Objective: Spinocerebellar ataxia (SCA) is a group of progressive disorder characterized by loss of balance and coordination. The management of patients with SCA focuses on control the symptoms through rehabilitation. These days, robotic exoskeleton gait training is gaining popularity because of easy accessibility. However, most studies have been conducted on robotic gait training in patients with stroke, spinal cord injury or multiple sclerosis. There have been few studies about robotic gait training in patients with ataxia. Therefore, we report therapeutic outcome of robotic exoskeleton-assisted gait training in a patient with SCA.
Case description: A 23-year-old woman with SCA type 7 (number of CAG repeats: 9/50) came to our clinic (Fig. 1). She complained of gait disturbance with postural instability. Muscle strength of both lower limbs was good (MRC grade 4). She walked with holding a walker. Contracture was not checked in both lower limbs. She complained of visual disturbance due to retinal problems, but not to the extent of affecting her walking ability. She was well informed of this clinical study and voluntarily participated in this program. The training program was conducted 30 minutes a session, 3 sessions a week, total 24 sessions for 8 weeks on an outpatient basis. The program consisted of standing training (5 minutes, including wearing and removing the equipment), weight bearing and weight shifting exercise (5 minutes), and over-ground walking on a flat hallway (20 minutes), while wearing Angelegs (SG-Robotics, Seoul, Korea), i.e., a kind of robotic exoskeleton, and the walking speed during the training was adjusted to the patient's pace. The functional outcomes were evaluated before training, after training, and at 4 weeks after the end of the program. No adverse event was reported. After training, the Korean-modified Barthel index score increased by 4 points in transfer item. The standard forward-backward and medial-lateral deviations measured by 3D dynamic posturography system (Prokin, TecnoBody S.R.L., Dalmine BG, Italy) was improved after training. According to the temporospatial data of gait analysis, gait speed and stride length were increased and maintained until 4 weeks after the end of the program (Table 1). There was no significant change in kinematic data of gait analysis (Fig. 2).
Conclusion: The robotic exoskeleton gait training was effective for improving the transfer function, static balance, gait speed and stride length during walking in the patient with SCA. Therapeutic effect lasted until 4 weeks after the end of the training.
Key Words: Spinocerebellar ataxia, Exoskeleton, Gait training, Balance
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Fig. 1. T1-weighted and T2-weighted magnetic resonance imaging from a patient with spinocerebellar ataxia. Significant atrophy involving cerebellar hemispheres (arrow) and pons was detected (A) T1-weighted image, sagittal view; (B) T2-weighted image, axial view.
Table 1. Functional and gait analysis data, Abbreviations : MMT, manual muscle test; MAS, modified Ashworth scale; K-MBI, Korean-modified Barthel index; BBS, Berg balance scale; SARA, scale for the assessment and rating of ataxia; C.o.P., center of pressure; MET, metabolic equivalent of task; VO2, oxygen consumption; EQ-5D, euro quality of life-5-dimension scale
Fig. 2. This figure shows the kinematic data of gait analysis. There was no significant change in kinematic data of gait analysis , IC: initial contact, LR: loading response, MSt: mid-stance, TSt: terminal stance, PSw: pre-swing, ISw: initial swing, MSw: mid-swing, TSw: terminal swing.
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