Authors (including presenting author) :
Cheung EYY, Wong EYW, Woo CW, Lau ACH, Lee JKY, Wong JTM, Chow KKT, Chau RMW
Affiliation :
Physiotherapy Department, Kowloon Hospital
Introduction :
Patients with severe neurological deficits may require heavy assistance in performing ambulation training which causes fatigue to both patients and therapists. Wheelchair maneuver training was the only functional ambulation training for patients with dependent mobility in the old days. With sufficient training, patients can ambulate in barrier-free environments independently. However, the vasomotor system is not challenged enough and the prolonged sitting position hinders the possibility of upright ambulation training. In early 2000s, robotic-assisted body weight supported treadmill training(RABWSTT) was developed to provide walking training with minimal manual assistance[1]. Robot-controlled orthosis assists lower limb movement during walking training while a harness system is used in combination to reduce the body weight support contributed by patient.
Objectives :
The current study aims at reviewing the effectiveness of RABWSTT in patients with neurological disorders in Kowloon Hospital.
Methodology :
Since 2013, Physiotherapy Department of Kowloon Hospital has implemented the RABWSTT system to facilitate ambulation training for people with neurological disorders. Outcome measures, including walking independence by using Modified Functional Ambulation Classification(MFAC), walking speed by 10-meter walk test(10MWT), and cardiovascular function by using submaximal exercise stress test.
Result & Outcome :
Seventy-four patients, with mainly spinal cord injury(SCI) and stroke, participated in the training. Patients showed improvement in walking independence of an average improvement of 1 category in MFAC. The time of completion of 10MWT was improved 5.04% from 13.9s to 13.2s. The training also promoted the cardiovascular system by improving the maximal oxygen consumption 2.72% from 25.7L/kg/min to 26.4L/kg/min.
With advancement of technology, overground exoskeleton training was developed in recent years to allow ambulation training with normal body weight supported by patients to maximize afferent feedback for neuroplasticity[2]. We have implemented the training for patients with SCI and 6 patients have completed 20 sessions of training. The patients yielded mean improvement in walking speed by 10MWT of 39.4s (34.4% improvement). The patient also walked 14.6m longer (61.0% improvement) in Six-minute Walk Test. Improvement of MAFC in one level was found.
The advancement of technology makes early repetitive upright ambulation training possible. Walking speed, endurance, independence and cardiovascular functions are also benefited. Further implementation of the patient’s buy-in ambulation training to different clientele is warranted to promote both clinical and functional outcomes of the patients.
