Person:

Edwards, Dylan

The incidence of physical disability in the community resulting from neurological dysfunction is predicted to increase in the coming years. The impetus for immediate and critical evaluation of physical neurorehabilitation strategies stems from the largely incomplete recovery following neurological damage, questionable efficacy of individual rehabilitation techniques, and the progressive acceptance of evidence-based medicine. The emergent technologies of non-invasive brain stimulation (NBS) and rehabilitation robotics enable a better understanding of the recovery process, as well as the mechanisms and effectiveness of intervention. With a more precise grasp of the relationship between dysfunctional and treatment-related plasticity, we can anticipate a move toward highly controlled and individualised prescription of rehabilitation. Both robotics and NBS can also be used to enhance motor control and learning in patients with neurological dysfunction. The merit of these contemporary methods as investigative and rehabilitation tools requires clarification and discussion. In this thematic series, five cohesive and eloquent papers address this issue from leading clinicians and scientists in the fields of robotics, NBS, plasticity and motor learning.

Background: The use of automated electromechanical devices for gait training in neurological patients is increasing, yet the functional outcomes of well-defined training programs using these devices and the characteristics of patients that would most benefit are seldom reported in the literature. In an observational study of functional outcomes, we aimed to provide a benchmark for expected change in gait function in early stroke patients, from an intensive inpatient rehabilitation program including both robotic and manual gait training. Methods: We followed 103 sub-acute stroke patients who met the clinical inclusion criteria for Body Weight Supported Robotic Gait Training (BWSRGT). Patients completed an intensive 8-week gait-training program comprising robotic gait training (weeks 0-4) followed by manual gait training (weeks 4-8). A change in clinical function was determined by the following assessments taken at 0, 4 and 8 weeks (baseline, mid-point and end-point respectively): Functional Ambulatory Categories (FAC), 10 m Walking Test (10 MWT), and Tinetti Gait and Balance Scales. Results: Over half of the patients made a clinically meaningful improvement on the Tinetti Gait Scale (>3 points) and Tinetti Balance Scale (>5 points), while over 80% of the patients increased at least 1 point on the FAC scale (0-5) and improved walking speed by more than 0.2 m/s. Patients responded positively in gait function regardless of variables gender, age, aetiology (hemorrhagic/ischemic), and affected hemisphere. The most robust and significant change was observed for patients in the FAC categories two and three. The therapy was well tolerated and no patients withdrew for factors related to the type or intensity of training. Conclusions: Eight-weeks of intensive rehabilitation including robotic and manual gait training was well tolerated by early stroke patients, and was associated with significant gains in function. Patients with mid-level gait dysfunction showed the most robust improvement following robotic training.