Robot-assisted gait training in Parkinson's disease

Robot-assisted gait training with the THERA-Trainer lyra with end-effector-guided steps vs. treadmill training with visual step instructions in patients with Parkinson's disease: A randomized controlled pilot study.

Parkinson's is one of the most common neurodegenerative diseases worldwide [1]. Some of the symptoms, such as balance and gait disorders and the risk of falls, respond poorly to pharmacotherapy [2]. Therefore, physiotherapy is an important component in the treatment of patients with Parkinson's disease [3]. With robot-assisted gait training or treadmill training, patients are able to increase the walking distance and step repetitions during therapy [4]. This is important for motor learning and improving walking ability in everyday life.

The aim of the present study was to investigate whether robot-assisted gait training with the THERA-Trainer lyra with end effector-guided steps can improve stride length more than treadmill training with visually specified steps.

In this randomized, controlled study, 20 patients with Parkinson's disease (Hoehn & Yahr 1-4) were randomly divided into 2 groups: a THERA-Trainer lyra and a treadmill group. Each group received 30 minutes of gait training 3 days per week for 4 weeks. The patients were assessed by a physiotherapist before the procedure, after each treatment and at the end of the procedure. The primary outcome parameter was stride length, measured using the 10-meter walk test.

There were no differences between the two groups at the start of the study. After four weeks, both groups had improved their stride length in the primary target size (THERA-Trainer lyra - Group A: mean 11.50 cm ±6.33; treadmill - Group B: mean 8.30 cm ±7.45), but it no significant differences were found between the two groups (p=0.58). Secondary outcome measures were walking speed and postural stability while walking, which also improved in both groups without significant difference. The results show a trend towards improving gait skills through training with THERA-Trainer lyra, however, larger studies are needed to further investigate the effectiveness of robot-assisted gait training with THERA-Trainer lyra in patients with Parkinson's disease.

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Veronica Seidl

Physiotherapy, Neurological Therapy Center Gmundnerberg, Altmünster, Austria

SOURCES

[1] GBD 2016 Parkinson's Disease Collaborators, 2018

[2] Ceballos-Baumann & Ebersbach, 2018

[3] Keus et al., 2014