scholarly journals Rehabilitation Improves Mitochondrial Energetics in Progressive Multiple Sclerosis: The Significant Role of Robot-Assisted Gait Training and of the Personalized Intensity

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 834 ◽  
Author(s):  
Fabio Manfredini ◽  
Sofia Straudi ◽  
Nicola Lamberti ◽  
Simone Patergnani ◽  
Veronica Tisato ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Healthy Subjects ◽  
Near Infrared ◽  
Endurance Performance ◽  
Gait Training ◽  
Walking Distance ◽  
Robot Assisted ◽  
Walking Capacity ◽  
Pyruvate Ratio

Abnormal levels of pyruvate and lactate were reported in multiple sclerosis (MS). We studied the response of markers of mitochondrial function to rehabilitation in relation to type, intensity and endurance performance in severely disabled MS patients. Forty-six progressive MS patients were randomized to receive 12 walking sessions of robot-assisted gait training (RAGT, n = 23) or conventional overground therapy (CT, n = 23). Ten healthy subjects were also studied. Blood samples were collected to determine lactate, pyruvate, and glutathione levels and lactate/pyruvate ratio pre–post rehabilitation. In vivo muscle metabolism and endurance walking capacity were assessed by resting muscle oxygen consumption (rmVO2) using near-infrared spectroscopy and by six-minute walking distance (6MWD), respectively. The levels of mitochondrial biomarkers and rmVO2, altered at baseline with respect to healthy subjects, improved after rehabilitation in the whole population. In the two groups, an enhanced response was observed after RAGT compared to CT for lactate (p = 0.012), glutathione (<0.001), lactate/pyruvate ratio (p = 0.08) and rmVO2 (p = 0.07). Metabolic biomarkers and 6MWD improvements were exclusively correlated with a training speed markedly below individual gait speed. In severely disabled MS patients, rehabilitation rebalanced altered serum metabolic and muscle parameters, with RAGT being more effective than CT. A determinable slow training speed was associated with better metabolic and functional recovery. Trial Registration: ClinicalTrials.gov NCT02421731.

Robot-assisted gait training in multiple sclerosis: a pilot randomized trial

2007 ◽  
Vol 14 (2) ◽  
pp. 231-236 ◽  
Author(s):  
S. Beer ◽  
B. Aschbacher ◽  
D. Manoglou ◽  
E. Gamper ◽  
J. Kool ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Effect Size ◽  
Knee Extensor ◽  
Gait Training ◽  
Walking Distance ◽  
Robot Assisted ◽  
Knee Extensor Strength ◽  
Walking Velocity ◽  
The Impact

Objective To evaluate feasibility and perform an explanatory analysis of the efficacy of robot-assisted gait training (RAGT) in MS patients with severe walking disabilities (Expanded Disability Status Scale [EDSS] 6.0—7.5) in a pilot trial. Methods Prospective, randomized, controlled clinical trial comparing RAGT with conventional walking training (CWT) in a group of stable MS patients ( n = 35) during an inpatient rehabilitation stay, 15 sessions over three weeks. All patients participated additionally in a multimodal rehabilitation program. The primary outcome measure was walking velocity and secondary measures were 6-minwalking distance, stride length and knee-extensor strength. All tests were performed by an external blinded assessor at baseline after three weeks and at follow-up after six months. Additionally, Extended Barthel Index (EBI) at entry and discharge was assessed (not blinded), and acceptance/convenience of RAGT rated by patients (Visual Analogue Scale [VAS]) was recorded. Results Nineteen patients were randomly allocated to RAGT and 16 patients to CWT. Groups were comparable at baseline. There were 5 drop-outs (2 related directly to treatment) in the RAGT group and 1 in the CWT group, leaving 14 RAGT patients and 15 CWT patients for final analysis. Acceptance and convenience of RAGT as rated by patients were high. Effect sizes were moderate to large, although not significant, for walking velocity (0.700, 95% CI -0.089 to 1.489), walking distance (0.401, 95% CI - 0.370 to 1.172) and knee-extensor strength (right: 1.105, 95% CI 0.278 to 1.932, left 0.650, 95% CI -0.135 to 1.436) favouring RAGT. Prepost within-group analysis revealed an increase of walking velocity, walking distance and knee-extensor strength in the RAGT group, whereas in CWT group only walking velocity was improved. In both groups outcome values returned to baseline at follow-up after six months ( n = 23). Conclusions Robot-assisted gait training is feasible and may be an effective therapeutic option in MS patients with severe walking disabilities. Effect size calculation and prepost analysis suggest a higher benefit on walking velocity and knee-extensor strength by RAGT compared to CWT. Due to several limitations, however, our results should be regarded as preliminary. Post hoc power calculation showed that two groups of 106 patients are needed to demonstrate a significant moderate effect size of 0.4 after three weeks of RAGT. Thus, further studies with a larger number of patients are needed to investigate the impact of this new treatment option in MS patients. Multiple Sclerosis 2008; 14: 231—236. http://msj.sagepub.com

The effect of robot-assisted gait training on cortical activation in stroke patients: A functional near-infrared spectroscopy study

2021 ◽  
pp. 1-9
Author(s):  
Kyeong Joo Song ◽  
Min Ho Chun ◽  
Junekyung Lee ◽  
Changmin Lee
Keyword(s):  
Gait Speed ◽  
Functional Outcomes ◽  
Near Infrared ◽  
Gait Training ◽  
Berg Balance Scale ◽  
Cortical Activation ◽  
Control Group ◽  
Stroke Patients ◽  
Robot Assisted ◽  
Functional Near Infrared Spectroscopy

OBJECTIVE: To investigate the effects of the robot–assisted gait training on cortical activation and functional outcomes in stroke patients. METHODS: The patients were randomly assigned: training with Morning Walk® (Morning Walk group; n = 30); conventional physiotherapy (control group; n = 30). Rehabilitation was performed five times a week for 3 weeks. The primary outcome was the cortical activation in the Morning Walk group. The secondary outcomes included gait speed, 10-Meter Walk Test (10MWT), FAC, Motricity Index–Lower (MI–Lower), Modified Barthel Index (MBI), Rivermead Mobility Index (RMI), and Berg Balance Scale (BBS). RESULTS: Thirty-six subjects were analyzed, 18 in the Morning Walk group and 18 in the control group. The cortical activation was lower in affected hemisphere than unaffected hemisphere at the beginning of robot rehabilitation. After training, the affected hemisphere achieved a higher increase in cortical activation than the unaffected hemisphere. Consequently, the cortical activation in affected hemisphere was significantly higher than that in unaffected hemisphere (P = 0.036). FAC, MBI, BBS, and RMI scores significantly improved in both groups. The Morning Walk group had significantly greater improvements than the control group in 10MWT (P = 0.017), gait speed (P = 0.043), BBS (P = 0.010), and MI–Lower (P = 0.047) scores. CONCLUSION: Robot-assisted gait training not only improved functional outcomes but also increased cortical activation in stroke patients.

The effects of robot-assisted gait training on locomotor function in subjects with multiple sclerosis: A three months follow-up study

2011 ◽  
Vol 33 ◽  
pp. S12-S13 ◽  
Author(s):  
E. Venturini ◽  
L. Balugani ◽  
F. Zarattin ◽  
G. Ferraresi ◽  
S. Straudi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Gait Training ◽  
Robot Assisted ◽  
Locomotor Function ◽  
Follow Up Study

Does robot-assisted gait training improve ambulation in highly disabled multiple sclerosis people? A pilot randomized control trial

2016 ◽  
Vol 23 (5) ◽  
pp. 696-703 ◽  
Author(s):  
Alessandra Pompa ◽  
Giovanni Morone ◽  
Marco Iosa ◽  
Luca Pace ◽  
Sheila Catani ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Outcome Measures ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Gait Training ◽  
Control Group ◽  
Robot Assisted ◽  
Robotic Training ◽  
Global Mobility ◽  
Pilot Randomized Control Trial

Background: Robotic training is commonly used to assist walking training in patients affected by multiple sclerosis (MS) with non-conclusive results. Objective: To compare the effect of robot-assisted gait training (RAGT) with that of conventional walking training (CWT) on gait competencies, global ability, fatigue and spasticity in a group of severely affected patients with MS. Methods: A pilot, single-blind randomized controlled trial was conducted in 43 severe (Expanded Disability Status Scale (EDSS) score of 6–7.5) and non-autonomous ambulant in-patients with MS. Experimental group performed 12 sessions of RAGT, whereas control group performed the same amount of CWT. Primary outcome measures were gait ability assessed by 2 minutes walking test and Functional Ambulatory Category; secondary outcomes were global ability (modified Barthel Index), global mobility (Rivermead Mobility Index), severity of disease (EDSS) and subjectively perceived fatigue (Fatigue Severity Scale). Results: The number of subjects who achieved a clinical significant improvement was significantly higher in RAGT than in CWT ( p < 0.05 for both primary outcome measures). RAGT also led to an improvement in all the other clinical parameters (global ability: p < 0.001, global mobility: p < 0.001, EDSS: p = 0.014 and fatigue: p = 0.001). Conclusions: RAGT improved the walking competencies in non-autonomous ambulant patients with MS, with benefits in terms of perceived fatigue.

Robot-assisted gait training is not superior to intensive overground walking in multiple sclerosis with severe disability (the RAGTIME study): A randomized controlled trial

2019 ◽  
Vol 26 (6) ◽  
pp. 716-724 ◽  
Author(s):  
Sofia Straudi ◽  
Fabio Manfredini ◽  
Nicola Lamberti ◽  
Carlotta Martinuzzi ◽  
Elisa Maietti ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Randomized Controlled Trial ◽  
Gait Speed ◽  
Controlled Trial ◽  
Gait Training ◽  
Overground Walking ◽  
Robot Assisted ◽  
Randomized Controlled ◽  
End Of Treatment

Background: Rehabilitation may attenuate the impact on mobility of patients with progressive multiple sclerosis (MS) and severe gait disabilities. Objective: In this randomized controlled trial, we compared robot-assisted gait training (RAGT) with conventional therapy (CT) in terms of gait speed, mobility, balance, fatigue and quality of life (QoL). Methods: Seventy-two patients with MS (expanded disability status scale score 6.0–7.0) were randomized to receive 12 training sessions over a 4-week period of RAGT ( n = 36) or overground walking therapy ( n = 36). The primary outcome was gait speed, assessed by the timed 25-foot walk test. Secondary outcome measures were walking endurance, balance, depression, fatigue and QoL. Tests were performed at baseline, intermediate, at the end of treatment and at a 3-month follow-up. Results: Sixty-six patients completed the treatments. At the end of treatment with respect to baseline, both groups significantly improved gait speed ( p < 0.001) and most secondary outcomes without between-group differences. Outcome values returned to baseline at follow-up. Conclusions: RAGT was not superior to CT in improving gait speed in patients with progressive MS and severe gait disabilities where a positive, even transitory, effect of rehabilitation was observed.

scholarly journals The Effects of Over-Ground Robot-Assisted Gait Training for Children with Ataxic Cerebral Palsy: A Case Report

Sensors ◽  
2021 ◽  
Vol 21 (23) ◽  
pp. 7875
Author(s):  
Myungeun Yoo ◽  
Jeong Hyeon Ahn ◽  
Eun Sook Park
Keyword(s):  
Cerebral Palsy ◽  
Conventional Therapy ◽  
Independent Living ◽  
Gait Training ◽  
Robot Assisted ◽  
Ataxic Gait ◽  
Timed Up And Go ◽  
Walking Capacity ◽  
Before And After ◽  
Gait Function

Poor balance and ataxic gait are major impediments to independent living in ataxic cerebral palsy (CP). Robot assisted-gait training (RAGT) has been shown to improve the postural balance and gait function in children with CP. However, there is no report on the application of RAGT for children with ataxic CP. Here, we report two cases of children with ataxic CP who underwent over-ground RAGT along with conventional therapy for 4 weeks. Outcome measures including the gross motor function measure (GMFM), pediatric balance scale, pediatric reach scale, one-minute walk test, and Timed Up and Go test were assessed before and after the 4-week intervention. Both cases were well adapted to the RAGT system without any significant adverse event. Improvements in the GMFM after RAGT, compared with that in the GMFM, after intensive conventional therapy have been reported previously. It is noteworthy that over-ground RAGT improved areas of the GMFM that did not improve with conventional therapy. In addition, over-ground RAGT with conventional therapy led to improvements in functional balance and walking capacity. These findings suggest that over-ground RAGT is feasible and may be a potential option for enhancing balance and functional walking capacity in children with ataxic CP.

scholarly journals In vivo high-resolution structural MRI-based atlas of human thalamic nuclei

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Manojkumar Saranathan ◽  
Charles Iglehart ◽  
Martin Monti ◽  
Thomas Tourdias ◽  
Brian Rutt
Keyword(s):  
Multiple Sclerosis ◽  
Essential Tremor ◽  
Healthy Subjects ◽  
Neurological Diseases ◽  
Structural Mri ◽  
Thalamic Nuclei ◽  
Conventional Mri ◽  
Mri Scans ◽  
Using Data

AbstractThalamic nuclei play critical roles in regulation of neurological functions like sleep and wakefulness. They are increasingly implicated in neurodegenerative and neurological diseases such as multiple sclerosis and essential tremor. However, segmentation of thalamic nuclei is difficult due to their poor visibility in conventional MRI scans. Sophisticated methods have been proposed which require specialized MRI acquisitions and complex post processing. There are few high spatial resolution (1 mm3 or higher) in vivo MRI thalamic atlases available currently. The goal of this work is the development of an in vivo MRI-based structural thalamic atlas at 0.7 × 0.7 × 0.5 mm resolution based on manual segmentation of 9 healthy subjects using the Morel atlas as a guide. Using data analysis from healthy subjects as well as patients with multiple-sclerosis and essential tremor and at 3T and 7T MRI, we demonstrate the utility of this atlas to provide fast and accurate segmentation of thalamic nuclei when only conventional T1 weighted images are available.

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