当前位置： SCI文献检索 > Journal of NeuroEngineering and Rehabilitation期刊下所有文献 > Shaping neuroplasticity by using powered exoskeletons in patients with stroke: a randomized clinical trial.

Shaping neuroplasticity by using powered exoskeletons in patients with stroke: a randomized clinical trial.

Abstract：

BACKGROUND:The use of neurorobotic devices may improve gait recovery by entraining specific brain plasticity mechanisms, which may be a key issue for successful rehabilitation using such approach. We assessed whether the wearable exoskeleton, Ekso™, could get higher gait performance than conventional overground gait training (OGT) in patients with hemiparesis due to stroke in a chronic phase, and foster the recovery of specific brain plasticity mechanisms. METHODS:We enrolled forty patients in a prospective, pre-post, randomized clinical study. Twenty patients underwent Ekso™ gait training (EGT) (45-min/session, five times/week), in addition to overground gait therapy, whilst 20 patients practiced an OGT of the same duration. All individuals were evaluated about gait performance (10 m walking test), gait cycle, muscle activation pattern (by recording surface electromyography from lower limb muscles), frontoparietal effective connectivity (FPEC) by using EEG, cortico-spinal excitability (CSE), and sensory-motor integration (SMI) from both primary motor areas by using Transcranial Magnetic Stimulation paradigm before and after the gait training. RESULTS:A significant effect size was found in the EGT-induced improvement in the 10 m walking test (d = 0.9, p < 0.001), CSE in the affected side (d = 0.7, p = 0.001), SMI in the affected side (d = 0.5, p = 0.03), overall gait quality (d = 0.8, p = 0.001), hip and knee muscle activation (d = 0.8, p = 0.001), and FPEC (d = 0.8, p = 0.001). The strengthening of FPEC (r = 0.601, p < 0.001), the increase of SMI in the affected side (r = 0.554, p < 0.001), and the decrease of SMI in the unaffected side (r = - 0.540, p < 0.001) were the most important factors correlated with the clinical improvement. CONCLUSIONS:Ekso™ gait training seems promising in gait rehabilitation for post-stroke patients, besides OGT. Our study proposes a putative neurophysiological basis supporting Ekso™ after-effects. This knowledge may be useful to plan highly patient-tailored gait rehabilitation protocols. TRIAL REGISTRATION:ClinicalTrials.gov , NCT03162263 .

journal_name

J Neuroeng Rehabil

journal_title

Journal of neuroengineering and rehabilitation

authors

Calabrò RS,Naro A,Russo M,Bramanti P,Carioti L,Balletta T,Buda A,Manuli A,Filoni S,Bramanti A

doi

10.1186/s12984-018-0377-8

subject

Has Abstract

pub_date

2018-04-25 00:00:00

pages

issue

issn

1743-0003

pii

10.1186/s12984-018-0377-8

journal_volume

pub_type

杂志文章,随机对照试验

在线工具

Shaping neuroplasticity by using powered exoskeletons in patients with stroke: a randomized clinical trial.