Physical Therapy Rehabilitation Science

korean Academy of Physical Therapy Rehabilitation Science (물리치료재활과학회)
권호 표지
DOI QR코드

DOI QR Code

The Effect of Robot-Assisted Gait Training with Rhythmic Auditory Stimulation on Lower Limb Function, Balance and Gait in Hemiplegic Stroke Patients

  • Ki-hyeon Kim (Department of Physical Therapy, Graduate School of Sahmyook University) ;
  • Dal-yeon Hwang (Rehabilitation Center, Department of Physical Medicine and Rehabilitation, Myongji Chunhye Rehabilitation Hospital) ;
  • Wan-hee Lee (Department of Physical Therapy, Sahmyook University College of Health Sciences)
  • Received : 2023.10.13
  • Accepted : 2023.12.11
  • Published : 2023.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: This study compared the effect of lower limb function, balance and gait between robot-assisted gait training with and without rhythmic auditory stimulation (RAS) in hemiplegic stroke patients. Design: Randomized controlled trial. Methods: Thirty-one strokepatients were randomly divided to robot-assisted gait training with RAS (RGTR) group (n=15) and control group (n=16). Both groups undergone robot-assisted gait training and conservative exercise therapy for 30 minutes each, five times a week, for 4 weeks. The RGTR group additionally received RAS during the robot-assisted gait training. To analyze the effect of the training, Lower limb function was Fugl-Meyer assessment lower extremity, balance ability was stability index and Berg balance scale, and Gait ability was using gait parameters obtained using a gait analyzer (Zebris FDM-T system) were measured. Results: According to the training, the RGTR group showed of increased significantly in lower limb function, balance, and gait ability in the within-group before-after difference (p<0.05).In the between-group difference comparison, the RGTR group were significantly better improvements in the Berg balance scale of balance ability and among gait ability, all gait parameters except for cadence than the control group (p<0.05). Conclusions: Thisstudy offer that robot-assisted gait training with RAS in performed together with conservative exercise therapy is an effective training method of improving balance and gait ability in hemiplegic stroke patients.

Keywords

References

  1. Ada L, Dean CM, Lindley R, Lloyd G. Improving community ambulation after stroke: the AMBULATE Trial. BMC Neurol. 2009;9:8. 
  2. Patterson KK, Gage WH, Brooks D, Black SE, McIlroy WE. Changes in gait symmetry and velocity after stroke: a cross-sectional study from weeks to years after stroke. Neurorehabil Neural Repair. 2010;24:783-90. 
  3. Krishnan C, Kotsapouikis D, Dhaher YY, Rymer WZ. Reducing robotic guidance during robot-assisted gait training improves gait function: a case report on a stroke survivor. Arch Phys Med Rehabil. 2013;94:1202-6. 
  4. Colombo G, Wirz M, Dietz V. Driven gait orthosis for improvement of locomotor training in paraplegic patients. Spinal Cord. 2001;39:252-5. 
  5. Riener R, Lunenburger L, Maier IC, Colombo G, Dietz V. Locomotor training in subjects with sensori-motor deficits: an overview of the robotic gait orthosis lokomat. Journal of Healthcare Engineering. 2010;1:197-216. 
  6. Pennycott A, Wyss D, Vallery H, Klamroth-Marganska V, Riener R. Towards more effective robotic gait training for stroke rehabilitation: a review. J Neuroeng Rehabil. 2012;9:65. 
  7. Thaut MH, Leins AK, Rice RR, Argstatter H, Kenyon GP, McIntosh GC, et al. Rhythmic auditory stimulation improves gait more than NDT/Bobath training in near-ambulatory patients early post-stroke: a single-blind, randomized trial. Neurorehabil Neural Repair. 2007;21:455-9. 
  8. Roerdink M, Lamoth CJ, Kwakkel G, van Wieringen PC, Beek PJ. Gait coordination after stroke: benefits of acoustically paced treadmill walking. Phys Ther. 2007;87:1009-22. 
  9. Park J, Park SY, Kim YW, Woo Y. Comparison between treadmill training with rhythmic auditory stimulation and ground walking with rhythmic auditory stimulation on gait ability in chronic stroke patients: A pilot study. Neuro Rehabilitation. 2015;37:193-202. 
  10. Lee S, Lee K, Song C. Gait Training with Bilateral Rhythmic Auditory Stimulation in Stroke Patients: A Randomized Controlled Trial. Brain Sci. 2018;8. 
  11. Kim J, Kim DY, Chun MH, Kim SW, Jeon HR, Hwang CH, et al. Effects of robot-(Morning Walk(®)) assisted gait training for patients after stroke: a randomized controlled trial. Clin Rehabil. 2019;33:516-23. 
  12. Park J, Chung Y. The effects of robot-assisted gait training using virtual reality and auditory stimulation on balance and gait abilities in persons with stroke. NeuroRehabilitation. 2018;43:227-35. 
  13. Balasubramanian CK, Li CY, Bowden MG, Duncan PW, Kautz SA, Velozo CA. Dimensionality and Item-Difficulty Hierarchy of the Lower Extremity Fugl-Meyer Assessment in Individuals With Subacute and Chronic Stroke. Arch Phys Med Rehabil. 2016;97:582-9.e2. 
  14. Duncan PW, Propst M, Nelson SG. Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. Phys Ther. 1983;63:1606-10. 
  15. Kohen-Raz R. Application of tetra-ataxiametric posturography in clinical and developmental diagnosis. Percept Mot Skills. 1991;73:635-56. 
  16. Berg KO, Maki BE, Williams JI, Holliday PJ, Wood-Dauphinee SL. Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil. 1992;73:1073-80. 
  17. Downs S, Marquez J, Chiarelli P. The Berg Balance Scale has high intraand inter-rater reliability but absolute reliability varies across the scale: a systematic review. J Physiother. 2013;59:93-9. 
  18. Bejek Z, Paroczai R, Illyes A, Kiss RM. The influence of walking speed on gait parameters in healthy people and in patients with osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2006;14:612-22. 
  19. Faude O, Donath L, Roth R, Fricker L, Zahner L. Reliability of gait parameters during treadmill walking in community-dwelling healthy seniors. Gait Posture. 2012;36:444-8. 
  20. Tian R, Zhang B, Zhu Y. Rhythmic Auditory Stimulation as an Adjuvant Therapy Improved Post-stroke Motor Functions of the Upper Extremity: A Randomized Controlled Pilot Study. Front Neurosci. 2020;14:649. 
  21. Kibushi B, Okada J. Auditory sEMG biofeedback for reducing muscle co-contraction during pedaling. Physiol Rep. 2022;10:e15288. 
  22. Loro A, Borg MB, Battaglia M, Amico AP, Antenucci R, Benanti P, et al. Balance Rehabilitation through Robot-Assisted Gait Training in Post-Stroke Patients: A Systematic Review and Meta-Analysis. Brain Sci. 2023;13. 
  23. Cha YJ, Kim JD, Choi YR, Kim NH, Son SM. Effects of gait training with auditory feedback on walking and balancing ability in adults after hemiplegic stroke: a preliminary, randomized, controlled study. Int J Rehabil Res. 2018;41:239-43. 
  24. Cha Y, Kim Y, Hwang S, Chung Y. Intensive gait training with rhythmic auditory stimulation in individuals with chronic hemiparetic stroke: a pilot randomized controlled study. NeuroRehabilitation. 2014;35:681-8. 
  25. Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic review. Lancet Neurol. 2009;8:741-54. 
  26. Schuck A, Labruyere R, Vallery H, Riener R, Duschau-Wicke A. Feasibility and effects of patient-cooperative robot-aided gait training applied in a 4-week pilot trial. J Neuroeng Rehabil. 2012;9:31. 
  27. Choi YH, Kim JD, Lee JH, Cha YJ. Walking and balance ability gain from two types of gait intervention in adult patients with chronic hemiplegic stroke: A pilot study. Assist Technol. 2019;31:112-5. 
  28. Yang C-H, Kim J-H, Lee B-H. Effects of real-time auditory stimulation feedback on balance and gait after stroke: a randomized controlled trial. J Exp Stroke Transl Med. 2016;9:1-5.