Comparison Of Robotic Gait Training To Conventional Manual Gait Training In Stroke Patients
Strokes are one of the leading causes of death in the world, in the United States one in every 20 deaths is caused by having a stroke. These have been visible in not only adults, which can be widely assumed, but also in young children below the age of 15. A stroke can be defined as a disease which has an effect on the arteries which lead up to the brain and is caused when the blood vessel ruptures or becomes clotted, which has significant damage to the oxygen delivery process. When this occurs, the brain does not receive the blood that is needed to oxygenate, therefore that part of the brain then dies. One of the main side effects of a stroke is the loss of sensation in one side of the body, otherwise known as hemiplegia, which in turn can have a detrimental effect on a patient’s mobility and motor skills.
As physiotherapists there are various ways in which we can improve an individual’s value of life after having a stroke, such as assisting stroke nurses in making decisions and applying our knowledge into making decisions as to how the patient should be positioned and when it is an appropriate time for them to start mobilising on their own or with the assistance from someone else, such as medical staff in the hospital, or friends and family when they return home. As technology is vastly advancing new scientific forms of aid have been developed in order to help patients with conditions that affect mobility, in order to improve their value of life. There has been an increase in the awareness of the use of robotic therapy as a walking aid to improve mobility in individuals following stroke.
Lokomat Gait Therapy, specifically, is a highly advanced electromechanical robot which provides a means of automated-assistive walking for patients with decreased mobility. This technological medical intervention had been thought to provide highly intensive physiological gait rehabilitation for severely impaired patients, such as those that have had a stroke. The purpose of this essay is to research the accuracy of Robotic gait training, in comparison to conventional manual gait training in stroke patients, and to justify its use in clinical environments.
The Lokomat is the first robotic walking aid which can be used on a treadmill in order to improve a pateint’s mobility in aiding locomotion. This is composed of an exoskeleton combined with a body weight support structure, it controls the joint angles at the knee and hip to create walking movements. This device has been shown to be more accurate than manual gait training, where physiotherapists would have to come together in order to move a patient’s limbs for them to have the sensation of walking. Robotic gait training uses high end technology and sensors in order to create a constant and accurate gait movement for a specific individual’s needs. The intensity, body weight support and also the speed can be adapted in order to provide gait impaired patients with the ability to experience walking in a safe environment.
The ability to adapt this device to each individual means that movements can be specifically altered in a way in which they would mimic how the patient would walk on their own without assistance. It allows patients to gradually work up to their goals and to develop skills in a more accurate and safer way. Conventional gait training has been said to have a lesser effect on restoring the normal gait patters in stroke patients, in comparison to technological forms of gait training such as the Lokomat. As mentioned previously conventional gait training involves the manual work of physiotherapists, this would involve the use of more than one physiotherapist to control the patients leg movements on a treadmill, therefore it cannot be gatunteed that it will be accurate or the same each time. Which makes it difficult to judge and analyse improvments that the patient is making, if any at all. The process also puts physical strain on the medical staff, which could in turn result in injury or time off work, which is not convenient for them or the area in which they are working in.
The Lokomat can be used by only one physio, were movements can be controlled by the machine, this allowed medical staff to be less strained and decreses chance of injury on them and the patient also. It also allows the physiotherapist to focus on both the patient and their treatment, rather than having to be solely focused on moving the patient’s limbs. This can be more convenient and more comfortable for the patient, if the physiotherapist has time to talk to them during the treatment and communicate with them it may feel like less of a hospital environment and may help them be less stressed about what they are trying to do and under less pressure, which could in turn decrease frustration and get better results. According to the National clinical guidelines for stroke, it is advised that patients should get at least one hour of physiotherapy each day.
However, it is rare that these aims are actually met in most clinical environments. This has been said to be a specifically big issue within the United Kingdom, as patients may only receive half of this up to four days per week, and not every day or for as long as recommended. This can be for many reasons, such as lack of equipment or space or lack of time in a day due to lack of staff to attend to patients for the recommended durations. These barriers are reported in relation to conventional gait therapy. It has been said that many physiotherapists are focusing on low intensity and low dose therapist lead mobilization techniques, although these can be useful to a certain extent they have not shown to be as helpful as robotic gait therapy in stoke patients. The intensity and frequency at which therapy is carried out can have a varying outcome on results. With the use of robotic gait therapy, this would allow patients to have more time to receive treatment, with the use of one physiotherapist. With the use of more than one of these machines, various stoke victims can be treated at once by the same physiotherapist, or fewer staff.
To conclude this research, robotic gait therapy, specifically the Lokomat may be comparable to conventional gait physiotherapy when considering gait speed and walking ability in severely disabled stroke patients. Participation in robot gait therapy is important and effective in recovery. The technological walking aid has a significant number of positive side effects on muscle repair and gait limitations. Although it is suggested that the Lokomat benefits in strengthening muscle in small populations, it has yet to be analysed within larger populations in comparison to the conventional methods. More research is needed into these new technological walking aids in stroke patients with a wider range of subjects in order to make a better comparison.
Overall, the Lokomat is an effective and convenient intervention in which stroke patients can receive rehabilitation from physiotherapists, with further investigation and by increasing the knowledge of medical staff and pateints about this form of rehabilitation, this could become a very successful intervention used in hospitals across the world.
