| 제목 |
Effects of End-effector Type Robot-assisted Gait Training in Spinal Cord Injury Patients |
| 소속 |
Inje University Ilsan Paik Hospital, Department of Rehabilitation Medicine1 |
| 저자 |
Kil-Byung Lim1, Jeehyun Yoo1†, Jiyong Kim1, Haseong Kim1, Sangwan Lee1, Sungsik Son1*, Changhun Lee1, Sung il Cho1 |
Objectives
There have been increasing interests on automated robotic devices that assist gait training for patients with various neurological disorders and gait disturbance. Robotic devices for Robot-Assisted Gait Training(RAGT) can be divided into end-effector type and exoskeleton type. The end-effector systems use footplates to generate a motion of the limb in space while hip joint and knee joint can move relatively freely, and may be reliable therapeutic tools to allow patients to perform constant, stereotyped movements. Recently, several previous studies have shown that stroke patients with gait disturbance who were treated with end-effector type RAGT device in combination with conventional physiotherapy exhibited greater improvement in functional gait than those treated with conventional physiotherapy alone. However, relatively few studies utilizing end-effector type RAGT have been conducted on patients with spinal cord injury. The purpose of this study is to investigate the effects of end-effector type RAGT on gait ability, motor recovery, and functional level of patients with spinal cord injury.
Subjects and Methods
The charts of ten patients with spinal cord injury who admitted or transferred to our department were reviewed in this study. The mean age, period from onset to the RAGT of the participants were 61.4 years and 402.5 days, respectively. They were 3 of American Spinal Injury Association impairment scale (AIS) C and 7 of AIS D patients, 4 of acute and 6 of chronic patients. They underwent RAGT using Morning Walk® from minimum of 8 times to maximum of 23 times, combined with concurrent conventional physiotherapy. We compared the test results of Lower Extremity Motor Score of International Standars for Neurological Classification of Spinal Cord Injury(LEMS), mobility subcategories of Spinal Cord Independence Measure-III(SCIM-III), Walking Index for Spinal Cord Injury-II(WISCI-II), and the amount of “mean body weight support (BWS)” measured from the saddle of Morning Walk® device assessed at the time of the first treatment session, and the last treatment session. The changes of these outcome measures between two time points were statistically analyzed.
Results
After the completion of treatment sessions, subjects showed statistically significant improvements in mobility scores of SCIM-III (p=.005), LEMS (p=.011), and WISCI-II (p=.005). On the other hand, the amount of mean BWS showed no statistically significant improvement (p=.153)(Table 1).
Conclusion
SCI patients who underwent RAGT using end-effector type robot showed significant improvement in mobility, motor recovery of lower extremities, and functional level without changes in the amount of body weight support from robotic device. RAGT using end-effector type robot might be efficacious in improving gait ability for SCI patients and further randomized-controlled study that use the end-effector type robots in RAGT would be needed.
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Table 1. Results of Wilcoxon signed-rank test for outcome scores before and after treatment(LEMS : Lower extremity motor score, SCIM : spinal cord independence measure, BWS : body weight support, WISCI : walking index for spinal cord injury) Minimum~Maximum(Median), *p<.05
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