Study highlights:
• Therapist-assisted walking rehabilitation showed greater improvements
in walking ability in ambulatory stroke survivors compared to
robotic-assisted therapy.
• Post-stroke patients in both groups improved their walking ability,
but the amount of improvement in the physical therapist-assisted group
was greater.
• Robotic devices may be best reserved for acute stroke patients who have no ability to walk on their own.
DALLAS, May 9 — Walking therapy for stroke survivors is
significantly more effective when conducted by a physical therapist
instead of a robot, according a small study reported in Stroke: Journal
of the American Heart Association.
Research suggests that, for a patient who has neurological damage
from stroke or spinal cord injury, moving the legs in a way that mimics
walking on a treadmill can facilitate walking recovery.
Physical therapists often assist stroke patients too weak to walk on
their own by fitting them in a harness, putting them on a treadmill and
helping them move as they would when walking. But this can be
physically demanding on a therapist, and robotic devices have been
developed as an alterative to relieve the therapist.
Some research has shown that robotic devices could improve walking
ability, but recent animal studies have indicated that providing strict
guidance during training could reduce the recovery achieved.
“We wanted to know whether using a robotic device that guides the limb
in a symmetrical walking pattern would facilitate greater improvements
in walking speed and symmetry than more traditional walking
interventions with a physical therapist,” said T. George Hornby, Ph.D.,
M.P.T., the study’s lead author.
Hornby and colleagues studied 48 stroke survivors who had suffered
strokes at least six months earlier and still had moderate to severe
trouble walking because of weakness on one side of their bodies.
Patients were randomly divided between robotic-assisted locomotor
training, or traditional physical therapist-assisted locomotor therapy.
During locomotor training, patients are fitted with a harness and
suspended from a frame over the treadmill. All patients received 12
30-minute therapy sessions during the four to five weeks of the study.
“We found that stroke patients improved their walking whether they had
the robotic device or the therapist helping them,” said Hornby, an
assistant professor in the physical therapy department at the
University of Illinois in Chicago. “However, the amount of improvement
was greater in the therapist-assisted group.”
The researchers noted greater improvements in the therapist-assisted
group in walking speed and patients’ amount of time spent on the weak
leg during walking. Patients in the therapist-assisted group who had
severe walking deficits also perceived that their quality of life
improved after therapy because they had fewer physical limitations. The
same was not true for the robotic therapy group.
The researchers hypothesize that the greater improvement in the
therapist-assisted group was because physical therapists allow for
human error, while the robotic device used in this study restricted
movement and minimized errors.
“When learning to walk again, if people can make mistakes and realize
their errors and change their behavior based on those errors, they may
learn better,” Hornby said. “We also think that patients work harder
and therefore improve more with therapists because the robotic device
moved patients’ legs for them throughout the therapy. Therapists only
help as needed.”
The results of the study are limited by the small size and because
researchers and patients were aware of which therapy patients received
(non-blinded).
The researchers suggest that the effectiveness of robotic devices may
be best reserved for acute stroke patients who have no ability to walk
on their own, while those who can walk independently — even at very
slow speeds — may be better served by human-assisted therapy.
The National Institute of Disability and Rehabilitation Research and the Department of Education funded this research.
Editor’s note: May is American Stroke Month. For more information on stroke, visit the American Stroke Association Web site: www.strokeassociation.org
Statements and conclusions of study authors that are published in
the American Heart Association scientific journals are solely those of
the study authors and do not necessarily reflect association policy or
position. The American Heart Association makes no representation or
warranty as to their accuracy or reliability.
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NR08 – 1060 (Stroke/Hornby)
