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Slow versus fast robot-assisted locomotor training after severe stroke: a randomized controlled trial
Rodrigues TA, Goroso DG, Westgate PM, Carrico C, Batistella LR, Sawaki L
American Journal of Physical Medicine & Rehabilitation 2017 Oct;96(10):S165-S170
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND AND PURPOSE: Robot-assisted locomotor training on a bodyweight-supported treadmill is a rehabilitation intervention that compels repetitive practice of gait movements. Standard treadmill speed may elicit rhythmic movements generated primarily by spinal circuits. Slower-than-standard treadmill speed may elicit discrete movements, which are more complex than rhythmic movements and involve cortical areas. OBJECTIVE: Compare effects of fast (ie, rhythmic) versus slow (ie, discrete) robot-assisted locomotor training on a bodyweight-supported treadmill in subjects with chronic, severe gait deficit after stroke. METHODS: Subjects (n = 18) were randomized to receive 30 sessions (5 d/wk) of either fast or slow robot-assisted locomotor training on a bodyweight-supported treadmill in an inpatient setting. Functional ambulation category, time up and go, 6-min walk test, 10-m walk test, Berg Balance Scale, and Fugl-Meyer Assessment were administered at baseline and postintervention. RESULTS: The slow group had statistically significant improvement on functional ambulation category (first quartile-third quartile, p = 0.004), 6-min walk test (95% confidence interval (CI) 1.8 to 49.0, p = 0.040), Berg Balance Scale (95% CI 7.4 to 14.8, p < 0.0001), time up and go (95% CI -79.1 to 5.0, p < 0.0030), and Fugl-Meyer Assessment (95% CI 24.1 to 45.1, p < 0.0001). The fast group had statistically significant improvement on Berg Balance Scale (95% CI 1.5 to 10.5, p = 0.02). CONCLUSIONS: In initial stages of robot-assisted locomotor training on a bodyweight-supported treadmill after severe stroke, slow training targeting discrete movement may yield greater benefit than fast training.

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