Effectiveness of an Exoskeleton Gait Training Versus Manual Therapy in Subacute Post Stroke Patients.

NCT ID: NCT02095795

Last Updated: 2014-03-31

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

28 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-03-31

Study Completion Date

2014-05-31

Brief Summary

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The main objective of the present study was to compare the effects of exoskeleton devices used in electromechanical-assisted gait training after stroke compared to over ground conventional physical therapy in a single blind research.

The second objective is to research when the devices can be used with the best chance of success in the functional recovery of gait in people who are unable to walk independently after stroke.

Detailed Description

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Stroke is the leading cause of death and of serious long term disability in adults, three mouths after stroke, 20% of people remain wheelchair bound, and 70% walk at reduced velocity and capacity.

People who suffer a stroke, when regain ambulatory function, walk with typically asymmetrical gait pattern, slow, and metabolically inefficient. These characteristics are associated with difficulty advancing and bearing weight though the more affected limb, leading to instability and increased risk of falls.

Manually-assisted body-weight supported Treadmill training (BWSTT) is a contemporary approach to gait rehabilitation after stroke, whereas an individual walks on a treadmill, the therapists manually facilitate hemiparetic limb and trunk control in an effort to normalize upright reciprocal stepping and dynamic postural control. Advantages of this approach are that little to no ambulatory function is required to initiate locomotion and early post stroke training effects are transferred of improvements in over ground gait including: symmetry, speed, and endurance as well as motor impairment and balance scores.

An example of electromechanical devices is Lokomat, a robotic gait orthosis combined with harness-supported body weight system is used together with a treadmill. However the main difference from treadmill training is that the patient's legs are guided by the robotic device according to a preprogrammed gait pattern. A computer-controlled robotic gait orthosis guides the patient, and the process of gait training in automated.

Lokomat can be used to give non ambulatory patients intensive practice in terms of high repetitions, of complex gait cycles with a reduced effort for therapists, as they no longer need to set the paretic limbs or assist trunk movements.

The main objective of the present study was to compare the effects of exoskeleton devices used in electromechanical-assisted gait training after stroke compared to over ground conventional physical therapy in a single blind research.

The second objective is to research when the devices can be used with the best chance of success in the functional recovery of gait in people who are unable to walk independently after stroke.

Conditions

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Stroke

Keywords

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Exercise Therapy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Investigators Outcome Assessors

Study Groups

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Technological Rehabilitation

Patients in the experimental group received a multimodal treatment intervention consisting of 60 minutes of conventional treatment according to the Bobath approach (Bobath B. Adult hemiplegia: evaluation and treatment. Oxford: Butterworth-Heineman, 1990) followed by 30 minutes of robotic gait training on the Lokomat robotic system with the supervision of an expert rehabilitator. Patients started the first session with 50% weight unload and 1.5 Km/h gait speed, performances increments are allowed only in the following sessions. Each patient received 20 sessions over a period of 4 weeks (5 sessions per week).

Group Type EXPERIMENTAL

Technological Rehabilitation

Intervention Type DEVICE

The Lokomat (Hocoma, Zurich, Switzerland) is robotic device conformed as an exoskeleton on the lower limbs of the patient. Through active and passive actuators, it realize a proper trajectory with an associated motion profile of the involved limbs. The results are physically guide repetitive, rhythmic, bilateral lower extremity movements in order to simulate a physiological gait cycle.The system uses a dynamic body weight-support system to support the participant above a motorized treadmill synchronized with the Lokomat. Participants were provided verbal encouragement to actively step in conjunction with the movement presented by the Lokomat.

Control Rehabilitation

Patients in the control group received the same number of treatment sessions of a similar duration as those in the experimental group but they received activities of overground walking exercises targeted to improve walking in substitution of the robotic gait trainer.

Group Type ACTIVE_COMPARATOR

Control Rehabilitation

Intervention Type OTHER

When needed, more than one therapist are employed in the intervention for safety reasons.

Interventions

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Technological Rehabilitation

The Lokomat (Hocoma, Zurich, Switzerland) is robotic device conformed as an exoskeleton on the lower limbs of the patient. Through active and passive actuators, it realize a proper trajectory with an associated motion profile of the involved limbs. The results are physically guide repetitive, rhythmic, bilateral lower extremity movements in order to simulate a physiological gait cycle.The system uses a dynamic body weight-support system to support the participant above a motorized treadmill synchronized with the Lokomat. Participants were provided verbal encouragement to actively step in conjunction with the movement presented by the Lokomat.

Intervention Type DEVICE

Control Rehabilitation

When needed, more than one therapist are employed in the intervention for safety reasons.

Intervention Type OTHER

Other Intervention Names

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Lokomat Manual rehabilitation with the therapist.

Eligibility Criteria

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Inclusion Criteria

* hemiparesis at least six months from stroke.

Exclusion Criteria

* Ashworth scale \>3
* Bone instability (unconsolidated fractures, vertebral instability, severe osteoporosis),
* Articular ankyloses, contractures
* Spasms with locomotion effects
* Mini Mental State Examination (MMSE) \[???\] \< 22 points and behavioral diseases involving aggressivity or psychotic disorders
* Clinicopathological conditions contraindicating the rehabilitation treatment (respiratory insufficiency, cardiac/circulatory failure, osteomyelitis, phlebitis and other conditions)
* Cutaneous lesions at lower limbs
* Weight \> 135 kg
* Height \> 200 cm
* Dysmetria of lower limbs more than 2 cm
Minimum Eligible Age

18 Years

Maximum Eligible Age

85 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Giovanni Taveggia

OTHER

Sponsor Role lead

Responsible Party

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Giovanni Taveggia

Medical Director

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Giovanni Taveggia, Physician

Role: PRINCIPAL_INVESTIGATOR

Habilita, Ospedale di Sarnico

Locations

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Habilta Zingonia

Ciserano, BG, Italy

Site Status RECRUITING

Habilita Sarnico

Sarnico, BG, Italy

Site Status RECRUITING

Countries

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Italy

Central Contacts

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Stefania Fogliaresi, Coordinator

Role: CONTACT

Phone: +39035918

Email: [email protected]

Paola Sabattini, Coordinator

Role: CONTACT

Phone: +39035481

Email: [email protected]

Facility Contacts

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Umberto Bonassi, Physician

Role: primary

Giovanni Taveggia, Physician

Role: primary

Other Identifiers

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Habilita-RAR-05

Identifier Type: -

Identifier Source: org_study_id