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Abstract
This study was designed to investigate the feasibility and the potential effects on walking performance of a short gait training with a novel impairment-specific hip assistance (iHA) through a bilateral active pelvis orthosis (APO) in patients with acquired brain injury (ABI). Fourteen subjects capable of independent gait and exhibiting mild-to-moderate gait deficits, due to an ABI, were enrolled. Subjects presenting deficit in hip flexion and/or extension were included and divided into two groups based on the presence (group A, n = 6) or absence (group B, n = 8) of knee hyperextension during stance phase of walking. Two iHA-based profiles were developed for the groups. The protocol included two overground gait training sessions using APO, and two evaluation sessions, pre and post training. Primary outcomes were pre vs. post-training walking distance and steady-state speed in the 6-min walking test. Secondary outcomes were self-selected speed, joint kinematics and kinetics, gait symmetry and forward propulsion, assessed through 3D gait analysis. Following the training, study participants significantly increased the walked distance and average steady-state speed in the 6-min walking tests, both when walking with and without the APO. The increased walked distance surpassed the minimal clinically important difference for groups A and B, (respectively, 42 and 57 m > 34 m). In group A, five out of six subjects had decreased knee hyperextension at the post-training session (on average the peak of the knee extension angle was reduced by 36%). Knee flexion during swing phase increased, by 16% and 31%, for A and B groups respectively. Two-day gait training with APO providing iHA was effective and safe in improving walking performance and knee kinematics in ABI survivors. These preliminary findings suggest that this strategy may be viable for subject-specific post-ABI gait rehabilitation.
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Details
1 Scuola Superiore Sant’Anna, The BioRobotics Institute, Pisa, Italy (GRID:grid.263145.7) (ISNI:0000 0004 1762 600X); Scuola Superiore Sant’Anna, Department of Excellence in Robotics & AI, Pisa, Italy (GRID:grid.263145.7) (ISNI:0000 0004 1762 600X)
2 IUVO S.R.L., Pisa, Italy (GRID:grid.263145.7)
3 Valduce Hospital, Villa Beretta Rehabilitation Center, Lecco, Italy (GRID:grid.417206.6) (ISNI:0000 0004 1757 9346)
4 Össur, Reykjavík, Iceland (GRID:grid.426244.2) (ISNI:0000 0004 0625 2831)
5 MossRehab and Einstein Healthcare Network, Department of PM&R, Elkins Park, USA (GRID:grid.419979.b) (ISNI:0000 0004 0453 5483)
6 IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy (GRID:grid.418563.d) (ISNI:0000 0001 1090 9021)
7 IUVO S.R.L., Pisa, Italy (GRID:grid.426244.2)
8 Scuola Superiore Sant’Anna, The BioRobotics Institute, Pisa, Italy (GRID:grid.263145.7) (ISNI:0000 0004 1762 600X); Scuola Superiore Sant’Anna, Department of Excellence in Robotics & AI, Pisa, Italy (GRID:grid.263145.7) (ISNI:0000 0004 1762 600X); IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy (GRID:grid.418563.d) (ISNI:0000 0001 1090 9021)