ABSTRACT
OBJECTIVE: To compare the efficacy of walking function recovery in patients in the early recovery period of ischemic stroke (IS) using an exoskeleton for the lower extremities and an active-passive pedal exercise bike. MATERIAL AND METHODS: An open randomized study of 47 patients in the early recovery period of IS was conducted. The rehabilitation course included exercises on an ExoAtlet exoskeleton in group 1 and exercises on a pedal simulator for active-passive training (5 days a week for 2 weeks) in group 2. Several tests were used to evaluate treatment results, including the Hauser walking index, the 10-meter walking test, the Berg balance scale, stabilometry, and biomechanics of walking. The complete training course was completed by 20 patients of group 1 and 21 of group 2. RESULTS: There was a significant increase in strength in paretic muscles, postural stability, functional level and walking speed in patients of both groups, but in patients of group 1, the dynamics of recovery was more pronounced (p<0.05). In group 1, there was a significant decrease in the level of disability and an increase in daily activity, which was higher compared to group 2. An analysis of the main indicators of the statokinesiogram showed the more pronounced positive shifts in patients of group 1, but significant differences were found only in the dynamics of the length and area of the curve in the test with eyes open. When studying the biomechanics of walking, it was found that the function of walking was changed: there was a significant decrease in the speed of movement by 2.2 times, the length of a double step by 1.6 times, and the pace of walking by 1.3 times compared to normal indicators. After the end of exercises, a significant increase in the length of the double step, speed and pace of walking as well as a decrease in the period of the locomotor cycle were found in group 1. CONCLUSION: The study revealed a positive impact of hardware rehabilitation on locomotion, both with the use of an exoskeleton and an active-passive pedal simulator. The use of an exoskeleton, have the advantages resulting in a significantly greater recovery of strength, stability, speed and symmetry of walking over the same period of training. A significant increase in postural stability in vertical position was revealed.
Subject(s)
Exoskeleton Device , Robotic Surgical Procedures , Robotics , Stroke Rehabilitation , Stroke , Humans , WalkingABSTRACT
INTRODUCTION: Neurodegeneration (ND) is the basis of the gradual increase in neurological deficit and cognitive impairment in patients with multiple sclerosis (MS). Morphometry of the brain is the method for monitoring of ND. The possibility of using neuropsychological tests for this purpose is being actively discussed. AIM: To examine the effect of treatment with interferon beta-1b (IFNb-1b) on the development of the neurodegenerative process according to morphometry and cognitive testing. MATERIAL AND METHODS: Twenty-three patients with relapsing-remitting MS were examined. The control group included 10 healthy people. All patients received IFNb-1b in a dose of 9.6 million IU. EDSS, MSFC, depression and anxiety Beck test, Wechsler test, magnetic resonance imaging (MRI) of the brain, voxel morphometry with FreeSurfer 5.3 were used. The EDSS score was 4.0 before treatment. RESULTS: In MS patients, MSFC and Wechsler scores were worse in comparison with similar indicators of the control group. Deterioration of neurological status, motor function test and PASAT during exacerbation was identified in 7 patients. Morphometry revealed the increase in hypointense white matter lesions (HWML) (p<0.05) in patients with MS. There was a downward trend in the cortical and subcortical gray matter volume and the increase in ventricular volume. A direct correlation between the amount of HWML and the degree of disability on EDSS scale (p=0.018), the inverse correlation between HWML and Wechsler test, PASAT (p<0.05) were identified. After a year of therapy, there were no statistically significant changes in motor and cognitive functions and no signs of 'pseudoatrophy'. CONCLUSION: Morphometric data in MS were changed compared to healthy controls. There were correlations between morphometry results, disability and cognitive dysfunction. After a year of IFNb-1b therapy, there were no significant changes in cognitive function and EDSS.
Subject(s)
Cognitive Dysfunction , Multiple Sclerosis , Disability Evaluation , Disease Progression , Humans , Magnetic Resonance ImagingABSTRACT
AIM: To investigate the efficacy and safety of the exoskeleton ExoAtlet in complex therapy of patients with multiple sclerosis (MS). MATERIAL AND METHODS: A pilot study within the prospective open controlled program was conducted. Eighteen patients with relapsing-remitting MS (RRMS) in remission and secondary progressive MS (SPMS) with the level of neurological deficit on the EDSS from 3 to 7 points have completed the study. EDSS, MSFC, HADS, MoCA scales were administered and the force measuring insoles F-Scan Tekscan (USA) were used to study the biomechanics of walking. RESULTS AND CONCLUSION: Good tolerability of workload within 30-40 min. was observed. The improvement in the EDSS was detected in 9 patients, in whole, a significant positive trend (p<0.01) was shown. The study of the biomechanics of the walk showed its significant impairment compared to healthy individuals: reduction of parameters of rate, speed and step length, significant instability, pronounced asymmetry, the decrease in support and shock lower limb function, high coefficient of variability of the parameters, the phenomenon of recurrence of the vertical component of support reactions. After a course of exercise of walking in the exoskeleton, the walking speed and stability increased, oscillation of the body decreased, support function increased, the phenomenon of cyclical changes of the vertical component of support reactions reduced. The results of the pilot study showed promising future research opportunities for robotic-assisted walking and maintenance of the vertical posture with the help of the exoskeleton ExoAtlet to restore the abilities of movement in MS patients with locomotor disorders.
