Neurology, neuropsychiatry, Psychosomatics | 2021
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\xa0 divided into two representative groups (22 and 20 participants). Patients of the 1 st group were training in the ES ExoAtlet for 10\xa0 days (original method and method of differentiation of efforts were used), the 2 nd group was assigned to physical therapy for\xa0 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): 1 st day (1 st ), 12 th day (2 nd ), and 33 rd day (3 rd ). Results and discussion . Comparison of both groups on the 2 nd 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\xa0 muscles, and suppression of the stretch reflex. At the 2 nd CPs, injections of incobotulinum toxin (Xeomin ® ) were performed. On the 3 rd CP, significantly (p<0.05) better results were\xa0 obtained in the 1 st 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 1 st and 3 rd 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.