Gait rehabilitation in patients with spastic hemiparesis: new opportunities

Abstract

Gait disturbances are a common consequence of stroke. New technologies, such as exoskeletons (ESs), may aid recovery, but their effectiveness has not yet been proven enough.Objective: to evaluate the effectiveness of medical ESs and spasticity treatment for gait rehabilitation in patients with spastic hemiparesis due to acute stroke.Patients and methods. The study included 42 patients with spasticity and gait disturbances who has had a stroke 1.5–4 years ago. Clinical assessment included: Tardieu scale (TS), Modified Ashworth scale (MAS), Rankin Scale, Visual Analogue Scale (VAS); 10 Meter Walk Test (10MWT) and Berg balance scale (BBТ), Rivermead Mobility Index (RMI). The patients were divided into two representative groups (22 and 20 participants). Patients of the 1st group were training in the ES ExoAtlet for 10 days (original method and method of differentiation of efforts were used), the 2nd group was assigned to physical therapy for the same period. Then all patients received an injection of 300–400 U of botulinum neurotoxin (BNT) under ultrasound control into the spastic muscles of the lower limb. The examination was carried out at three control points (CPs): 1st day (1st), 12th day (2nd), and 33rd day (3rd).Results and discussion. Comparison of both groups on the 2nd CT showed significantly (p<0.05) better results in the 1st group: 10MWT (0.43 and 0.47 m/s), BBT (42 and 44.5), muscles of the back of the thigh – hamstrings assessed by TS (132° and 137.5°). Gait speed apparently increased due to balance training, correction of postural-phobic disorders, stretching of spastic muscles, and suppression of the stretch reflex. At the 2nd CPs, injections of incobotulinum toxin (Xeomin®) were performed. On the 3rd CP, significantly (p<0.05) better results were obtained in the 1st group according to tests: 10MWT (0.49 and 0.56 m/s), BBT (46 and 49), TS (144° and 155°). Comparison of group differences between the 1st and 3rd CPs showed an absolute increase in test results (p<0.01): 10MWT (0.07 and 0.12 m/s), BBT (3.5 and 8.5), TS (14.5° and 22°). Improvement in gait indicators on the third CP demonstrates the potentiating effect of BONT injections and ES exercises.Conclusion. ES ExoAtlet use is a promising technique for restoring gait: the combined use of an exoskeleton and BONT gives a pronounced potentiating effect.

Keywords

• gait disturbances
• spasticity
• post-stroke rehabilitation
• exorehabilitation
• exoskeleton exoatlet
• botulinum neurotoxin
• incobotulinum toxin (xeomin®)