| 저자 |
Changhun Lee1*, Jeehyun Yoo1, Jiyong Kim1, Sung il Cho1, Ha Seong Kim1, Sangwan Lee1, Sungsik Son1, Kil-Byung Lim 1† |
Objective: Ataxia is a common clinical presentation of stroke patients with infratentorial lesion and usually accompanied with gait disturbance and balance impairment. Infratentorial stroke can be defined as stroke occurring below the tentorium cerebelli, including the cerebellum and brainstem. Since cerebellum and cranial nuclei located within brainstem are associated with motor coordination, vestibular and somatosensory functions, damages in these structures may cause impaired control of equilibrium and inter-limb coordination. On the other hand, patients with infratentorial lesion present mild motor weakness compared to patients with supratentorial lesion. Therefore, balance impairment, not motor weakness, is the major cause of gait disturbance in those patients. Although many studies investigated improvements in balance and related walking ability after robot-assist gait training (RAGT), to our knowledge, most of those studies did not separate the positive effect of muscle strength improvement from the effect of balance improvement. The purpose of this report is to investigate the effects of over-ground exoskeletal robot-assisted gait training on balance improvement in a stroke patient with infratentorial lesion without motor weakness.
Case presentation: We present a case of a 61-year-old female patient diagnosed with cerebellar hemorrhage (Figure 1). Her chief complaint was balance impairment with gait disturbance. We evaluated patient's muscle strength with modified medical research council scale (mMRC scale), mobility with sub-scores of modified Barthel Index (MBI) (stair climbing/transfer/ambulation), and balance ability with Berg Balance Scale (BBS). On initial evaluation, her motor power was checked 4/4 (upper/lower) by mMRC scale, 16 of MBI mobility score, 35 points on BBS. RAGT utilizing EXOWALK PRO®, which is a type of over-ground exoskeletal robot for gait training was conducted 30 minutes per session, 5 sessions a week for 2.5 weeks. After the end of overall training sessions, the patient showed improvement in MBI and BBS. Patient’s motor power did not change from the initial evaluation (Table 1).
Conclusion: Although there was no improvement in motor power, patient showed improvement in mobility, and dynamic balance, which are closely related to patient’s gait ability. This case study shows that, RAGT using exoskeletal type rehabilitation robot, might improve balance in stroke patients with infratentorial lesion, without motor weakness. |
