Autore: SLVGPL96

  • Valutazione dell’equilibrio e del cammino in pazienti con stroke: correlazione tra indici stabilometrici e parametri di gait analysis

    Evaluation of balance and gait in stroke patients: correlation between stabilometric indices and gait analysis parameters

    Introduction

    Stroke is the leading cause of disability worldwide. Restoring balance and a more fluid, safe and correct gait is a prerequisite for the patient to recover autonomy in activities of daily life. Furthermore, a consequence of impaired gait recovery in stroke patients is the high risk of falls, which worsens their quality of life [ 1 ]. Since many falls are predictable, early identification of the risk of falls is crucial for developing tailored interventions to prevent such falls. Recently, an instrumental fall risk assessment index was developed using the Hunova® robotic platform with the aim of giving an early indication of this risk using numerical data of both static and dynamic balance [ 2 ]. In order to combine an instrumental assessment of balance and walking with a clinical evaluation, the aim of this study is to evaluate the correlation between the Silver Index and gait analysis parameters in order to be able to propose more personalized rehabilitation training.

    Methods

    We enrolled 12 stroke patients, aged between 70 and 95 years. The risk of falls evaluation was performed by Hunova® robotic platform computing the Silver Index. The gait was analyzed by an optoelectronic system with 8 infrared cameras (SMART-DX500 – BTS Bioengineering, Milan, IT). We used the Davis protocol that includes 22 markers. For each patient we calculated the mean values as well as the coefficient of variation (CV) and the multiple correlation coefficient (CMC) of spatio-temporal parameters and joint kinematic parameters. We assessed CV and CMC to quantify variability of the discrete and continuous variables, respectively [ 3 ]. We used Spearman test to calculate the correlation between the Silver Index and the gait analysis parameters.

    Results

    The correlation analysis shows a statistically significant correlation between the Silver Index and the stance phase of the unaffected side (%) (p=0.036, ρ=0.700) and between the Silver Index and the swing phase of the unaffected side (%) (p=0.036, ρ=-0.700). Furthermore, the Silver Index correlates with the variability of step width (p=0.007, ρ=-0.816).

    Discussion and Conclusion

    These preliminary results show that the risk of falling is higher in patients who have a longer stance phase of the unaffected limb and a shorter duration of the swing phase always of the unaffected limb. Furthermore, our results show that patients who fall more have less variability in step width. This could be an indication that these patients are unable to make the continuous adjustments that occur physiologically during gait and thus fail to produce dynamic adaptation during walking.

    REFERENCES

    [ 1 ] Cattaneo D, et al. Frontiers in Neurology 2019;10:865.

    [ 2 ] Cella A, et al. PLoS One 2020;15:e0234904.

    [ 3 ] Serrao M, et al. Cerebellum 2012;11(1):194-211.

  • Efficacia della riabilitazione robotica dell’equilibrio nel paziente anziano con esisti di stroke.

    Effectiveness of Robotic Balance Rehabilitation in Elderly Patients with Stroke Outcomes

    Introduction

    Stroke is one of the major socio-health problems, the second leading cause of death, and the primary cause of disability worldwide. Due to the aging of the population, the incidence of this condition is constantly increasing, leading to a rise in the demand for care. In recent years, the rehabilitation landscape has been enriched with new technologies to improve the quality and efficiency of functional recovery after an acute event. Regarding balance, in particular, a robotic device has been developed for the functional sensorimotor evaluation and rehabilitation of lower limbs and trunk. Literature works have shown how this tool, the Hunova® robotic platform, is effective in balance rehabilitation for adults with stroke outcomes. The aim of this study is to evaluate the effects of technological rehabilitation using the Hunova® robotic platform on static and dynamic balance in a group of elderly patients with stroke outcomes

    Methods

    12 elderly patients with stroke outcomes were randomized into two groups: the experimental group (GH) received specific balance disorder rehabilitation on the Hunova® platform for 45 minutes per day, 3 days a week, for 4 weeks, in addition to conventional rehabilitation treatment; the control group (GC) only received the rehabilitation treatment as planned in the rehabilitation project. All patients were clinically and instrumentally assessed at the beginning (T0) and the end (T1) of the treatment. The assessment included the Motricity Index Lower Limb (MI-LL), the Berg Balance Scale (BBS), the Time Up&Go (TUG), Short Physical Performance Battery (SPPB), the Hauser Ambulation Index (HAI), the Functional Ambulation Classification (FAC), and the Walking Handicap Scale (WHS). The instrumental assessment of balance was performed using the Hunova® robotic platform, both in static and dynamic conditions

    Results

    Intra-group analysis in GH shows significant improvement in the MI-LL on both the affected and unaffected sides, and in GC for the MI-LL,TUG,BBS,SPPB,HAI,FAC and WHS on the affected side. Between the groups there is greater improvement in GH compared to GC in the TUG,BBS and HAI. Instrumental assessment reveals statistically significant differences in GH under static conditions with open eyes(OA), in CenterOfPressure(COP) displacement, and in trunk movements; for the closed-eye(OC) evaluation significant differences are observed in trunk movements. Dynamic assessment there is improvement in COP displacement during OA and in trunk movements.Intergroup analysis in static evaluation there is greater improvement in GH compared to GC in COPAreaOC, COPAreaOA and M-L range of trunk oscillations during OA. In dynamic evaluation with OA improvements are seen in COPArea and trunk movement quantity

    Discussion and Conclusion

    From an analysis of preliminary data, it emerges that the group of elderly patients with stroke outcomes who underwent technological balance treatment using the Hunova® robotic platform in combination with conventional therapy, showed greater improvement in both static and dynamic balance, with eyes open and eyes closed, compared to the group that underwent conventional rehabilitation alone

    REFERENCES

    Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic review. Lancet Neurol. 2009; 8, 741-54.