| 제목 |
Cardiopulmonary burden and perceived exertion of robotic-assisted gait training after stroke |
| 소속 |
Seoul National University Hospital, Department of Rehabilitation Medicine1, Sogang University, Dept of Mechanical Engineering2, University of Ulsan College of Medicine, Asan Medical Center, Department of Physical Medicine and Rehabilitation3, National Traffic Injury Rehabilitation Hospital, Department of Rehabilitation Medicine4, Chung-Ang University Hospital, Chung-Ang University College of Medicine5, Ewha Womans University, School of Medicine, Dept. of rehabilitation medicine6, National Rehabilitation Center, Department of Neurorehabilitation7, Yeouido St. Mary’s Hospital, Department of Rehabilitation Medicine8, Sogang University, Department of Computer Science and Engineering9, National Rehabilitation Center , Department of Rehabilitative and Assistive Technology 10, University of Ulsan College of Medicine, Asan Medical Center, Dept. of Biomedical Engineering11 |
| 저자 |
Heejae Kim1*, Doyoung Jeon 2, Min Ho Chun3, Tae-Woo KIM4, Jaewon Beom5, Hasuk Bae6, Joon-Ho Shin7, Sun Jae Won8, Jihoon Yang9, Won-Kyung Song10, Jaesoon Choi11, Byung-Mo Oh1†, Ju Chan Kim1, Ji Soo Choi1 |
Background
Robotic-assisted gait training (RAGT) is widely used for stroke patients to improve their walking ability by providing the high- intensity repetition. However, the burden on cardiopulmonary system during RAGT has rarely been studied.
Objective
The purpose of this study was to clarify the cardiopulmonary burden of RAGT in stroke patients by assessing the change of vital signs and the rating of perceived exertion (RPE) during training and to elucidate the exercise intensity of RAGT in light of the recent physical activity guidelines.
Methods
In this multicenter prospective study, vital signs were recorded from the stroke patients during RAGT with either the end-effector or exoskeleton type robotic devices from January 2018 to April 2019. All patients received RAGT for more than 20 minutes a session, between 1 to 13 sessions for a total 3 weeks. During the training, blood pressure and RPE were measured every 5 minutes and heart rate and respiratory rate were recorded every minute using a wireless electrocardiography sensing device. Using the results, we investigated the change of vital signs and RPE and the influence of type of stroke ( infarction or hemorrhage), presence of comorbidity on cardiopulmonary system. Heart rate reserve (HRR) was calculated from measured heart rate and the Karvonen formula. The calculated exercise intensity was compared with the physical activity guideline of American College of Sports Medicine (ACSM), which recommends moderate-intensity exercise (HRR 40% -70% or RPE 11-14) for stroke patients.
Results
A total of 87 patients, 418 sessions were included for the analysis. The median age of patients was 61.5 years (range, 24 to 89 years). Although the heart rate and respiratory rate increases over time, the changes were not significant. Other biological signals showed no significant change during training. In a repeated measure analysis of variance, there was no significant time effect by type of stroke, presence of hypertension, cardiovascular disease. None of the vital sign changes met the exercise termination criteria of ACSM. The RPE reached 11 (moderate intensity) at 15 min and remained until the end of the RAGT. However, the heart rate remained below 40% of HRR during RAGT.
Conclusion
The RAGT did not impose great cardiopulmonary burden for stroke patients regardless of the presence of hypertension, or cardiovascular disease; or the type of stroke. However, current RAGT training protocol stays below the level of recommended moderate intensity in terms of cardiopulmonary training. Further studies on the effect of RAGT with higher training intensity seems warranted.
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Figure 1. Average heart rate and recommended target heart rate
Figure 2. Average Rating of perceived exertion (RPE) and recommended intensity of RPE
Average Respiratory Rate
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