Article

Literature in the application of gait training techniques in persons
with traumatic brain injury (TBI) is limited. Current techniques require multiple
staff and are physically demanding. The use of a robotic locomotor training may
provide improved training capacity for this population. OBJECTIVE: To examine the
impact of 3 different modes of locomotor therapy on gait velocity and
spatiotemporal symmetry using an end effector robot (G-EO);
a robotic exoskeleton
(Lokomat), and manual assisted partial-body weight-supported treadmill training
(PBWSTT) in participants with traumatic brain injury. DESIGN: Randomized,
prospective study. SETTING: Tertiary rehabilitation hospital. PARTICIPANTS: A
total of 22 individuals with >/=12 months chronic TBI with hemiparetic pattern
able to walk overground without assistance at velocities between 0.2 and 0.6 m/s.
INTERVENTION: Eighteen sessions of 45 minutes of assigned locomotor training.
OUTCOME MEASURES: Overground walking self-selected velocity (SSV), maximal
velocity (MV), spatiotemporal asymmetry ratio, 6-Minute Walk Test (6MWT), and
mobility domain of Stroke Impact Scale (MSIS). RESULTS: Severity in walking
dysfunction was similar across groups as determined by walking velocity data. At
baseline, participants in the Lokomat group had a baseline velocity that was
slightly slower compared with the other groups. Training elicited a statistically
significant median increase in SSV for all groups compared with pretraining
(Lokomat, P = .04; G-EO, P = .03; and PBWSTT, P = .02) and MV excluding the G-EO
group (Lokomat, P = .04; PBWSTT, P = .03 and G-EO, P = .15). There were no
pre-post significant differences in swing time, stance time, and step length
asymmetry ratios at SSV or MV for any of the interventions. Mean rank in the
change of SSV and MV was not statistically significantly different between
groups. Participants in the G-EO and PBWSTT groups significantly improved their
6MWT posttraining (P = .04 and .03, respectively). The MSIS significantly
improved only for the Lokomat group (P = .04 and .03). The data did not elicit
between-groups significant differences for 6MWT and MSIS. There was less use of
staff for Lokomat than G-EO. CONCLUSIONS: Locomotor therapy using G-EO, Lokomat,
or PBWSTT in individuals with chronic TBI increased SSV and MV without
significant changes in gait symmetry. Staffing needed for therapy provision was
the least for the Lokomat. A larger study may further elucidate changes in gait
symmetry and other training parameters.
LEVEL OF EVIDENCE: II.
CI - Copyright (c) 2017 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS