Robot-assisted gait training in patients with Parkinson’s disease: Implications for clinical practice. A systematic review

Issue title: Thematic Issue: Integrating Robot-assisted Therapy Into Neurorehabilitation Clinical Practice: Where Are We Now? Where Are We Heading?

Guest editors: Giovanni Morone, Robert Riener and Stefano Mazzoleni

Article type: Review Article

Authors: Carmignano, Simona Maria^{a; b} | Fundarò, Cira^c | Bonaiuti, Donatella^d | Calabrò, Rocco Salvatore^e | Cassio, Anna^f | Mazzoli, Davide^g | Bizzarini, Emiliana^h | Campanini, Isabellaⁱ | Cerulli, Simona^j | Chisari, Carmelo^k | Colombo, Valentina^l | Dalise, Stefania^k | Gazzotti, Valeria^m | Mazzoleni, Danieleⁿ | Mazzucchelli, Miryamⁿ | Melegari, Corrado^o | Merlo, Andrea^{g; i} | Stampacchia, Giulia^p | Boldrini, Paolo^q | Mazzoleni, Stefano^r | Posteraro, Federico^s | Benanti, Paolo^t | Castelli, Enrico^u | Draicchio, Francesco^v | Falabella, Vincenzo^w | Galeri, Silvia^x | Gimigliano, Francesca^y | Grigioni, Mauro^z | Mazzon, Stefano^aa | Molteni, Franco^bb | Morone, Giovanni^cc | Petrarca, Maurizio^dd | Picelli, Alessandro^ee | Senatore, Michele^ff | Turchetti, Giuseppe^gg | Andrenelli, Elisa^{hh; *}

Affiliations: [a] Centro Terapeutico Riabilitativo (CTR), Potenza, Italy | [b] University of Salerno, Salerno, Italy | [c] Neurophysiopatology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Montescano, Pavia, Italy | [d] Piero Redaelli Geriatric Institute, Milan, Italy | [e] IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy | [f] Spinal Cord Unit and Intensive Rehabilitation Medicine, Ospedale di Fiorenzuola d’Arda, AUSL Piacenza, Piacenza, Italy | [g] Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy | [h] Department of Rehabilitation Medicine, Spinal Cord Unit, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy | [i] Department of Neuromotor and Rehabilitation, LAM-Motion Analysis Laboratory, San Sebastiano Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy | [j] Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy | [k] Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy | [l] Montecatone Rehabilitation Institute, Imola, Italy | [m] Centro Protesi Vigorso di Budrio, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Bologna, Italy | [n] School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy | [o] Elias Neuroriabilitazione, Parma, Italy | [p] Spinal Cord Unit, Pisa University Hospital, Pisa, Italy | [q] Italian Society of Physical Medicine and Rehabilitation (SIMFER), Rome, Italy | [r] Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy | [s] Department of Rehabilitation, Versilia Hospital – AUSL12, Viareggio, Italy | [t] Pontifical Gregorian University, Rome, Italy | [u] Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy | [v] Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy | [w] Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy | [x] IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy | [y] Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy | [z] National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy | [aa] Rehabilitation Unit, ULSS (Local Health Authority) Euganea, Camposampiero Hospital, Padua, Italy | [bb] Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy | [cc] IRCCS Santa Lucia Foundation, Rome, Italy | [dd] Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children’s Hospital, Rome, Italy | [ee] Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy | [ff] Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy | [gg] Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy | [hh] Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy

Correspondence: [*] Address for correspondence: Elisa Andrenelli, Department of Experimental and Clinical Medicine, Neurorehabilitation Clinic, Università Politecnica delle Marche, Via Tronto 10, 60126 Ancona, Ancona, Italy. Tel.: +39 0715964582; E-mail: elisa.andrenelli@gmail.com.

Abstract: BACKGROUND:Gait impairments are common disabling symptoms of Parkinson’s disease (PD). Among the approaches for gait rehabilitation, interest in robotic devices has grown in recent years. However, the effectiveness compared to other interventions, the optimum amount of training, the type of device, and which patients might benefit most remains unclear. OBJECTIVE:To conduct a systematic review about the effects on gait of robot-assisted gait training (RAGT) in PD patients and to provide advice for clinical practice. METHODS:A search was performed on PubMed, Scopus, PEDro, Cochrane library, Web of science, and guideline databases, following PRISMA guidelines. We included English articles if they used a robotic system with details about the intervention, the parameters, and the outcome measures. We evaluated the level and quality of evidence. RESULTS:We included twenty papers out of 230 results: two systematic reviews, 9 randomized controlled trials, 4 uncontrolled studies, and 5 descriptive reports. Nine studies used an exoskeleton device and the remainders end-effector robots, with large variability in terms of subjects’ disease-related disability. CONCLUSIONS:RAGT showed benefits on gait and no adverse events were recorded. However, it does not seem superior to other interventions, except in patients with more severe symptoms and advanced disease.

Keywords: Parkinson’s disease, rehabilitation, gait, medical device

DOI: 10.3233/NRE-220026

Journal: NeuroRehabilitation, vol. 51, no. 4, pp. 649-663, 2022