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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 systemic blood pressure over the course of training. Systemic blood pressure (a, b) and stroke volume (c) similarly decreased in all group. Only diastolic BP was more affected by ROBO-FES than by other interventions. Error bars indicate standard deviations.
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fig5: Changes in systemic blood pressure over the course of training. Systemic blood pressure (a, b) and stroke volume (c) similarly decreased in all group. Only diastolic BP was more affected by ROBO-FES than by other interventions. Error bars indicate standard deviations.

Mentions: Diastolic but not systolic blood pressure was affected by group (KW 7.76, P = 0.0009, Bonferroni-corrected P = 0.0081, baseline diastolic pressure included as covariate, post hoc difference between ROBO-FES and ROBO, P < 0.05, Figures 5(a) and 4(b). Similarly, group effects on stroke volume were only significant (KW 6.97, P = 0.0306) if multiple comparisons were not corrected for (P = 0.28). There was a significant difference between groups at baseline (P < 0.0001). If baseline values were entered as a covariate into an ANOVA model, the group effect disappeared (P = 0.075, uncorrected, Figure 5(c)).


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 systemic blood pressure over the course of training. Systemic blood pressure (a, b) and stroke volume (c) similarly decreased in all group. Only diastolic BP was more affected by ROBO-FES than by other interventions. Error bars indicate standard deviations.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig5: Changes in systemic blood pressure over the course of training. Systemic blood pressure (a, b) and stroke volume (c) similarly decreased in all group. Only diastolic BP was more affected by ROBO-FES than by other interventions. Error bars indicate standard deviations.
Mentions: Diastolic but not systolic blood pressure was affected by group (KW 7.76, P = 0.0009, Bonferroni-corrected P = 0.0081, baseline diastolic pressure included as covariate, post hoc difference between ROBO-FES and ROBO, P < 0.05, Figures 5(a) and 4(b). Similarly, group effects on stroke volume were only significant (KW 6.97, P = 0.0306) if multiple comparisons were not corrected for (P = 0.28). There was a significant difference between groups at baseline (P < 0.0001). If baseline values were entered as a covariate into an ANOVA model, the group effect disappeared (P = 0.075, uncorrected, Figure 5(c)).

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