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Early poststroke rehabilitation using a robotic tilt-table stepper and functional electrical stimulation.

Kuznetsov AN, Rybalko NV, Daminov VD, Luft AR - Stroke Res Treat (2013)

Bottom Line: To prevent persistent deficits, rehabilitation may be more effective if started early.Conclusions.Robotic tilt-table exercise with or without FES is safe and may be more effective in improving leg strength and cerebral blood flow than tilt table alone.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology and Neurosurgery, National Pirogov Centre of Therapy and Surgery, Nignaya Pervomaiskaya Street 70, Moscow 105203, Russia.

ABSTRACT
Background. Stroke frequently leaves survivors with hemiparesis. To prevent persistent deficits, rehabilitation may be more effective if started early. Early training is often limited because of orthostatic reactions. Tilt-table stepping robots and functional electrical stimulation (FES) may prevent these reactions. Objective. This controlled convenience sample study compares safety and feasibility of robotic tilt-table training plus FES (ROBO-FES) and robotic tilt-table training (ROBO) against tilt-table training alone (control). A preliminary assessment of efficacy is performed. Methods. Hemiparetic ischemic stroke survivors (age 58.3 ± 1.2 years, 4.6 ± 1.2 days after stroke) were assigned to 30 days of ROBO-FES (n = 38), ROBO (n = 35), or control (n = 31) in addition to conventional physical therapy. Impedance cardiography and transcranial doppler sonography were performed before, during, and after training. Hemiparesis was assessed using the British Medical Research Council (MRC) strength scale. Results. No serious adverse events occurred; 8 patients in the tilt-table group prematurely quit the study because of orthostatic reactions. Blood pressure and CBFV dipped <10% during robot training. In 52% of controls mean arterial pressure decreased by ≥20%. ROBO-FES increased leg strength by 1.97 ± 0.88 points, ROBO by 1.50 ± 0.85 more than control (1.03 ± 0.61, P < 0.05). CBFV increased in both robotic groups more than in controls (P < 0.05). Conclusions. Robotic tilt-table exercise with or without FES is safe and may be more effective in improving leg strength and cerebral blood flow than tilt table alone.

No MeSH data available.


Related in: MedlinePlus

Changes in cerebral blood flow parameters over the course of treatment. (a) and (b) Systolic and diastolic blood flow velocity in the middle cerebral artery (MCA) of the affected hemisphere increased in robotic groups more than in control. (c) and (d) Indices of pulsatility and vascular resistance were mainly improved by ROBO-FES, while ROBO training had similar effects as compared with control. Error bars indicate standard deviations.
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fig4: Changes in cerebral blood flow parameters over the course of treatment. (a) and (b) Systolic and diastolic blood flow velocity in the middle cerebral artery (MCA) of the affected hemisphere increased in robotic groups more than in control. (c) and (d) Indices of pulsatility and vascular resistance were mainly improved by ROBO-FES, while ROBO training had similar effects as compared with control. Error bars indicate standard deviations.

Mentions: The groups showed different changes in MCA blood flow velocity over the 30-day training period (for systolic, KW 69.2, and diastolic velocity, KW 67.4, both P < 0.0001, Bonferroni-corrected P = 0.0002, Figures 4(a) and 3(b)). Cerebral blood flow velocity changed most after ROBO-FES followed by ROBO and control (all differences between groups were significant for systolic and diastolic velocity). The pulsatility index (PI) improved in ROBO-FES more than in control and ROBO (group effect KW 60.1, P < 0.0001, Bonferroni-corrected P < 0.0001, Dunn's post hoc test P < 0.05; difference between ROBO and control was not significant). There was a significant group effect on the resistance index (RI, KW 6.14, P = 0.0465), but the result was no longer significant when multiple comparison correction was applied (P = 0.42). Dunn's post hoc tests for comparisons between groups were insignificant (Figures 4(c) and 3(d)). All models on MCA blood flow parameters gave similar results if the respective baseline variable was included as a covariate into the model.


Early poststroke rehabilitation using a robotic tilt-table stepper and functional electrical stimulation.

Kuznetsov AN, Rybalko NV, Daminov VD, Luft AR - Stroke Res Treat (2013)

Changes in cerebral blood flow parameters over the course of treatment. (a) and (b) Systolic and diastolic blood flow velocity in the middle cerebral artery (MCA) of the affected hemisphere increased in robotic groups more than in control. (c) and (d) Indices of pulsatility and vascular resistance were mainly improved by ROBO-FES, while ROBO training had similar effects as compared with control. Error bars indicate standard deviations.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3649757&req=5

fig4: Changes in cerebral blood flow parameters over the course of treatment. (a) and (b) Systolic and diastolic blood flow velocity in the middle cerebral artery (MCA) of the affected hemisphere increased in robotic groups more than in control. (c) and (d) Indices of pulsatility and vascular resistance were mainly improved by ROBO-FES, while ROBO training had similar effects as compared with control. Error bars indicate standard deviations.
Mentions: The groups showed different changes in MCA blood flow velocity over the 30-day training period (for systolic, KW 69.2, and diastolic velocity, KW 67.4, both P < 0.0001, Bonferroni-corrected P = 0.0002, Figures 4(a) and 3(b)). Cerebral blood flow velocity changed most after ROBO-FES followed by ROBO and control (all differences between groups were significant for systolic and diastolic velocity). The pulsatility index (PI) improved in ROBO-FES more than in control and ROBO (group effect KW 60.1, P < 0.0001, Bonferroni-corrected P < 0.0001, Dunn's post hoc test P < 0.05; difference between ROBO and control was not significant). There was a significant group effect on the resistance index (RI, KW 6.14, P = 0.0465), but the result was no longer significant when multiple comparison correction was applied (P = 0.42). Dunn's post hoc tests for comparisons between groups were insignificant (Figures 4(c) and 3(d)). All models on MCA blood flow parameters gave similar results if the respective baseline variable was included as a covariate into the model.

Bottom Line: To prevent persistent deficits, rehabilitation may be more effective if started early.Conclusions.Robotic tilt-table exercise with or without FES is safe and may be more effective in improving leg strength and cerebral blood flow than tilt table alone.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology and Neurosurgery, National Pirogov Centre of Therapy and Surgery, Nignaya Pervomaiskaya Street 70, Moscow 105203, Russia.

ABSTRACT
Background. Stroke frequently leaves survivors with hemiparesis. To prevent persistent deficits, rehabilitation may be more effective if started early. Early training is often limited because of orthostatic reactions. Tilt-table stepping robots and functional electrical stimulation (FES) may prevent these reactions. Objective. This controlled convenience sample study compares safety and feasibility of robotic tilt-table training plus FES (ROBO-FES) and robotic tilt-table training (ROBO) against tilt-table training alone (control). A preliminary assessment of efficacy is performed. Methods. Hemiparetic ischemic stroke survivors (age 58.3 ± 1.2 years, 4.6 ± 1.2 days after stroke) were assigned to 30 days of ROBO-FES (n = 38), ROBO (n = 35), or control (n = 31) in addition to conventional physical therapy. Impedance cardiography and transcranial doppler sonography were performed before, during, and after training. Hemiparesis was assessed using the British Medical Research Council (MRC) strength scale. Results. No serious adverse events occurred; 8 patients in the tilt-table group prematurely quit the study because of orthostatic reactions. Blood pressure and CBFV dipped <10% during robot training. In 52% of controls mean arterial pressure decreased by ≥20%. ROBO-FES increased leg strength by 1.97 ± 0.88 points, ROBO by 1.50 ± 0.85 more than control (1.03 ± 0.61, P < 0.05). CBFV increased in both robotic groups more than in controls (P < 0.05). Conclusions. Robotic tilt-table exercise with or without FES is safe and may be more effective in improving leg strength and cerebral blood flow than tilt table alone.

No MeSH data available.


Related in: MedlinePlus