Chronic Post-stroke Hemiplegic Patients Clinical Trial
Official title:
Effects of End-effector Type Robot Assisted Gait Therapy on Gait Pattern and Energy Consumption in Chronic Post-stroke Hemiplegic Patients
Verified date | September 2020 |
Source | Yonsei University |
Contact | n/a |
Is FDA regulated | No |
Health authority | |
Study type | Interventional |
Restoration of gait independence in stroke patients is one of the most important goals of
rehabilitation therapy, and gait rehabilitation is one of the most important treatments in
the treatment of stroke because it is a major factor affecting rehabilitation after stroke.
In the rehabilitation of patients with post - stroke walking disorders, previous physical
therapy was mainly manual therapy using therapist 's physical effort and walking training
with walking aids. In recent years, however, emphasis has been placed on therapies based on
motor learning concepts, which allow the patient to intensively train the exercise as closely
as possible to the ultimate goal.
The robot used for walking rehabilitation includes exoskeleton walking robot such as Lokomat®
(Hocoma AG, Switzerland), Walkbot-G® (P & S Mechanics, Korea), MorningWalk® (Curexo, Korea)
According to the Systematic Review, which compares two types of robot-assisted gait treatment
divided into end-effector type, which is not an exoskeletal type such as System® (Rehatech,
Switzerland) It has been reported that the percentage of patients who were able to walk
independently when treated with a robot was higher than that of an exoskeleton-type robot.
In this regard, in terms of acquisition of independent gait, studies on the therapeutic
effect of the exoskeleton-type robot and the end-effector-type robot before and after the
gait therapy were continuously performed, but 80% of the patients obtained independent gait,
Despite the fact that many of these patients have abnormal walking, research has not yet been
conducted. In previous studies, there was a statistically significant improvement in
parameters of Gait speed, Cadence, and step length when compared with spatiotemporal
parameters in training using exoskeleton robots for stroke patients. In another study, Gait
speed and Cadence did not show a statistically significant improvement, and the effect on
Gait speed and Cadence is still unknown. However, unlike exoskeletal robots, end-effector
robotic gait training has been reported to improve Gait speed in most studies compared to
conventional gait training. In addition, Cadence, Temporal symmetry ratio, Single, an
improved side stride length, an improvement in the symmetry index of stance phase, and an
improvement in Gait endurance.
In this way, the end effector type robot walking training is more likely to improve walking
quality than the exoskeleton type robot. The end-effector type robot, which is different from
the exoskeleton type, reproduces the gait using the ankle joint to induce the movement of the
knee joint and the hip joint. Therefore, it is possible to control the ankle joint, which is
essential for improving the gait pattern. It is considered that the end effector type robot
which can control the ankle joint is more likely to induce the improvement of the gait
pattern than the existing exoskeleton type robot because it shows limitations in reproducing
the ankle rocker motion.
Status | Completed |
Enrollment | 40 |
Est. completion date | November 4, 2019 |
Est. primary completion date | November 4, 2019 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility |
Inclusion Criteria: - Stroke patient visited Shinchon Severance Hospital Rehabilitation Department - Adults over 19 years - Ischemic or hemorrhagic stroke confirmed by brain magnetic resonance imaging or computed tomography - Patients who have had a stroke for more than 3 months - Those who have hemiplegia after a stroke - If the walking pattern is abnormal and the walking speed is less than 0.8m / sec - Those who have a score of K-MMSE score of 24 or higher in the Korean version - A person who can walk independently with 3 or more points in the Functional Ambulation Category (FAC) classified as 0 ~ 5 according to the degree of need for assistance in walking - The patients who understand the research and have voluntary participation Exclusion Criteria: - Those who have difficulty walking before stroke - Modified Ashworth scale of the lower extremity muscle is 3 or more - Patients with ataxia - Severe lower extremity joints, osteoporosis, and untreated fractures. - Patients who weigh more than 135kg - Damage of the skin in contact with the machine during robot walking - Patients who underwent orthopedic or neurosurgical surgery within 6 months of the start of the study - uncontrolled hypertension or orthostatic hypotension - Patients who are likely to spread pathogenic microorganisms due to contact - Not cutting - Cardiovascular disease, venous thrombosis or heart failure, respiratory disease - Malignant neoplasm - Other basic diseases that can not tolerate robot assisted walking - If the tester is judged as not suitable for this study |
Country | Name | City | State |
---|---|---|---|
Korea, Republic of | Department of Rehabilitation Medicine, Severance Hospital, Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine | Seoul |
Lead Sponsor | Collaborator |
---|---|
Yonsei University |
Korea, Republic of,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Difference of Self selected gait velocity between before and after Robot Assisted Gait Therapy | The change of gait speed that the patient feels most comfortable with according to the flow of the three time points (before and immediately after treatment and after 6 weeks of treatment) | before and immediately after treatment and after 6 weeks of treatment | |
Secondary | Difference between two interventional groups according to the time course | Three-dimensional motion analysis | before and immediately after treatment and after 6 weeks of treatment | |
Secondary | Dynamic EMG | The EMG signal will be measured by attaching the surface EMG to the skin over the Medial GCM, Tibialis Anterior, Vastus Medialis, Rectus Femoris, Medial Hamstring, and Gluteus Maximus muscles. The EMG signal will be measured and converted to root mean square (RMS) values. | before and immediately after treatment and after 6 weeks of treatment | |
Secondary | Foot pressure | The foot pressure will be measured using a F-ScanĀ® system (Tekscan, USA) with a 0.16-mm thick, 980 force-sensing resistors (3.88 sensors per centimeter square) After inserting the pressure insoles, calibrating will be done according to the Tekscan user manual. Then the parameters below will be measured. | before and immediately after treatment and after 6 weeks of treatment | |
Secondary | Fugl-Meyer Assessment(FMA) for Lower extremities | The following five measures, calculated as 34 points E. LOWER EXTREMITY: i. Reflex activity ii. Volitional movement within synergies iii. Volitional movement mixing synergies iv. Volitional movement with little or no synergy v. Normal reflex activity F. COORDINATION / SPEED: out of six i. Tremor ii. Dysmetria iii. Time |
before and immediately after treatment and after 6 weeks of treatment | |
Secondary | 10m walking test | Measure the time using a stopwatch when walking at a distance of 10 meters from the starting point, 2 meters, 8 meters, 10 meters. | before and immediately after treatment and after 6 weeks of treatment | |
Secondary | Berg balance scale(BBS) | Balance assessment tool consisting of 14 items and 56 points Scoring: A five-point scale, ranging from 0-4. "0" indicates the lowest level of function and "4" the highest level of function. Total Score(Summed each item's subscores) = 0-56 Interpretation: 41-56 = low fall risk, 21-40 = medium fall risk, 0 -20 = high fall risk, A change of 8 points is required to reveal a genuine change in function between 2 assessments. Item(Subscores ranging from 0-4 for each): Sitting to standing, Standing unsupported, Sitting unsupported, Standing to sitting, Transfers, Standing with eyes closed, Standing with feet together, Reaching forward with outstretched arm, Retrieving object from floor, Turning to look behind, Turning 360 degrees, Placing alternate foot on stool, Standing with one foot in front, Standing on one foot |
before and immediately after treatment and after 6 weeks of treatment | |
Secondary | Timed up and go test(TUG) | Static and dynamic balance Measuring tool measures the time to get up from the chair, move forward 3 meters, and then return to sit on the chair <10 seconds is normal 11-20 seconds: normal limits for frail elderly and disabled patients 20 seconds or more: Needs assistance in outdoor gait 30 seconds or more: risk of falling too high |
before and immediately after treatment and after 6 weeks of treatment | |
Secondary | Functional Ambulation Category(FAC) | Rated as 0 ~ 5 points for evaluating the independence of walking 0 point: If you can not walk or need more than 2 people point: One person needs sustained support to balance or move the body center points: If you need one intermittent help to help balance or negotiate points: Independent walking is possible under instruction or observation without physical contact. points: You can walk on the ground independently, but you need help when you walk on stairs, ramps, or unstable flat points: If you are able to walk completely independently regardless of the terrain |
before and immediately after treatment and after 6 weeks of treatment | |
Secondary | Modified Ashworth Scale(MAS) | 0: No increase in muscle tone Slight increase in muscle tone, manifested by a catch and release or by minimal resistance at the end of the range of motion when the affected part(s) is moved in flexion or extension 1+: Slight increase in muscle tone, manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved Considerable increase in muscle tone, passive movement difficult Affected part(s) rigid in flexion or extension |
before and immediately after treatment and after 6 weeks of treatment | |
Secondary | Rivermead Mobility Index(RMI) | Indicators for assessing mobility disability in terms of gait, balance, and transfer in stroke patients. Out of 15 items, 14 self-report items and 1 observation item. Evaluate each item as Yes (1 point) / No (0 points). The more difficult the items from 1 to 15, the higher the degree of difficulty, the higher the score, the higher the mobility performance | before and immediately after treatment and after 6 weeks of treatment | |
Secondary | Functional independence measure(FIM) | Indicators for assessing independence in performing daily living activities A total of 18 items, with a maximum of 7 points per item, a minimum of 126 points Items 7:Complete Independence (Timely, Safely) 6: Modified Independence (Device) 5: Supervision (Subject = 100%+) 4: Minimal Assist (Subject = 75%+) 3: Moderate Assist (Subject = 50%+) 2: Maximal Assist (Subject = 25%+) 1: Total Assist (Subject = less than 25%) |
before and immediately after treatment and after 6 weeks of treatment |