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1. Gait robot-assisted rehabilitation in persons with spinal cord injury: A scoping review

Author

Stampacchia, G, Gazzotti, V, Olivieri, M, Andrenelli, E, Bonaiuti, D, Calabro, R, Carmignano, S, Cassio, A, Fundaro, C, Companini, I, Mazzoli, D, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Mazzoleni, D, Melegari, C, Merlo, A, Boldrini, P, Mazzoleni, S, Posteraro, F, Mazzucchelli, M, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bizzarrini, E, Stampacchia G., Gazzotti V., Olivieri M., Andrenelli E., Bonaiuti D., Calabro R. S., Carmignano S. M., Cassio A., Fundaro C., Companini I., Mazzoli D., Cerulli S., Chisari C., Colombo V., Dalise S., Mazzoleni D., Melegari C., Merlo A., Boldrini P., Mazzoleni S., Posteraro F., Mazzucchelli M., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., Bizzarrini E., Stampacchia, G, Gazzotti, V, Olivieri, M, Andrenelli, E, Bonaiuti, D, Calabro, R, Carmignano, S, Cassio, A, Fundaro, C, Companini, I, Mazzoli, D, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Mazzoleni, D, Melegari, C, Merlo, A, Boldrini, P, Mazzoleni, S, Posteraro, F, Mazzucchelli, M, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bizzarrini, E, Stampacchia G., Gazzotti V., Olivieri M., Andrenelli E., Bonaiuti D., Calabro R. S., Carmignano S. M., Cassio A., Fundaro C., Companini I., Mazzoli D., Cerulli S., Chisari C., Colombo V., Dalise S., Mazzoleni D., Melegari C., Merlo A., Boldrini P., Mazzoleni S., Posteraro F., Mazzucchelli M., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., and Bizzarrini E.

Abstract

BACKGROUND: Many robots are available for gait rehabilitation (BWSTRT and ORET) and their application in persons with SCI allowed an improvement of walking function.OBJECTIVE: The aim of the study is to compare the effects of different robotic exoskeletons gait training in persons with different SCI level and severity.METHODS: Sixty-two studies were included in this systematic review; the study quality was assessed according to GRADE and PEDro's scale.RESULTS: Quality assessment of included studies (n = 62) demonstrated a prevalence of evidence level 2; the quality of the studies was higher for BWSTRT (excellent and good) than for ORET (fair and good). Almost all persons recruited for BWSTRT had an incomplete SCI; both complete and incomplete SCI were recruited for ORET. The SCI lesion level in the persons recruited for BWSTRT are from cervical to sacral; mainly from thoracic to sacral for ORET; a high representation of AIS D lesion resulted both for BWSTRT (30%) and for ORET (45%). The walking performance, tested with 10MWT, 6MWT, TUG and WISCI, improved after exoskeleton training in persons with incomplete SCI lesions, when at least 20 sessions were applied. Persons with complete SCI lesions improved the dexterity in walking with exoskeleton, but did not recover independent walking function; symptoms such as spasticity, pain and cardiovascular endurance improved.CONCLUSION: Different exoskeletons are available for walking rehabilitation in persons with SCI. The choice about the kind of robotic gait training should be addressed on the basis of the lesion severity and the possible comorbidities.

Published
2022

2. Evidence-based improvement of gait in post-stroke patients following robot-assisted training: A systematic review

Author

Mazzucchelli, M, Mazzoleni, D, Campanini, I, Merlo, A, Mazzoli, D, Melegari, C, Colombo, V, Cerulli, S, Piscitelli, D, Perin, C, Andrenelli, E, Bizzarini, E, Calabro, R, Carmignano, S, Cassio, A, Chisari, C, Dalise, S, Fundaro, C, Gazzotti, V, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bonaiuti, D, Mazzucchelli M., Mazzoleni D., Campanini I., Merlo A., Mazzoli D., Melegari C., Colombo V., Cerulli S., Piscitelli D., Perin C., Andrenelli E., Bizzarini E., Calabro R. S., Carmignano S. M., Cassio A., Chisari C., Dalise S., Fundaro C., Gazzotti V., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., Bonaiuti D., Mazzucchelli, M, Mazzoleni, D, Campanini, I, Merlo, A, Mazzoli, D, Melegari, C, Colombo, V, Cerulli, S, Piscitelli, D, Perin, C, Andrenelli, E, Bizzarini, E, Calabro, R, Carmignano, S, Cassio, A, Chisari, C, Dalise, S, Fundaro, C, Gazzotti, V, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bonaiuti, D, Mazzucchelli M., Mazzoleni D., Campanini I., Merlo A., Mazzoli D., Melegari C., Colombo V., Cerulli S., Piscitelli D., Perin C., Andrenelli E., Bizzarini E., Calabro R. S., Carmignano S. M., Cassio A., Chisari C., Dalise S., Fundaro C., Gazzotti V., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., and Bonaiuti D.

Abstract

Background: The recovery of walking after stroke is a priority goal for recovering autonomy. In the last years robotic systems employed for Robotic Assisted Gait Training (RAGT) were developed. However, literature and clinical practice did not offer standardized RAGT protocol or pattern of evaluation scales. Objective: This systematic review aimed to summarize the available evidence on the use of RAGT in post-stroke, following the CICERONE Consensus indications. Methods: The literature search was conducted on PubMed, Cochrane Library and PEDro, including studies with the following criteria: 1) adult post-stroke survivors with gait disability in acute/subacute/chronic phase; 2) RAGT as intervention; 3) any comparators; 4) outcome regarding impairment, activity, and participation; 5) both primary studies and reviews. Results: Sixty-one articles were selected. Data about characteristics of patients, level of disability, robotic devices used, RAGT protocols, outcome measures, and level of evidence were extracted. Conclusion: It is possible to identify robotic devices that are more suitable for specific phase disease and level of disability, but we identified significant variability in dose and protocols. RAGT as an add-on treatment seemed to be prevalent. Further studies are needed to investigate the outcomes achieved as a function of RAGT doses delivered.

Published
2022

3. Evidence-based improvement of gait in post-stroke patients following robot-assisted training: A systematic review.

Author

Mazzucchelli M, Mazzoleni D, Campanini I, Merlo A, Mazzoli D, Melegari C, Colombo V, Cerulli S, Piscitelli D, Perin C, Andrenelli E, Bizzarini E, Calabro RS, Carmignano SM, Cassio A, Chisari C, Dalise S, Fundaro C, Gazzotti V, Stampacchia G, Boldrini P, Mazzoleni S, Posteraro F, Benanti P, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Morone G, Petrarca M, Picelli A, Senatore M, Turchetti G, and Bonaiuti D

Subjects
Adult, Humans, Gait, Stroke Rehabilitation methods, Robotics, Gait Disorders, Neurologic etiology, Stroke complications
Abstract

Background: The recovery of walking after stroke is a priority goal for recovering autonomy. In the last years robotic systems employed for Robotic Assisted Gait Training (RAGT) were developed. However, literature and clinical practice did not offer standardized RAGT protocol or pattern of evaluation scales., Objective: This systematic review aimed to summarize the available evidence on the use of RAGT in post-stroke, following the CICERONE Consensus indications., Methods: The literature search was conducted on PubMed, Cochrane Library and PEDro, including studies with the following criteria: 1) adult post-stroke survivors with gait disability in acute/subacute/chronic phase; 2) RAGT as intervention; 3) any comparators; 4) outcome regarding impairment, activity, and participation; 5) both primary studies and reviews., Results: Sixty-one articles were selected. Data about characteristics of patients, level of disability, robotic devices used, RAGT protocols, outcome measures, and level of evidence were extracted., Conclusion: It is possible to identify robotic devices that are more suitable for specific phase disease and level of disability, but we identified significant variability in dose and protocols. RAGT as an add-on treatment seemed to be prevalent. Further studies are needed to investigate the outcomes achieved as a function of RAGT doses delivered.

Published
2022
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4. Gait robot-assisted rehabilitation in persons with spinal cord injury: A scoping review.

Author

Stampacchia G, Gazzotti V, Olivieri M, Andrenelli E, Bonaiuti D, Calabro RS, Carmignano SM, Cassio A, Fundaro C, Companini I, Mazzoli D, Cerulli S, Chisari C, Colombo V, Dalise S, Mazzoleni D, Melegari C, Merlo A, Boldrini P, Mazzoleni S, Posteraro F, Mazzucchelli M, Benanti P, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Morone G, Petrarca M, Picelli A, Senatore M, Turchetti G, and Bizzarrini E

Subjects
Humans, Gait, Walking, Robotics, Spinal Cord Injuries rehabilitation, Exoskeleton Device
Abstract

Background: Many robots are available for gait rehabilitation (BWSTRT and ORET) and their application in persons with SCI allowed an improvement of walking function., Objective: The aim of the study is to compare the effects of different robotic exoskeletons gait training in persons with different SCI level and severity., Methods: Sixty-two studies were included in this systematic review; the study quality was assessed according to GRADE and PEDro's scale., Results: Quality assessment of included studies (nā€Š=ā€Š62) demonstrated a prevalence of evidence level 2; the quality of the studies was higher for BWSTRT (excellent and good) than for ORET (fair and good). Almost all persons recruited for BWSTRT had an incomplete SCI; both complete and incomplete SCI were recruited for ORET. The SCI lesion level in the persons recruited for BWSTRT are from cervical to sacral; mainly from thoracic to sacral for ORET; a high representation of AIS D lesion resulted both for BWSTRT (30%) and for ORET (45%). The walking performance, tested with 10MWT, 6MWT, TUG and WISCI, improved after exoskeleton training in persons with incomplete SCI lesions, when at least 20 sessions were applied. Persons with complete SCI lesions improved the dexterity in walking with exoskeleton, but did not recover independent walking function; symptoms such as spasticity, pain and cardiovascular endurance improved., Conclusion: Different exoskeletons are available for walking rehabilitation in persons with SCI. The choice about the kind of robotic gait training should be addressed on the basis of the lesion severity and the possible comorbidities.

Published
2022
Full Text
View/download PDF

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