beck H, Beyer F, Gering F et al. Sports therapy interventions following total hip replacement: a randomized controlled trial. Dtsch Arztebl Int. 2019;116(1-2):1-8.
  17. Wijnen A, Bouma SE, Seeber GH et al. The therapeutic validity and effectiveness of physiotherapeutic exercise following total hip arthroplasty for osteoarthritis: a systematic review. PLoS One. 2018;13(3):e0194517. https://doi.org/10.1371/journal.pone.0194517
  18. Jun MH, Lee JH. Recent development of rehabilitation robots. J Korean Med Assoc. 2013;56(1):23-9. https://doi.org/10.5124/jkma.2013.56.1.23
  19. Lee HJ, Lee SH, Seo K et al. Training for walking efficiency with a wearable hip-assist robot in patients with stroke: a pilot randomized controlled trial. Stroke. 2019;50(12):3545-52. https://doi.org/10.1161/STROKEAHA.119.025950
  20. Kawasaki S, Ohata K, Yoshida T et al. Gait improvements by assisting hip movements with the robot in children with cerebral palsy: a pilot randomized controlled trial. J Neuroeng Rehabil. 2020;17(1):87. https://doi.org/10.1186/s12984-020-00712-3
  21. Yoshioka T, Kubota S, Sugaya H et al. Feasibility and efficacy of knee extension training using a single-joint hybrid assistive limb, versus conventional rehabilitation during the early postoperative period after total knee arthroplasty. J Rural Med. 2021;16(1):22-8. https://doi.org/10.2185/jrm.2020-024
  22. Tanaka Y, Oka H, Nakayama S et al. Improvement of walking ability during postoperative rehabilitation with the hybrid assistive limb after total knee arthroplasty: a randomized controlled study. SAGE Open Med. 2017;5:2050312117712888. https://doi.org/10.1177/2050312117712888
  23. Koseki K, Mutsuzaki H, Yoshikawa K et al. Early recovery of walking ability in patients after total knee arthroplasty using a hip-wearable exoskeleton robot: a case-controlled clinical trial. Geriatr Orthop Surg Rehabil. 2021;12:21514593211027675.
  24. Koseki K, Mutsuzaki H, Yoshikawa et al. Gait training using the honda walking assistive device® in a patient who underwent total hip arthroplasty: a single-subject study. Medicina (Kaunas). 2019:14;55(3):69. https://doi.org/10.3390/medicina55030069
  25. Duncan PW, Weiner DK, Chandler J et al. Functional reach: a new clinical measure of balance. J Gerontol. 1990:45(6):M192-7. https://doi.org/10.1093/geronj/45.6.M192
  26. Rockwood K, Awalt E, Carver D et al. Feasibility and measurement properties of the functional reach and the timed up and go tests in the canadian study of health and aging. J Gerontol A Biol Sci Med Sci. 2000:55(2):M70-3. https://doi.org/10.1093/gerona/55.2.M70
  27. Giorgetti MM, Harris BA, Jette A. Reliability of clinical balance outcome measures in the elderly. Physiother Res Int. 1998:3(4):274-83. https://doi.org/10.1002/pri.150
  28. Koo EJ, Kim JS. Effects of structured education program using CDROM on anxiety and self-care compliance in patients undergoing orthopedic spinal surgery. J Muscle and Health. 2011;18(1):39-49. https://doi.org/10.5953/JMJH.2011.18.1.039
  29. Jung KS, Seo HD, Lee KW et al. The effect of change in gait speed on vertical force of the cane and distribution of affected foot in the persons with chronic stroke. J Korean Soc Phys Med. 2012;7(2):223-30. https://doi.org/10.13066/kspm.2012.7.2.223
  30. Lee YJ. Essentials of musculoskeletal care. Seoul, Hanwoori, 2003:108-9.
  31. Kim H, Kim JP. Development of an Intelligent legged walking rehabilitation robot. KSME. 2017;41(9):825-37.
  32. Nantel J, Termoz N, Centomo H et al. Postural balance during quiet standing in patients with total hip arthroplasty and surface replacement arthroplasty. Clin Biomech (Bristol, Avon). 2008;23(4):402-7. https://doi.org/10.1016/j.clinbiomech.2007.10.011
  33. Trudelle-Jackson E, Smith SS. Effects of a late-phase exercise program after total hip arthroplasty: a randomized controlled trial. Arch Phys Med Rehabil. 2004;85(7):1056-62. https://doi.org/10.1016/j.apmr.2003.11.022
  34. Trudelle-Jackson E, Emerson R, Smith S. Outcomes of total hip arthroplasty: a study of patients one year postsurgery. J Orthop Sports Phys Ther. 2002;32(6):260-7. https://doi.org/10.2519/jospt.2002.32.6.260
  35. Clarke GR, Thomas MJ, Rathod-Mistry T et al. Hallux valgus severity, great toe pain, and plantar pressures during gait: a cross-sectional study of community-dwelling adults. Musculoskeletal Care. 2020;18(3):383-90. https://doi.org/10.1002/msc.1472
  36. Browne W, Nair BKR. The timed up and go test. Med J Aust. 2019;210(1):13-4. https://doi.org/10.5694/mja2.12045
  37. Kim MK, Kim S, Kim SS. Effect of elastic resistive exercise combine with standard exercise protocol on lower extremity muscles strength and pain scales following total hip arthroplasty. KSSLS. 2007;31:901-9. https://doi.org/10.51979/KSSLS.2007.11.31.901
  38. Kim JH, Kim OS. Balance confidence and balance ability among community-residing stroke patients. J Korean Biol Nurs Sci. 2010;22(4):430-7.
  39. Judge JO, Lindsey C, Underwood M et al. Balance improvements in older women: effects of exercise training. J Phys Ther. 1993;73(4):254-62. https://doi.org/10.1093/ptj/73.4.254