PNF and Movement

Korea Proprioceptive Neuromuscular Facilitation Association (대한고유수용성신경근촉진법학회)
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Short-Term Clinical Effects of Robot-Assisted Gait Training Applied to Patients Undergoing Lower Extremity Surgery: A Pilot Study

하지 수술환자에게 적용한 로봇보조 보행훈련의 단기간 임상적 효과: 예비 연구

  • Lee, Ha-Min (Department of Public Health Sciences, Graduate School, Dankook University) ;
  • Kwon, Jung-Won (Department of Physical Therapy, College of Health and Welfare Sciences, Dankook University)
  • 이하민 (단국대학교 보건복지대학원 임상물리치료학전공) ;
  • 권중원 (단국대학교 공공보건대학 물리치료학과)
  • Received : 2022.08.11
  • Accepted : 2022.08.14
  • Published : 2022.08.31
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Abstract

Purpose: This study aimed to investigate the effect of robot-assisted gait training on the active ranges of motion, gait abilities, and biomechanical characteristics of gait in patients who underwent lower extremity surgery, and to verify the effectiveness and clinical usefulness of robot-assisted gait training. Methods: This study was conducted on 14 subjects who underwent lower extremity surgery. The subjects participated in robot-assisted gait training for 2 weeks. The active ranges of motion of the lower extremities were evaluated, and gait abilities were assessed using 10-m and 2-min walk tests. An STT Systems Inertial Measurement Unit was used to collect data on biomechanical characteristics during gait. Spatiotemporal parameters were used to measure cadence, step length, and velocity, and kinematic parameters were used to measure hip and knee joint movement during gait. Results: Significant improvements in the active ranges of motion of the hip and knee joints (flexion, extension, abduction, and adduction) and in the 10-m and 2-min walk test results were observed after robot-assisted gait training (p < 0.05). In addition, biomechanical characteristics of gait, spatiotemporal factors (cadence, step length, and velocity), and kinematic factors (gait hip flexion-extension, internal rotation-external rotation angle, and knee joint flexion-extension) were also significantly improved (p < 0.05). Conclusion: The results of this study are of clinical importance as they demonstrate that robot-assisted gait training can be used as an effective intervention method for patients who have undergone lower extremity surgery. Furthermore, the findings of this study are clinically meaningful as they expand the scope of robot-assisted gait training, which is currently mainly applied to patients with central nervous system conditions.

Keywords

Acknowledgement

본 연구는 산업통상자원부와 한국산업기술진흥원의 "광역협력권산업육성사업(지역주도형R&D)" (과제번호 P0006196) 으로 수행된 연구결과입니다.

References

  1. Aprile I, Iacovelli C, Goffredo M, et al. Efficacy of end-effector robot-assisted gait training in subacute stroke patients: clinical and gait outcomes from a pilot bi-centre study. NeuroRehabilitation. 2019;45(2):201-212. https://doi.org/10.3233/NRE-192778
  2. Arnold JB, Mackintosh S, Olds TS, et al. Improvements in knee biomechanics during walking are associated with increased physical activity after total knee arthroplasty. Journal of Orthopaedic Research. 2015;33(12):1818-1825. https://doi.org/10.1002/jor.22969
  3. Audenaert EA, Peeters I, Vigneron L, et al. Hip morphological characteristics and range of internal rotation in femoroacetabular impingement. The American Journal of Sports Medicine, 2012;40(6):1329-1336. https://doi.org/10.1177/0363546512441328
  4. Bang DH, Shin WS. Effects of robot-assisted gait training on spatiotemporal gait parameters and balance in patients with chronic stroke: a randomized controlled pilot trial. NeuroRehabilitation. 2016;38(4):343-349. https://doi.org/10.3233/NRE-161325
  5. Barthuly AM, Bohannon RW, Gorack W. Gait speed is a responsive measure of physical performance for patients undergoing short-term rehabilitation. Gait & Posture. 2012;36(1):61-64. https://doi.org/10.1016/j.gaitpost.2012.01.002
  6. Bennett D, Humphreys L, O'Brien S, et al. Gait kinematics of age-stratified hip replacement patients--a large scale, long-term follow-up study. Gait & Posture. 2008;28(2):194-200. https://doi.org/10.1016/j.gaitpost.2007.11.010
  7. Bennett D, Ogonda L, Elliott D, et al. Comparison of gait kinematics in patients receiving minimally invasive and traditional hip replacement surgery: a prospective blinded study. Gait & Posture. 2006;23(3):374-382. https://doi.org/10.1016/j.gaitpost.2005.04.008
  8. Bessler J, Prange-Lasonder GB, Schaake L, et al. Safety assessment of rehabilitation robots: a review identifying safety skills and current knowledge gaps. Frontiers in Robotics and AI. 2021;8:602878. https://doi.org/10.3389/frobt.2021.602878
  9. Brooks D, Davis AM, Naglie G. Validity of 3 physical performance measures in inpatient geriatric rehabilitation. Archives of Physical Medicine and Rehabilitation. 2006;87(1):105-110. https://doi.org/10.1016/j.apmr.2005.08.109
  10. Calabro RS, Cacciola A, Berte F, et al. Robotic gait rehabilitation and substitution devices in neurological disorders: where are we now? Neurological Sciences. 2016;37(4):503-514. https://doi.org/10.1007/s10072-016-2474-4
  11. Cardoso TB, Ocarino JM, Fajardo CC, et al. Hip external rotation stiffness and midfoot passive mechanical resistance are associated with lower limb movement in the frontal and transverse planes during gait. Gait & Posture. 2020;76:305-310. https://doi.org/10.1016/j.gaitpost.2019.12.030
  12. Cheng PY, Lai PY. Comparison of exoskeleton robots and end-effector robots on training methods and gait biomechanics. International Conference on Intelligent Robotics and Applications. 2013;8102:258-266.
  13. Coulter CL, Scarvell JM, Neeman TM, et al. Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review. Journal of Physiotherapy. 2013;59(4):219-226. https://doi.org/10.1016/S1836-9553(13)70198-X
  14. Ewen AM, Stewart S, St Clair Gibson A, et al. Post-operative gait analysis in total hip replacement patients-a review of current literature and meta-analysis. Gait & Posture. 2012;36(1):1-6. https://doi.org/10.1016/j.gaitpost.2011.12.024
  15. Foucher KC, Wimmer MA. Contralateral hip and knee gait biomechanics are unchanged by total hip replacement for unilateral hip osteoarthritis. Gait & posture. 2012;35(1):61-65. https://doi.org/10.1016/j.gaitpost.2011.08.006
  16. Goto K, Morishita T, Kamada S, et al. Feasibility of rehabilitation using the single-joint hybrid assistive limb to facilitate early recovery following total knee arthroplasty: a pilot study. Assistive Technology, 2017;29(4):197-201. https://doi.org/10.1080/10400435.2016.1219883
  17. Hussein S, Schmidt H, Volkmar M, et al. Muscle activation of stroke patients during stair climbing in robot assisted gait training. 2008 2nd IEEE RAS & EMBS International Conference on Biomedical Robotics and Biomechatronics. 2008:875-880.
  18. Jan MH, Lin CH, Lin YF, et al. Effects of weight-bearing versus nonweight-bearing exercise on function, walking speed, and position sense in participants with knee osteoarthritis: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation. 2009;90(6):897-904. https://doi.org/10.1016/j.apmr.2008.11.018
  19. Jette DU, Hunter SJ, Burkett L, et al. Physical therapist management of total knee arthroplasty. Physical Therapy. 2020;100(9):1603-1631. https://doi.org/10.1093/ptj/pzaa099
  20. Joo SY, Lee SY, Cho YS, et al. Effects of robot-assisted gait training in patients with burn injury on lower extremity: a single-blind, randomized controlled trial. Journal of Clinical Medicine. 2020;9(9):2813. https://doi.org/10.3390/jcm9092813
  21. Kim SY, Noh JH. Management of femoral peritrochanteric fracture with proximal femoral nail. Journal of the Korean Orthopaedic Association. 2006;41(3):541-546. https://doi.org/10.4055/jkoa.2006.41.3.541
  22. Kirker SG, Jenner JR, Simpson DS, et al. Changing patterns of postural hip muscle activity during recovery from stroke. Clinical Rehabilitation. 2000;14(6):618-626. https://doi.org/10.1191/0269215500cr370oa
  23. Koo KI, Hwang CH. Five-day rehabilitation of patients undergoing total knee arthroplasty using an end-effector gait robot as a neuromodulation blending for deafferentation, weight offloading and stereotyped movement: interim analysis. PLoS One. 2020;15(12):e0241117. https://doi.org/10.1371/journal.pone.0241117
  24. Labruyere R. van Hedel HJ. Strength training versus robot-assisted gait training after incomplete spinal cord injury: a randomized pilot study in patients depending on walking assistance. Journal of Neuroengineering and Rehabilitation. 2014;11:4. https://doi.org/10.1186/1743-0003-11-4
  25. Lang CE, MacDonald JR, Gnip C. Counting repetitions: an observational study of outpatient therapy for people with hemiparesis post-stroke. Journal of Neurologic Physical Therapy. 2007;31(1):3-10. https://doi.org/10.1097/01.NPT.0000260568.31746.34
  26. Li J, Wu T, Xu Z, et al. A pilot study of post-total knee replacement gait rehabilitation using lower limbs robot-assisted training system. European Journal of Orthopaedic Surgery & Traumatology. 2014;24(2):203-208. https://doi.org/10.1007/s00590-012-1159-9
  27. Majumder S, Mondal T, Deen MJ. A simple, low-cost and efficient gait analyzer for wearable healthcare applications. IEEE Sensors Journal. 2018;19(6):2320-2329. https://doi.org/10.1109/JSEN.2018.2885207
  28. Mehrholz J, Pohl M. Electromechanical-assisted gait training after stroke: a systematic review comparing end-effector and exoskeleton devices. Journal of Rehabilitation Medicine. 2012;44(3):193-199. https://doi.org/10.2340/16501977-0943
  29. Nantel J, Termoz N, Centomo H, et al. Postural balance during quiet standing in patients with total hip arthroplasty and surface replacement arthroplasty. Clinical Biomechanics. 2008;23(4):402-407. https://doi.org/10.1016/j.clinbiomech.2007.10.011
  30. Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry, 3th ed. Philadelphia. FA Davis. 2004.
  31. Oosting E, Hoogeboom TJ, Appelman-de Vries SA, et al. Preoperative prediction of inpatient recovery of function after total hip arthroplasty using performance-based tests: a prospective cohort study. Disability and Rehabilitation. 2016;38(13):1243-1249. https://doi.org/10.3109/09638288.2015.1076074
  32. Peters DM, Fritz SL, Krotish DE. Assessing the reliability and validity of a shorter walk test compared with the 10-Meter Walk Test for measurements of gait speed in healthy, older adults. Journal of Geriatric Physical Therapy. 2013;36(1):24-30. https://doi.org/10.1519/JPT.0b013e318248e20d
  33. Roos EM. Effectiveness and practice variation of rehabilitation after joint replacement. Current Opinion in Rheumatology. 2003;15(2):160-162. https://doi.org/10.1097/00002281-200303000-00014
  34. Sale P, Russo EF, Russo M, et al. Effects on mobility training and de-adaptations in subjects with spinal cord injury due to a wearable robot: a preliminary report. BMC Neurology. 2016;16:12. https://doi.org/10.1186/s12883-016-0536-0
  35. Sanz-Morere CB, Martini E, Meoni B, et al. Robot-mediated overground gait training for transfemoral amputees with a powered bilateral hip orthosis: a pilot study. Journal of Neuroengineering and Rehabilitation. 2021;18(1):111. https://doi.org/10.1186/s12984-021-00902-7
  36. Sherrington C, Lord SR, Herbert RD. A randomized controlled trial of weight-bearing versus non-weight-bearing exercise for improving physical ability after usual care for hip fracture. Archives of Physical Medicine and Rehabilitation. 2004;85(5):710-716. https://doi.org/10.1016/S0003-9993(03)00620-8
  37. Srivastava S, Kao PC, Reisman DS, et al. Robotic assist-as-needed as an alternative to therapist-assisted gait rehabilitation. International Journal of Physical Medicine & Rehabilitation. 2016;4(5):370.
  38. Stevens JE, Mizner RL, Snyder-Mackler L. Neuromuscular electrical stimulation for quadriceps muscle strengthening after bilateral total knee arthroplasty: a case series. Journal of Orthopaedic & Sports Physical Therapy. 2004;34(1):21-29. https://doi.org/10.2519/jospt.2004.34.1.21
  39. Straudi S, Benedetti MG, Venturini E, et al. Does robot-assisted gait training ameliorate gait abnormalities in multiple sclerosis? a pilot randomized-control trial. NeuroRehabilitation. 2013;33(4):555-563. https://doi.org/10.3233/NRE-130990
  40. Turner DL, Ramos-Murguialday A, Birbaumer N, et al. Neurophysiology of robot-mediated training and therapy: a perspective for future use in clinical populations. Frontiers in Neurology. 2013;4:184.
  41. van de Port IG, Kwakkel G, Lindeman E. Community ambulation in patients with chronic stroke: how is it related to gait speed? Journal of Rehabilitation Medicine. 2008;40(1):23-27. https://doi.org/10.2340/16501977-0114
  42. van Kammen K, Boonstra AM, van der Woude LHV, et al. Lokomat guided gait in hemiparetic stroke patients: the effects of training parameters on muscle activity and temporal symmetry. Disability and Rehabilitation. 2020;42(21):2977-2985. https://doi.org/10.1080/09638288.2019.1579259
  43. Weidow J, Tranberg R, Saari T, et al. Hip and knee joint rotations differ between patients with medial and lateral knee osteoarthritis: gait analysis of 30 patients and 15 controls. Journal of Orthopaedic Research. 2006;24(9):1890-1899. https://doi.org/10.1002/jor.20194
  44. Witherspoon JW, Vasavada R, Logaraj RH, et al. Two-minute versus 6-minute walk distances during 6-minute walk test in neuromuscular disease: is the 2-minute walk test an effective alternative to a 6-minute walk test? European Journal of Paediatric Neurology. 2019;23(1):165-170. https://doi.org/10.1016/j.ejpn.2018.10.001
  45. Yeung LF, Ockenfeld C, Pang MK, et al. Design of an exoskeleton ankle robot for robot-assisted gait training of stoke patients. IEEE International Conference on Rehabilitation Robotics. 2017;2017:211-215.