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Does robotic gait training improve balance in Parkinson's disease? A randomized controlled trial.
No full textBACKGROUND: Treadmill training (with or without robotic assistance) has been reported to improve balance skills in patients with Parkinson's disease (PD). However, its effectiveness on postural instability has been evaluated mainly in patients with mild to moderate PD (Hoehn & Yahr stage ≤3). Patients with more severe disease may benefit from robot-assisted gait training performed by the Gait-Trainer GT1, as a harness supports them with their feet placed on motor-driven footplates. The aim of this study was to determine whether robot-assisted gait training could have a positive influence on postural stability in patients with PD at Hoehn & Yahr stage 3-4.
METHODS: Thirty-four patients with PD at Hoehn & Yahr stage 3-4 were randomly assigned into two groups. All patients received twelve, 40-min treatment sessions, three days/week, for four consecutive weeks. The Robotic Training group (n = 17) underwent robot-assisted gait training, while the Physical Therapy group (n = 17) underwent a training program not specifically aimed at improving postural stability. Patients were evaluated before, immediately after and 1-month post-treatment. Primary outcomes were: Berg Balance scale; Nutt's rating.
RESULTS: A significant improvement was found after treatment on the Berg Balance Scale and the Nutt's rating in favor of the Robotic Training group (Berg: 43.44 ± 2.73; Nutt: 1.38 ± 0.50) compared to the Physical Therapy group (Berg: 37.27 ± 5.68; Nutt: 2.07 ± 0.59). All improvements were maintained at the 1-month follow-up evaluation.
CONCLUSIONS: Robot-assisted gait training may improve postural instability in patients with PD at Hoehn & Yahr stage 3-4
Robot-assisted gait training is not superior to balance training for improving postural instability in patients with mild to moderate Parkinson's disease: a single-blind randomized controlled trial.
No full textObjective: The main aim was to compare robotic gait training vs. balance training for reducing postural instability in patients with Parkinson's disease. The secondary aim was to compare their effects on the level of confidence during activities of daily living requiring balance, functional mobility and severity of disease. Design: Randomized controlled trial. Setting: University hospital. Subjects: A total of 66 patients with Parkinson's disease at Hoehn and Yahr Stage 3. Intervention: After balanced randomization, all patients received 12, 45-minute treatment sessions, three days a week, for four consecutive weeks. A group underwent robot-assisted gait training with progressive gait speed increasing and body-weight support decreasing. The other group underwent balance training aimed at improving postural reactions (self and externally induced destabilization, coordination, locomotor dexterity exercises). Main measures: Patients were evaluated before, after and one month posttreatment. Main outcome measure: Berg Balance Scale. Secondary outcomes: Activities-Specific Balance Confidence Scale; Timed Up and Go Test; Unified Parkinson's Disease Rating Scale. Results: No significant differences were found between the groups for the Berg Balance Scale either immediately after intervention (mean score in the robotic training group 51.58 ±3.94; mean score in the balance training group 51.15 ±3.46), or one-month follow-up (mean score in the robotic training group 51.03 ±4.63; mean score in the balance training group 50.97 ±4.28). Similar results were found for all the secondary outcome measures
STUDIO RANDOMIZZATO CONTROLLATO SUGLI EFFETTI DEL GANGTRAINER NEI DISTURBI DELLA DEAMBULAZIONE IN PAZIENTI AFFETTI DA MALATTIA DI PARKINSON
No full textIl morbo di Parkinson è una malattia neurodegenerativa cronico-progressiva che coinvolge i neuroni dopaminergici della sostanza nera e caratterizzata da tremore, rigidità e bradicinesia, uniti ad altre manifestazioni di tipo motorio, (freezing, amimia, instabilità posturale). Scopo del presente studio è di valutare l’efficacia del training della deambulazione eseguito mediante l’impiego del dispositivo robotico Gang-Trainer GT1 in pazienti affetti da Morbo di Parkinson, confrontandolo con un trattamento convenzionale. 36 soggetti affetti da Morbo di Parkinson, con stadio di malattia Hohen & Yahr compreso tra 2,5 e 3 sono stati assegnati, dopo randomizzazione, a due gruppi di trattamento: robotico (18) e convenzionale (18). Il trattamento consisteva di 12 sedute, da 45 minuti ciascuna, tre volte a settimana, di rieducazione al cammino. Le valutazioni sono state eseguite prima, subito alla fine e dopo un mese dal termine del trattamento. Misure primarie di outcome: six-minute walking test, ten meters walking test. Misure secondarie di outcome: analisi spazio-temporale del cammino con GAITRite System, in particolare lunghezza del passo, coefficiente di variazione della durata del passo, cadenza e rapporto tra durata di singolo e doppio supporto, Parkinson Fatigu Scale (PFS), UPDRS. Al Mann-Whitney test, il gruppo trattato con Gang-Trainer ha mostrato un miglioramento statisticamente significativo, nei confronti del gruppo di controllo, dei seguenti outcome: six-minute walking test, ten meters walking test, lunghezza del passo, rapporto tra singolo/doppio supporto, PFS e UPDRS, sia al post-trattamento che al follow-up. I risultati ottenuti dal presente studio indicano l’efficacia di un trattamento riabilitativo del cammino basato su un dispositivo robotico nei soggetti con Malattia di Parkinson rispetto ad un trattamento riabilitativo di tipo convenzionale
Does robotic gait training improve balance in Parkinson's disease? A randomized controlled trial.
No full textBACKGROUND: Treadmill training (with or without robotic assistance) has been reported to improve balance skills in patients with Parkinson's disease (PD). However, its effectiveness on postural instability has been evaluated mainly in patients with mild to moderate PD (Hoehn & Yahr stage ≤3). Patients with more severe disease may benefit from robot-assisted gait training performed by the Gait-Trainer GT1, as a harness supports them with their feet placed on motor-driven footplates. The aim of this study was to determine whether robot-assisted gait training could have a positive influence on postural stability in patients with PD at Hoehn & Yahr stage 3-4.
METHODS: Thirty-four patients with PD at Hoehn & Yahr stage 3-4 were randomly assigned into two groups. All patients received twelve, 40-min treatment sessions, three days/week, for four consecutive weeks. The Robotic Training group (n = 17) underwent robot-assisted gait training, while the Physical Therapy group (n = 17) underwent a training program not specifically aimed at improving postural stability. Patients were evaluated before, immediately after and 1-month post-treatment. Primary outcomes were: Berg Balance scale; Nutt's rating.
RESULTS: A significant improvement was found after treatment on the Berg Balance Scale and the Nutt's rating in favor of the Robotic Training group (Berg: 43.44 ± 2.73; Nutt: 1.38 ± 0.50) compared to the Physical Therapy group (Berg: 37.27 ± 5.68; Nutt: 2.07 ± 0.59). All improvements were maintained at the 1-month follow-up evaluation.
CONCLUSIONS: Robot-assisted gait training may improve postural instability in patients with PD at Hoehn & Yahr stage 3-4
Robot-assisted gait training in patients with parkinson disease: a randomized controlled trial.
No full textBACKGROUND: Gait impairment is a common cause of disability in Parkinson disease (PD). Electromechanical devices to assist stepping have been suggested as a potential intervention. OBJECTIVE: To evaluate whether a rehabilitation program of robot-assisted gait training (RAGT) is more effective than conventional physiotherapy to improve walking. METHODS: A total of 41 patients with PD were randomly assigned to 45-minute treatment sessions (12 in all), 3 days a week, for 4 consecutive weeks of either robotic stepper training (RST; n = 21) using the Gait Trainer or physiotherapy (PT; n = 20) with active joint mobilization and a modest amount of conventional gait training. Participants were evaluated before, immediately after, and 1 month after treatment. Primary outcomes were 10-m walking speed and distance walked in 6 minutes. RESULTS: Baseline measures revealed no statistical differences between groups, but the PT group walked 0.12 m/s slower; 5 patients withdrew. A statistically significant improvement was found in favor of the RST group (walking speed 1.22 ± 0.19 m/s [P = .035]; distance 366.06 ± 78.54 m [P < .001]) compared with the PT group (0.98 ± 0.32 m/s; 280.11 ± 106.61 m). The RAGT mean speed increased by 0.13 m/s, which is probably not clinically important. Improvements were maintained 1 month later. CONCLUSIONS: RAGT may improve aspects of walking ability in patients with PD. Future trials should compare robotic assistive training with treadmill or equal amounts of overground walking practice
ROBOT-ASSISTED GAIT TRAINING VERSUS TREADMILL TRAINING NEL TRATTAMENTO DELL’INSTABILITÀ POSTURALE NELLA MALATTIA DI PARKINSON: STUDIO RANDOMIZZATO CONTROLLATO SU 54 PAZIENTI
No full textIntroduzione - L’instabilità posturale è disabilitante per il paziente con Parkinson. Vi sono evidenze che il Treadmill Training (TT) possa avere un effetto positivo sull’equilibrio nella malattia di Parkinson (1-3). Scopo dello studio è valutare l’efficacia di un trattamento robotico del cammino (GT) versus TT nei soggetti con Parkinson affetti da instabilità posturale. Materiali e Metodi - Criteri d’inclusione: diagnosi di Parkinson; punteggio Hoehn & Yahr di 3; Mini Mental State Examination superiore a 23. Criteri d’esclusione: gravi discinesie; variazioni della terapia farmacologica durante lo studio; altre condizioni neurologiche o ortopediche in grado di influenzare lo studio; co-morbidità cardiovascolari. I partecipanti allo studio sono stati randomizzati in tre gruppi di trattamento. Ogni paziente ha seguito un programma di 12 sedute riabilitative di 45 minuti ciascuna, 3 volte la settimana per 4 settimane consecutive. Gruppo 1: training robotico del passo tramite GT. Gruppo 2: training del passo tramite TT. Gruppo 3: trattamento riabilitativo convenzionale. I pazienti sono stati valutati prima (T0), subito al termine (T1) e a un mese di distanza dalla fine del trattamento (T2). Outcome primario: Berg Balance Scale; Nutt rating. Outcome secondario: Timed up & go test; Activities-specific Balance Confidence; Unified Parkinson’s Disease Rating Scale; Geriatric Depression Scale. Per l’analisi statistica è stata eseguita una ANOVA 3x3. Il Tukey test è stato usato per le comparazioni post-hoc. La significatività statistica è stata posta per valori di p<0,05. Risultati - Sono stati reclutati 54 pazienti affetti da malattia di Parkinson idiopatica. Nelle misure di outcome primario e nella Activities-specific Balance Confidence sono stati osservati miglioramenti significativi tra i gruppi 1-3 e i gruppi 2-3, ma non tra i gruppi 1-2 nelle comparazioni post-hoc. Conclusioni - Il trattamento mediante GT e quello mediante TT sembrano essere in grado di migliorare l’equilibrio nei pazienti affetti da morbo di Parkinson rispetto al trattamento convenzionale. Non appaiono evidenti differenze tra l’effetto del GT e del TT nella categoria di pazienti oggetto di studio
ROBOTIC GAIT TRAINING VERSUS EQUAL INTENSITY TREADMILL TRAINING IN PARKINSON DISEASE: A RANDOMIZED CONTROLLED TRIAL
No full textIntroduction. There is a lack of evidence about the most effective strategy for training gait in mild to moderate Parkinson disease. The aim of this study was to compare the effects of robotic gait training versus equal intensity treadmill training and conventional physiotherapy on walking ability in patients with mild to moderate Parkinson disease. Materials and methods. Sixty patients with Parkinson disease (Hoehn and Yahr stage 3) were randomly assigned into three groups. All patients received twelve, 45-minute treatment sessions, three days a week, for four consecutive weeks. The Robotic Gait Training group (n=20) underwent robot-assisted gait training. The Treadmill Training group (n=20) performed equal intensity treadmill training without body-weight support. The Physical Therapy group (n=20) underwent conventional gait therapy according to the proprioceptive neuromuscular facilitation concept. Patients were evaluated before, after and 3 months post-treatment. Primary outcomes were the 10-meter walking test and the sixminute walking test. Results. As to the primary outcomes, robotic gait training and equal intensity treadmill training were found more effective than conventional physiotherapy after treatment, as well as no significant difference was found between robotic gait training and treadmill training. Findings were confirmed at the 3-month followup evaluation. Only patients who underwent robotic gait training obtained clinically meaningful improvements in the 10-meter walking test (0.28±0.08m/ s) and the six-minute walking test (84.75±25.85m) after treatment. Conclusions. Our findings support the hypothesis that robotic gait training may be more clinically effective for improving walking ability than equal intensity treadmill training and conventional physiotherapy in mild to moderate Parkinson disease
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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