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Open Access Research article

Robot-assisted walking training for individuals with Parkinson’s disease: a pilot randomized controlled trial

Patrizio Sale1*, Maria Francesca De Pandis2, Domenica Le Pera1, Ivan Sova1, Veronica Cimolin3, Andrea Ancillao1, Giorgio Albertini1, Manuela Galli13, Fabrizio Stocchi1 and Marco Franceschini1*

Author Affiliations

1 IRCCS “San Raffaele Pisana”, Via della Pisana 235, Rome 00163, Italy

2 “San Raffaele Cassino” Institute, Tosinvest Sanità SpA, Rome, Italy

3 Dipartimento di Bioingegneria, Politecnico di Milano, Milan, Italy

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BMC Neurology 2013, 13:50  doi:10.1186/1471-2377-13-50

Published: 24 May 2013

Abstract

Background

Over the last years, the introduction of robotic technologies into Parkinson’s disease rehabilitation settings has progressed from concept to reality. However, the benefit of robotic training remains elusive. This pilot randomized controlled observer trial is aimed at investigating the feasibility, the effectiveness and the efficacy of new end-effector robot training in people with mild Parkinson’s disease.

Methods

Design. Pilot randomized controlled trial.

Setting. Robot assisted gait training (EG) compared to treadmill training (CG).

Participants. Twenty cognitively intact participants with mild Parkinson’s disease and gait disturbance.

Interventions. The EG underwent a rehabilitation programme of robot assisted walking for 40 minutes, 5 times a week for 4 weeks. The CG received a treadmill training programme for 40 minutes, 5 times a week for 4 weeks.

Main outcome measures. The outcome measure of efficacy was recorded by gait analysis laboratory. The assessments were performed at the beginning (T0) and at the end of the treatment (T1). The main outcome was the change in velocity. The feasibility of the intervention was assessed by recording exercise adherence and acceptability by specific test.

Results

Robot training was feasible, acceptable, safe, and the participants completed 100% of the prescribed training sessions. A statistically significant improvement in gait index was found in favour of the EG (T0 versus T1). In particular, the statistical analysis of primary outcome (gait speed) using the Friedman test showed statistically significant improvements for the EG (p = 0,0195). The statistical analysis performed by Friedman test of Step length left (p = 0,0195) and right (p = 0,0195) and Stride length left (p = 0,0078) and right (p = 0,0195) showed a significant statistical gain. No statistically significant improvements on the CG were found.

Conclusions

Robot training is a feasible and safe form of rehabilitative exercise for cognitively intact people with mild PD. This original approach can contribute to increase a short time lower limb motor recovery in idiopathic PD patients. The focus on the gait recovery is a further characteristic that makes this research relevant to clinical practice. On the whole, the simplicity of treatment, the lack of side effects, and the positive results from patients support the recommendation to extend the use of this treatment. Further investigation regarding the long-time effectiveness of robot training is warranted.

Trial registration

ClinicalTrials.gov NCT01668407

Keywords:
Parkinson’s disease; Gait analysis; Lower limb; Robot