Current approaches to restoring walking in patients during the acute phase of cerebral stroke

摘要

The aim of this study was to create a complex program for restoring walking in stroke patients using motor-assisted walking trainers. The study included patients (mean age 59 ± 10.4 years) in the acute phase of stroke who were unable to walk independently; 53 patients were in the study group and 25 in the control group. The mean time from onset to treatment using motor-assisted trainers was 14 ± 1.6 days and was defined on the basis of adequate test results. The rehabilitation program included daily 30-min sessions of physical therapy. Patients of the study group but not controls also received 20-min sessions using Motomed Viva 2 and Gait Trainer 1 (GT1) motor-assisted trainers accompanied by continuous monitoring of arterial blood pressure and heart rate. Patients received 5-12 (mean 7 ± 1) sessions on the GT1. After complex rehabilitation treatment, patients of the study group, as compared with controls, showed significant (p < 0.01) improvements in dynamics on the standing stability, walking functionality, and the Berg and Bartel scales; all patients of this group became able to walk with a support or completely independently. In the study group there were significant (p < 0.05) decreases in the proportions of patients with impaired proprioception (from 37.7% to 9.4%) and lower limb ataxia (from 37% to 11.3%); no such changes occurred in the control group. These results lead to the conclusion that the complex use of reflex kinesiotherapy and robot-driven mechanotherapy in patients during the acute phase of stroke produces improvements in functional activity and increases the level of independence by discharge from hospital.