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Clinical effects of robot-assisted gait training and treadmill training for Parkinson's disease. A randomized controlled trial.
Ann Phys Rehabil Med. 2019 Sep; 62(5):303-312.AP

Abstract

BACKGROUND

Although gait disorders strongly contribute to perceived disability in people with Parkinson's disease, clinical trials have failed to identify which task-oriented gait training method can provide the best benefit. Freezing of gait remains one of the least investigated and most troublesome symptoms.

OBJECTIVE

We aimed to compare the effects of robot-assisted gait training and treadmill training on endurance and gait capacity in people with Parkinson disease; the secondary aim was to compare the effect of the treatments in people with freezing and/or severe gait disability and assess changes in overall disease-related disability and quality of life.

METHODS

Outpatients with Parkinson disease (Hoehn and Yahr stage≥2) were randomly assigned to receive 20 sessions of 45-min gait training assisted by an end-effector robotic device (G-EO System) or treadmill training. Outcome assessments were the 6-min walk test, Timed Up and Go test, Freezing of Gait Questionnaire, Unified Parkinson's Disease Rating Scales and Parkinson's Disease Quality of Life Questionnaire-39 administered before (T0) and after treatment (T1).

RESULTS

We included 96 individuals with Parkinson disease: 48 with robot-assisted gait training and 48 treadmill training. Both groups showed significant improvement in all outcomes. As compared with baseline, with robot-assisted gait training and treadmill training, endurance and gait capacity were enhanced by 18% and 12%, respectively, and motor symptoms and quality of life were improved by 17% and 15%. The maximum advantage was observed with the Freezing of Gait Questionnaire score, which decreased by 20% after either treatment. On post-hoc analysis, dependent walkers benefited more than independent walkers from any gait training, whereas freezers gained more from robot-assisted than treadmill training in terms of freezing reduction.

CONCLUSIONS

Repetitive intensive gait training is an effective treatment for people with Parkinson disease and can increase endurance and gait velocity, especially for those with severe walking disability. Advantages are greater with robot-assisted gait training than treadmill training for individuals with freezing of gait - related disability.

Authors+Show Affiliations

Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, University Hospital of Ancona, "Politecnica delle Marche" University, Ancona, Italy. Electronic address: m.capecci@univpm.it.Rehabilitation Department IRCCS San Raffaele-Pisana, Rome, Italy.Rehabilitation Department IRCCS San Raffaele-Pisana, Rome, Italy.Rehabilitation Department IRCCS San Raffaele-Pisana, Rome, Italy; Ospedale Sant'Isidoro Trescore Balneario FERB Onlus, Italy.Rehabilitation Department IRCCS San Raffaele-Pisana, Rome, Italy.Rehabilitation Department IRCCS San Raffaele-Pisana, Rome, Italy.San Raffaele Cassino Rehabilitation Institute, Cassino, Italy.Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, University Hospital of Ancona, "Politecnica delle Marche" University, Ancona, Italy.Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, University Hospital of Ancona, "Politecnica delle Marche" University, Ancona, Italy.Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, University Hospital of Ancona, "Politecnica delle Marche" University, Ancona, Italy.Rehabilitation Department IRCCS San Raffaele-Pisana, Rome, Italy; San Raffaele University, Rome, Italy.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

31377382

Citation

Capecci, Marianna, et al. "Clinical Effects of Robot-assisted Gait Training and Treadmill Training for Parkinson's Disease. a Randomized Controlled Trial." Annals of Physical and Rehabilitation Medicine, vol. 62, no. 5, 2019, pp. 303-312.
Capecci M, Pournajaf S, Galafate D, et al. Clinical effects of robot-assisted gait training and treadmill training for Parkinson's disease. A randomized controlled trial. Ann Phys Rehabil Med. 2019;62(5):303-312.
Capecci, M., Pournajaf, S., Galafate, D., Sale, P., Le Pera, D., Goffredo, M., De Pandis, M. F., Andrenelli, E., Pennacchioni, M., Ceravolo, M. G., & Franceschini, M. (2019). Clinical effects of robot-assisted gait training and treadmill training for Parkinson's disease. A randomized controlled trial. Annals of Physical and Rehabilitation Medicine, 62(5), 303-312. https://doi.org/10.1016/j.rehab.2019.06.016
Capecci M, et al. Clinical Effects of Robot-assisted Gait Training and Treadmill Training for Parkinson's Disease. a Randomized Controlled Trial. Ann Phys Rehabil Med. 2019;62(5):303-312. PubMed PMID: 31377382.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical effects of robot-assisted gait training and treadmill training for Parkinson's disease. A randomized controlled trial. AU - Capecci,Marianna, AU - Pournajaf,Sanaz, AU - Galafate,Daniele, AU - Sale,Patrizio, AU - Le Pera,Domenica, AU - Goffredo,Michela, AU - De Pandis,Maria Francesca, AU - Andrenelli,Elisa, AU - Pennacchioni,Mauro, AU - Ceravolo,Maria Gabriella, AU - Franceschini,Marco, Y1 - 2019/08/01/ PY - 2019/02/09/received PY - 2019/06/28/revised PY - 2019/06/30/accepted PY - 2019/8/5/pubmed PY - 2020/3/4/medline PY - 2019/8/5/entrez KW - Freezing KW - Gait KW - Parkinson disease KW - Rehabilitation KW - Robotics SP - 303 EP - 312 JF - Annals of physical and rehabilitation medicine JO - Ann Phys Rehabil Med VL - 62 IS - 5 N2 - BACKGROUND: Although gait disorders strongly contribute to perceived disability in people with Parkinson's disease, clinical trials have failed to identify which task-oriented gait training method can provide the best benefit. Freezing of gait remains one of the least investigated and most troublesome symptoms. OBJECTIVE: We aimed to compare the effects of robot-assisted gait training and treadmill training on endurance and gait capacity in people with Parkinson disease; the secondary aim was to compare the effect of the treatments in people with freezing and/or severe gait disability and assess changes in overall disease-related disability and quality of life. METHODS: Outpatients with Parkinson disease (Hoehn and Yahr stage≥2) were randomly assigned to receive 20 sessions of 45-min gait training assisted by an end-effector robotic device (G-EO System) or treadmill training. Outcome assessments were the 6-min walk test, Timed Up and Go test, Freezing of Gait Questionnaire, Unified Parkinson's Disease Rating Scales and Parkinson's Disease Quality of Life Questionnaire-39 administered before (T0) and after treatment (T1). RESULTS: We included 96 individuals with Parkinson disease: 48 with robot-assisted gait training and 48 treadmill training. Both groups showed significant improvement in all outcomes. As compared with baseline, with robot-assisted gait training and treadmill training, endurance and gait capacity were enhanced by 18% and 12%, respectively, and motor symptoms and quality of life were improved by 17% and 15%. The maximum advantage was observed with the Freezing of Gait Questionnaire score, which decreased by 20% after either treatment. On post-hoc analysis, dependent walkers benefited more than independent walkers from any gait training, whereas freezers gained more from robot-assisted than treadmill training in terms of freezing reduction. CONCLUSIONS: Repetitive intensive gait training is an effective treatment for people with Parkinson disease and can increase endurance and gait velocity, especially for those with severe walking disability. Advantages are greater with robot-assisted gait training than treadmill training for individuals with freezing of gait - related disability. SN - 1877-0665 UR - https://www.unboundmedicine.com/medline/citation/31377382/Clinical_effects_of_robot_assisted_gait_training_and_treadmill_training_for_Parkinson's_disease__A_randomized_controlled_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1877-0657(19)30107-1 DB - PRIME DP - Unbound Medicine ER -