PMID- 30171076
OWN - NLM
STAT- MEDLINE
DCOM- 20190826
LR  - 20190826
IS  - 1526-632X (Electronic)
IS  - 0028-3878 (Linking)
VI  - 91
IP  - 14
DP  - 2018 Oct 2
TI  - Robot-assisted gait training to reduce pusher behavior: A randomized controlled 
      trial.
PG  - e1319-e1327
LID - 10.1212/WNL.0000000000006276 [doi]
AB  - OBJECTIVE: To determine the effects of 2 weeks of intensive robot-assisted gait 
      training (RAGT) on pusher behavior compared to nonrobotic physiotherapy (nR-PT). 
      METHODS: In a single-blind, randomized, controlled trial with 2 parallel arms, we 
      compared 2 weeks of daily RAGT (intervention group) with the same amount of nR-PT 
      (control group). Patients with subacute stroke who had pusher behavior according 
      to the Scale for Contraversive Pushing (SCP) were included. The primary research 
      questions were whether changes in pusher behavior would differ between groups 
      post intervention, and at a follow-up 2 weeks afterward (SCP and Burke 
      Lateropulsion Scale, Class II evidence). Secondary outcomes included the 
      Performance-Oriented Mobility Assessment, the Functional Ambulation 
      Classification, and the Subjective Visual Vertical. RESULTS: Thirty-eight 
      patients were randomized. Thereof, 30 patients received the allocated 
      intervention and were included in the analyses. RAGT led to a larger reduction of 
      pusher behavior than nR-PT at post test (SCP: U = 69.00, r = -0.33, p = 0.037; 
      Burke Lateropulsion Scale: U = 47.500, r = -0.50, p = 0.003) and at follow-up 
      (SCP: U = 54.00, r = -0.44, p = 0.008). Pusher behavior had ceased in 6 of 15 
      participants in the intervention group and 1 of 15 participants in the control 
      group at post test. At follow-up, 9 of 15 and 5 of 15 participants, respectively, 
      no longer exhibited the behavior. CONCLUSIONS: Two weeks of RAGT seems to 
      persistently reduce pusher behavior, possibly by recalibrating the disturbed 
      inner reference of verticality. The potential benefits of RAGT on pusher behavior 
      and verticality perception require further investigation. TRIAL REGISTRATION: 
      German Clinical Trials Register (registration number: DRKS00003444). 
      CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that RAGT is 
      beneficial to reduce pusher behavior in patients with stroke.
CI  - (c) 2018 American Academy of Neurology.
FAU - Bergmann, Jeannine
AU  - Bergmann J
AD  - From the Schoen Klinik Bad Aibling; and German Center for Vertigo and Balance 
      Disorders, Ludwig-Maximilians University of Munich, Germany. 
      jbergmann@Schoen-Kliniken.de.
FAU - Krewer, Carmen
AU  - Krewer C
AD  - From the Schoen Klinik Bad Aibling; and German Center for Vertigo and Balance 
      Disorders, Ludwig-Maximilians University of Munich, Germany.
FAU - Jahn, Klaus
AU  - Jahn K
AD  - From the Schoen Klinik Bad Aibling; and German Center for Vertigo and Balance 
      Disorders, Ludwig-Maximilians University of Munich, Germany.
FAU - Muller, Friedemann
AU  - Muller F
AD  - From the Schoen Klinik Bad Aibling; and German Center for Vertigo and Balance 
      Disorders, Ludwig-Maximilians University of Munich, Germany.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20180831
PL  - United States
TA  - Neurology
JT  - Neurology
JID - 0401060
MH  - Aged
MH  - Brain Ischemia/rehabilitation
MH  - Cerebral Hemorrhage/rehabilitation
MH  - Female
MH  - Follow-Up Studies
MH  - *Gait
MH  - Humans
MH  - Male
MH  - Perceptual Disorders/etiology/rehabilitation
MH  - *Posture
MH  - *Robotics
MH  - Severity of Illness Index
MH  - Single-Blind Method
MH  - *Stroke Rehabilitation/methods
MH  - *Therapy, Computer-Assisted/methods
MH  - Treatment Outcome
EDAT- 2018/09/02 06:00
MHDA- 2019/08/27 06:00
CRDT- 2018/09/02 06:00
PHST- 2017/11/24 00:00 [received]
PHST- 2018/07/02 00:00 [accepted]
PHST- 2018/09/02 06:00 [pubmed]
PHST- 2019/08/27 06:00 [medline]
PHST- 2018/09/02 06:00 [entrez]
AID - WNL.0000000000006276 [pii]
AID - 10.1212/WNL.0000000000006276 [doi]
PST - ppublish
SO  - Neurology. 2018 Oct 2;91(14):e1319-e1327. doi: 10.1212/WNL.0000000000006276. Epub 
      2018 Aug 31.