Effect of Robot Technology for Post Stroke Gait Improvement

Effect of Robot Technology for Post Stroke footstep ImprovementIntroductionStroke is a one of the almost severe health problem worldwide it is a syndrome characterised by signs and symptoms that develop rapidly resulting in focal and global loss of cerebral functions. These sign and symptoms resulting from vascular insufficiency last for over 24 hours eventu exclusivelyy results in severe physical and working(a) disability or may also cause death.It has been also found that per year prevalence charge per unit of misfortune is broad(prenominal) i.e. 2/1000. However, the mortality rate of buffet is reduce in past few years but it is still the second most cause of death worldwide following inveterate heart disease and third-most leading cause of death in New Zealand following cancer at first and chronic heart disease at second. Moreover, because of the poor functional outcome in majority of post- barb patients, makes touch as an utmost cause of disability worldwide as one-third of post stroke population suffers with severe functional disability even after five years of stroke. Besides, over 7000 stroke incident reports per year in New Zealand 3/4th of this post stroke population have to live dependently on otherwises for their Activities of daily living. Eventually, post-stroke functional disability and reformation cost of post stroke victims results in increase holistic socioeconomic burden in friendship with victim and their respective family member, increases the worldwide economic burden at 4% (Barker, 2010).According to old studies neuroplasticity mechanism plays an imperative role in post-stroke functional progression. In an endeavour to achieve effective functional recovery, it is mandatory to use neuroplasticity mechanism effectively is an inseparable goal to include during the stroke rehabilitation (Pekna, 2012). Whilst, multidisciplinary discussion approach and job specific training embellish with consistent repetition or high durabilit y task practice are also vital for functional recovery after stroke1. Therefore, it is prerequisite to include these fundamental principal during the goal setting of stroke rehabilitation (Langhorne, 2011).Furthermore previous studies reveals coordinated reciprocal movements and pastoral tone is reduce or lost subsequently post-stroke. Therefore, footstep alteration is one of the most common disability among post-stroke patient as 30% of the stroke survivors have impaired walking ability i.e., slow walking velocity in conjunction with decrease endurance and poor ability to adopt constrains during walking (Tilling, 2001). Eventually, in an endeavour to improve activities of daily living and functional independence among stroke victim an independent ambulation is an of the essence(predicate) goal to achieve during stroke rehabilitation.Kwakkel (1999), suggest the imperative role of motor control in improving the ability to control and beat normal pattern of movement. Besides, it h as been also found from studies that for an efficient motor relearning programme it is important to emphasize on the three essential components Neural Muscular and Biomechanical . Therefore, it is essential to focus on high intensity and diversity of specific tasks during the post stroke relearning of skilful movements. Consequently, multidisciplinary approach is supposed to be more beneficial and important for the motor relearning of the stroke patients.Evidently it has been conclude from the previous studies although innumerable of stroke victims reported worldwide besides a huge variability in treatment approaches for post-stroke rehabilitation also exists. Therefore, in manoeuvre to reduce post-stroke disability, it is essential to have a reliable and effective rehabilitation treatment.In the recent years a new engine room with the help of advance computational approaches and sophisticated electromechanical components has been developed and named as Robot. A robot is develop an d design in much(prenominal) a way that it can be re-programmable and perform multi-functional tasks by moving specialize devices. Therefore, it can be used to accomplish a specific task by programming it to produce variable specific motion movements (Pignolo, 2009). As it has been already conclude that the utmost requirements are the consistent repetition or high intensity task practice in stroke rehabilitation because of the available advancement in technology, it is advantageous to use robot as an effective preventive in stroke rehabilitation (Stein, 2012).Majority of studies have been done to determine the effect of conventional rehabilitation approaches on the variables (function and walking speed) associated with pace training of stroke patients. In most of these studies conventional physiotherapy treatment was included to rehabilitate the rate of the stroke patients therefore the results of these studies is mainly based upon whizz treatment approach. Apparently, results of these single treatment approach studies may not be that much beneficial because of the diversity in post-stroke functional loss. Eventually, as soon as robot technology is accepted as an effective intervention for the rehabilitation for stroke majority of studies are now focus on effectiveness of therapeutic rehabilitation robots wallow dramatically.As it has been already found, that the high dosage intensive training and high intensity functional task practice plays an imperative role in stroke rehabilitation. Besides, it has been also reveal that robotic technology has the advantage of delivering this high dosage intensive training and consistent practice of specific functional task. Therefore robot technology as an intervention can play an imperative role in minimizing the adverse post stroke disability effect.Therefore, the aim of the current study is to compare the effect of robotic technology as an intervention on the functional improvement and gait training in the insig ht of severalise that a robotic technology as an intervention enhances functional and gait improvement among post-stroke people.METHODSSearch StrategyIn the present study, a variety of electronic database were attend for the initial writings search EBSCO and Medline health database, Elsevier, PubMed, google, Pedro, AUT library database. Extensive key word were included for the initial search Stroke post-stroke disability neuroplasticity motor disorder functional impairment gait dysfunction stroke rehabilitation conventional treatment approach, robot intervention . In the manoeuvre of standardized approach during the search procedure the list of keyword and all their combinations were used uniformly for searching the literature. Furthermore, additional keywords were added to the main keywords list included round off,critical,meta and systematic review when searching for past review articles on stretching and physical exercise interventions.Study SelectionInclusion Criteria There was not limitation on the date of publication but search was limited to articles publish in face expression. The studies having randomized controlled trial and quasi-experimental studies comparing either the experimental group with another intervention or with a control group were eligible to include in the present study. The study was restricted to those post-stroke patients who are in sub-acute or chronic stage, fully cooperative and able to follow command, having robot assisted rehabilitation for gait impairment and functional disability. Participants included in studies should not have any pathological restricted ROM, amputation of any lower limb joint. Furthermore, pilot studies and single grounds studies were excluded in the present study.Data extractionData from included studies were extracted for the variables of interest Gait improvement and functional independence. Then for the tabulated presentation of data it was then presented in the table 2, under the headings Auth or Study design Intervention Outcome measures and Main findings.Internal validity of the studiesThe internal validity of the included studies for the appraisal and demolishing of intervention were checked through a modified version of the Cochrane Musculoskeletal Injuries Group (CMIG) scoring system that comprises of eleven items covering aspects of study design. A last(a) overall polish off or quality rating (out of a possible 11) for all the included studies was then awarded to each intervention root word.Data synthesisIn all the included studies effect of the robot assisted intervention on post-stroke patients was analysed through gait improvement and functional independence. However, most of the studies included in this literature review also have a diversity in the variables of interest therefore, in an endeavour to check quality of the included studies a pattern of evidence approach was thus used and marked accordingly on the basis of their design and consistency of findin g low quality if it commemorated 5 to 6 ascertain quality if it scored 6 to 8 and high quality if it scored 9 or above. Among the included eight studies one found to be of high quality with score at 9 and remaining studies were of declare quality with an average score at 6 to 8.RESULTSInitially after searching various database, two one thousand articles were identified and out of these articles only twenty articles were found to be appropriate for the abstract review. Thereafter, only 10 text file were found to have the full paper review, and then out of these 8 intervention studies were selected on the basis of the inclusion criteria and were further subject to critical appraisal and scoring. The primary reasons for the rejection of papers were the intervention other than Robot. Secondly, remaining non-included studies were focused on the population having either acute phase of stroke, restricted rom and amputation of the lower limb. The information relating to each paper incl uded in the review is shown Figure 1. Figure 1 FlowchartEfficacy of robot intervention in Stroke rehabilitationSelected variables Robot intervention Gait improvement and Functional independenceTwo thousand paper were found100 articles identified, 20 were suitable for abstract review,10 papers were selected for the full paper review8 intervention studies were selected on the basis of the inclusion criteria and were further subject to critical appraisal and scoringInclusion criteria-RCT Quasi experimental English language Robot intervention Stroke patientsExclusion criteria Restricted rom Amputation, Pilot studies, Single case studiesResults One study include is of high quality score at 9 and seven are of moderate quality score at 6 to 8QualityThe scores related to the quality of the papers (QS) varied from 6 to 9. One paper attained a strong quality score each at 9, while all others were at moderate quality score at 6 to 8. The key elements associated with the quality of each pape r (blinding of subjects and treatment providers etc.), that were not addressed well are presented in display board 1.Table 1 Internal validity of the studiesS.NAuthorABCDEFGHIJKQuality score1Bandy, W.D. (1994)YYYYYNNYYYY92Bandy, W.D. (1997)YYYN.PNNN.PYYYY73Baranda, P. S. (2010),YYYN.PN.PNN.PYYYY74Feland, J. B. (1999).YYYYYNNYYYY95Feland, J. B. (2001)YYYN.PN.PNNYYYY76Ford, G. S. (2005)YYYYNNN.PNYYY77Odunaiya, N.A. (2005)YYYNNN.PNN.PYYY68OHora, J. (2011)YYYNNNNNYYY69Zakas, A. B. (2013)YYYYN.PN.PN.PYYYY8ParticipantsFrom the overall prospective, there were a total of 327 subjects in all the included studies. All the subject included in the studies were stroke patients, having gait impairments and functional dependency. Firstly, it has been found that in all the included studies an informed consent form was gathered from subjects for their ethical approval. Moreover, in order to keep subjects blinded to the interventions a randomization of subjects in different groups was done by an app ropriate manner. Furthermore, in all the included studies Robot intervention was used as an intervention for the rehabilitation of gait and functional independence. The Robotic device used in all the included studies for the intervention was Lokomat.