Characterization of unexpected postural changes during robot-assisted gait training in paraplegic patients.
METHODS
This is a retrospective study.


OBJECTIVE
The objectives of this study were to categorize unexpected postural changes (UPCs) during gait training in paraplegic patients with wearable gait-assist robots, to reveal the incidence of the UPC and its time-dependent changes during initial gait training period and to investigate neurological level-specific differences.


METHODS
This study was conducted in Fujita Health University, Aichi, Japan.


METHODS
We investigated five patients (46.2±14.6 years; lesion level: T6:3, T12:2). All patients had previously achieved gait with wearable robot and walker at supervision level. The UPCs were counted for 2 years and classified according to their type. The time-course data were calculated from the incidence of UPCs for 10 days from initial gait training with the walker. The neurological level-specific differences were investigated between T6 and T12 injuries.


RESULTS
Eighty-five UPCs were observed and classified into three categories: anterior breakdown, posterior breakdown (PBD) and mal-timing. The average rate over the entire period was 0.96±0.62 (incidents/h/subject). PBD, which was defined as hyperflexion of both hip joints, occurred with the highest frequency (0.64±0.64 incidents/h/subject). During initial gait training, there was a gradual decrease in the occurrence of UPC. For neurological level-specific differences, UPCs were observed more frequently in T6 injuries (1.36±0.35 incidents/h/subject) compared with T12 injuries (0.36±0.31 incidents/h/subject).


CONCLUSIONS
PBDs might be the result of near collisions between the trunk of the user and the walker, which make it difficult for the users to move their trunk over an anterior stance limb. Training that is focused upon well-timed forward movements of the walker might be required to avoid the occurrence of this common UPC.
Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan.|Department of Rehabilitation, Kawamura Hospital, Gifu, Japan.
S
S
Koyama
Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan.
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S
Tanabe
Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan.
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E
Saitoh
Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan.
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S
Hirano
Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan.
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Y
Shimizu
Department of Rehabilitation, Fujita Health University Hospital, Toyoake, Japan.
M
M
Katoh
Tomei Brace Company, Seto, Japan.
A
A
Uno
ASKA Corporation, Kariya, Japan.
T
T
Takemitsu
D000328:Adult; D000067190:Exoskeleton Device; D005260:Female; D020233:Gait Disorders, Neurologic / Q000175:diagnosis / Q000503:physiopathology* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000175:diagnosis / Q000503:physiopathology* / Q000534:rehabilitation*; D004856:Postural Balance; D011187:Posture; D015203:Reproducibility of Results; D012371:Robotics / Q000379:methods*; D012680:Sensitivity and Specificity; D013813:Therapy, Computer-Assisted / Q000379:methods; D013904:Thoracic Vertebrae / Q000293:injuries; D016896:Treatment Outcome