Ann Rehabil Med.  2018 Apr;42(2):195-203. 10.5535/arm.2018.42.2.195.

Effect of Caregiver Driven Robot-Assisted In-Ward Training in Subacute Stroke Patients: A Case Series

• Kim SB
• Lee KW
• Lee JH
• Lee SJ
• Park JG
• Park JW

• KMID: 2432189
• DOI: http://doi.org/10.5535/arm.2018.42.2.195

Abstract

OBJECTIVE
To evaluate the effect of caregiver driven robot-assisted in-ward training in subacute stroke patients.
METHODS
A retrospective evaluation was performed for patients treated with caregiver driven robot-assisted in-ward training to retain gait function from June 2014 and December 2016. All patients received more than 2 weeks of caregiver driven robot-assisted in-ward training after undergoing conventional programs. The robot was used as a sitting device, a standing frame, or a high-walker depending on functional status of the patient. Patients were evaluated before and after robot training. Patient records were assessed by Korean version of Modified Barthel Index (K-MBI), Functional Independence Measure (FIM), and Functional Ambulation Category (FAC).
RESULTS
Initially, patients used the robot as a sitting device (n=6), a standing frame (n=7), or a partial body-weight support high-walker (n=2). As patient functions were improved, usage level of the robot was changed to the next level. At the end of the treatment, the robot was used as a sitting device (n=1), a standing frame (n=6), or high-walker (n=8). Scores of K-MBI (Δ17.47±10.72) and FIM (Δ19.80±12.34) were improved in all patients.
CONCLUSION
Patients' usage level of the robot and functional scores were improved. Therefore, performing additional caregiver driven robot-assisted in-ward training is feasible and beneficial for subacute stroke patients.

Keyword

Stroke rehabilitation; Stroke; Robot

MeSH Terms

Caregivers*
Gait
Humans
Retrospective Studies
Stroke*
Walking

Figure

• 

  Fig. 1 Transfer assistance robot, an inward gait training device, consisted of waist and leg straps, height remote control, and handle. (A) All straps are unfastened. (B) All straps are fastened.

• 

  Fig. 2 Patients used body weight support device to exercise in the ward by themselves. (A) Patient could maintain sitting balance by using device in the ward. (B) Patient could maintain standing balance by using device in the ward. (C) Patient could do gait training independently by using the device in the ward.

Reference

1. Belagaje SR. Stroke rehabilitation. Continuum (Minneap Minn). 2017; 23(1, Cerebrovascular Disease):238–253. PMID: 28157752.

2. Kwakkel G, van Peppen R, Wagenaar RC, Wood Dauphinee S, Richards C, Ashburn A, et al. Effects of augmented exercise therapy time after stroke: a meta-analysis. Stroke. 2004; 35:2529–2539. PMID: 15472114.

3. Teasell RW, Kalra L. What's new in stroke rehabilitation. Stroke. 2004; 35:383–385. PMID: 14757887.

4. Bhogal SK, Teasell R, Speechley M. Intensity of aphasia therapy, impact on recovery. Stroke. 2003; 34:987–993.

5. Astrand A, Saxin C, Sjoholm A, Skarin M, Linden T, Stoker A, et al. Poststroke physical activity levels no higher in rehabilitation than in the acute hospital. J Stroke Cerebrovasc Dis. 2016; 25:938–945. PMID: 26851969.

6. Miller EL, Murray L, Richards L, Zorowitz RD, Bakas T, Clark P, et al. Comprehensive overview of nursing and interdisciplinary rehabilitation care of the stroke patient: a scientific statement from the American Heart Association. Stroke. 2010; 41:2402–2448. PMID: 20813995.

7. Vloothuis JD, Mulder M, Veerbeek JM, Konijnenbelt M, Visser-Meily JM, Ket JC, et al. Caregiver-mediated exercises for improving outcomes after stroke. Cochrane Database Syst Rev. 2016; 12:CD011058. PMID: 28002636.

8. Galvin R, Stokes E, Cusack T. Family-Mediated Exercises (FAME): an exploration of participant's involvement in a novel form of exercise delivery after stroke. Top Stroke Rehabil. 2014; 21:63–74. PMID: 24521841.

9. Gandolfi M, Geroin C, Tomelleri C, Maddalena I, Kirilova Dimitrova E, Picelli A, et al. Feasibility and safety of early lower limb robot-assisted training in sub-acute stroke patients: a pilot study. Eur J Phys Rehabil Med. 2017; 53:870–882. PMID: 28084064.

10. Tsunoda T, Maeshima S, Watanabe M, Nagai A, Ueno Y, Ozeki Y, et al. Rehabilitation for a patient with hemiplegia, ataxia, and cognitive dysfunction caused by pontine hemorrhage. Case Rep Neurol. 2015; 7:213–220. PMID: 26600785.

11. Redzuan NS, Engkasan JP, Mazlan M, Freddy Abdullah SJ. Effectiveness of a video-based therapy program at home after acute stroke: a randomized controlled trial. Arch Phys Med Rehabil. 2012; 93:2177–2183. PMID: 22789773.

12. van den Berg M, Crotty M Prof, Liu E, Killington M, Kwakkel G, van Wegen E. Early supported discharge by caregiver-mediated exercises and e-health support after stroke: a proof-of-concept trial. Stroke. 2016; 47:1885–1892. PMID: 27301941.

13. Galvin R, Cusack T, O'Grady E, Murphy TB, Stokes E. Family-mediated exercise intervention (FAME): evaluation of a novel form of exercise delivery after stroke. Stroke. 2011; 42:681–686. PMID: 21233462.

14. Kalra L, Evans A, Perez I, Melbourn A, Patel A, Knapp M, et al. Training carers of stroke patients: randomised controlled trial. BMJ. 2004; 328:1099. PMID: 15130977.

15. Veerbeek JM, van Wegen E, van Peppen R, van der Wees PJ, Hendriks E, Rietberg M, et al. What is the evidence for physical therapy poststroke? A systematic review and meta-analysis. PLoS One. 2014; 9:e87987. PMID: 24505342.

16. Dean CM, Channon EF, Hall JM. Sitting training early after stroke improves sitting ability and quality and carries over to standing up but not to walking: a randomised trial. Aust J Physiother. 2007; 53:97–102. PMID: 17535145.

17. Braun T, Marks D, Thiel C, Zietz D, Zutter D, Gruneberg C. Effects of additional, dynamic supported standing practice on functional recovery in patients with sub-acute stroke: a randomized pilot and feasibility trial. Clin Rehabil. 2016; 30:374–382. PMID: 25952591.

18. Hesse S. Treadmill training with partial body weight support after stroke: a review. NeuroRehabilitation. 2008; 23:55–65. PMID: 18356589.

19. Combs-Miller SA, Kalpathi Parameswaran A, Colburn D, Ertel T, Harmeyer A, Tucker L, et al. Body weight-supported treadmill training vs. overground walking training for persons with chronic stroke: a pilot randomized controlled trial. Clin Rehabil. 2014; 28:873–884. PMID: 24519922.

20. Manning CD, Pomeroy VM. Effectiveness of treadmill retraining on gait of hemiparetic stroke patients. Physiotherapy. 2003; 89:337–349.

21. Hesse S, Uhlenbrock D, Sarkodie-Gyan T. Gait pattern of severely disabled hemiparetic subjects on a new controlled gait trainer as compared to assisted treadmill walking with partial body weight support. Clin Rehabil. 1999; 13:401–410. PMID: 10498347.

22. Gama GL, Celestino ML, Barela JA, Forrester L, Whitall J, Barela AM. Effects of gait training with body weight support on a treadmill versus overground in individuals with stroke. Arch Phys Med Rehabil. 2017; 98:738–745. PMID: 28034719.