Skip to main content
Top
Published in: Trials 1/2022

Open Access 01-12-2022 | Stroke | Study protocol

RObotic-Assisted Rehabilitation for balance and gait in Stroke patients (ROAR-S): study protocol for a preliminary randomized controlled trial

Authors: Silvia Giovannini, Chiara Iacovelli, Fabrizio Brau, Claudia Loreti, Augusto Fusco, Pietro Caliandro, Lorenzo Biscotti, Luca Padua, Roberto Bernabei, Letizia Castelli

Published in: Trials | Issue 1/2022

Login to get access

Abstract

Background

Stroke, the incidence of which increases with age, has a negative impact on motor and cognitive performance, quality of life, and the independence of the person and his or her family, leading to a number of direct and indirect costs. Motor recovery is essential, especially in elderly patients, to enable the patient to be independent in activities of daily living and to prevent falls. Several studies have shown how robotic training associated with physical therapy influenced functional and motor outcomes of walking after stroke by improving endurance and walking strategies.
Considering data from previous studies and patients’ needs in gait and balance control, we hypothesized that robot-assisted balance treatment associated with physical therapy may be more effective than usual therapy performed by a physical therapist in terms of improving static, dynamic balance and gait, on fatigue and cognitive performance.

Methods

This is an interventional, single-blinded, preliminary randomized control trial. Twenty-four patients of both sexes will be recruited, evaluated, and treated at the UOC Rehabilitation and Physical Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome from January to December 2022. Patients will be randomized into two groups: the experimental group will perform specific rehabilitation for balance disorder using the Hunova® robotic platform (Movendo Technology srl, Genoa, IT) for 3 times a week, for 4 weeks (12 total sessions), and for 45 min of treatment, in addition to conventional treatment, while the conventional group (GC) will perform only conventional treatment as per daily routine. All patients will undergo clinical and instrumental evaluation at the beginning and end of the 4 weeks of treatment.

Conclusions

The study aims to evaluate the improvement in balance, fatigue, quality of life, and motor and cognitive performance after combined conventional and robotic balance treatment with Hunova® (Movendo Technology srl, Genoa, IT) compared with conventional therapy alone. Robotic assessment to identify the most appropriate and individualized rehabilitation treatment may allow reducing disability and improving quality of life in the frail population. This would reduce direct and indirect social costs of care and treatment for the National Health Service and caregivers.

Trial registration

ClinicalTrials.gov NCT05280587. Registered on March 15, 2022.
Appendix
Available only for authorised users
Literature
1.
go back to reference Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014;383:245–55.CrossRef Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014;383:245–55.CrossRef
2.
go back to reference Gresham GE, Fitzpatrick TE, Wolf PA, McNamara PM, Kannel WB, Dawber TR. Residual disability in survivors of stroke–the Framingham study. N Engl J Med. 1975;293:954–6.CrossRef Gresham GE, Fitzpatrick TE, Wolf PA, McNamara PM, Kannel WB, Dawber TR. Residual disability in survivors of stroke–the Framingham study. N Engl J Med. 1975;293:954–6.CrossRef
3.
go back to reference Fattore G, Torbica A, Susi A, Giovanni A, Benelli G, Gozzo M, et al. The social and economic burden of stroke survivors in Italy: a prospective, incidence-based, multi-centre cost of illness study. BMC Neurol. 2012;12:1–11. Fattore G, Torbica A, Susi A, Giovanni A, Benelli G, Gozzo M, et al. The social and economic burden of stroke survivors in Italy: a prospective, incidence-based, multi-centre cost of illness study. BMC Neurol. 2012;12:1–11.
4.
go back to reference Hatem SM, Saussez G, della Faille M, Prist V, Zhang X, Dispa D, et al. Rehabilitation of motor function after stroke: a multiple systematic review focused on techniques to stimulate upper extremity recovery. Front Hum Neurosci. 2016;10:442.CrossRef Hatem SM, Saussez G, della Faille M, Prist V, Zhang X, Dispa D, et al. Rehabilitation of motor function after stroke: a multiple systematic review focused on techniques to stimulate upper extremity recovery. Front Hum Neurosci. 2016;10:442.CrossRef
5.
go back to reference Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic review. Lancet Neurol. 2009;8:741–54.CrossRef Langhorne P, Coupar F, Pollock A. Motor recovery after stroke: a systematic review. Lancet Neurol. 2009;8:741–54.CrossRef
6.
go back to reference Selves C, Stoquart G, Lejeune T. Gait rehabilitation after stroke: review of the evidence of predictors, clinical outcomes and timing for interventions. Acta Neurol Belg. 2020;120:783–90.CrossRef Selves C, Stoquart G, Lejeune T. Gait rehabilitation after stroke: review of the evidence of predictors, clinical outcomes and timing for interventions. Acta Neurol Belg. 2020;120:783–90.CrossRef
7.
go back to reference Biscetti F, Giovannini S, Straface G, Bertucci F, Angelini F, Porreca C, et al. RANK/RANKL/OPG pathway: genetic association with history of ischemic stroke in Italian population. Eur Rev Med Pharmacol Sci. 2016;20:4574–80.PubMed Biscetti F, Giovannini S, Straface G, Bertucci F, Angelini F, Porreca C, et al. RANK/RANKL/OPG pathway: genetic association with history of ischemic stroke in Italian population. Eur Rev Med Pharmacol Sci. 2016;20:4574–80.PubMed
8.
go back to reference Giovannini S, Brau F, Galluzzo V, Santagada DA, Loreti C, Biscotti L, et al. Falls among older adults: screening, identification, rehabilitation, and management. Appl Sci. 2022;12:7934. Giovannini S, Brau F, Galluzzo V, Santagada DA, Loreti C, Biscotti L, et al. Falls among older adults: screening, identification, rehabilitation, and management. Appl Sci. 2022;12:7934.
9.
go back to reference Giovannini S, Onder G, Leeuwenburgh C, Carter C, Marzetti E, Russo A, et al. Myeloperoxidase levels and mortality in frail community-living elderly individuals. J Gerontol A Biol Sci Med Sci. 2010;65:369–76.CrossRef Giovannini S, Onder G, Leeuwenburgh C, Carter C, Marzetti E, Russo A, et al. Myeloperoxidase levels and mortality in frail community-living elderly individuals. J Gerontol A Biol Sci Med Sci. 2010;65:369–76.CrossRef
10.
go back to reference Onder G, Giovannini S, Sganga F, Manes-Gravina E, Topinkova E, Finne-Soveri H, et al. Interactions between drugs and geriatric syndromes in nursing home and home care: results from Shelter and IBenC projects. Aging Clin Exp Res. 2018;30:1015–21. Onder G, Giovannini S, Sganga F, Manes-Gravina E, Topinkova E, Finne-Soveri H, et al. Interactions between drugs and geriatric syndromes in nursing home and home care: results from Shelter and IBenC projects. Aging Clin Exp Res. 2018;30:1015–21.
11.
go back to reference Laudisio A, Antonelli Incalzi R, Gemma A, Giovannini S, lo Monaco MR, Vetrano DL, et al. Use of proton-pump inhibitors is associated with depression: a population-based study. Int Psychogeriatr. 2018;30:153–9. Laudisio A, Antonelli Incalzi R, Gemma A, Giovannini S, lo Monaco MR, Vetrano DL, et al. Use of proton-pump inhibitors is associated with depression: a population-based study. Int Psychogeriatr. 2018;30:153–9.
13.
go back to reference Aprile I, Iacovelli C, Padua L, Galafate D, Criscuolo S, Gabbani D, et al. Efficacy of robotic-assisted gait training in chronic stroke patients: preliminary results of an Italian bi-centre study. NeuroRehabilitation. 2017;41:775–82.CrossRef Aprile I, Iacovelli C, Padua L, Galafate D, Criscuolo S, Gabbani D, et al. Efficacy of robotic-assisted gait training in chronic stroke patients: preliminary results of an Italian bi-centre study. NeuroRehabilitation. 2017;41:775–82.CrossRef
14.
go back to reference Aprile I, Iacovelli C, Goffredo M, Cruciani A, Galli M, Simbolotti C, et al. Efficacy of end-effector robot-assisted gait training in subacute stroke patients: clinical and gait outcomes from a pilot bi-centre study. NeuroRehabilitation. 2019;45:201–12.CrossRef Aprile I, Iacovelli C, Goffredo M, Cruciani A, Galli M, Simbolotti C, et al. Efficacy of end-effector robot-assisted gait training in subacute stroke patients: clinical and gait outcomes from a pilot bi-centre study. NeuroRehabilitation. 2019;45:201–12.CrossRef
15.
go back to reference Aprile I, Guardati G, Cipollini V, Papadopoulou D, Mastrorosa A, Castelli L, et al. Robotic rehabilitation: an opportunity to improve cognitive functions in subjects with stroke. an explorative study. Front Neurol. 2020;11:588285. Aprile I, Guardati G, Cipollini V, Papadopoulou D, Mastrorosa A, Castelli L, et al. Robotic rehabilitation: an opportunity to improve cognitive functions in subjects with stroke. an explorative study. Front Neurol. 2020;11:588285.
16.
go back to reference Cattaneo D, Carpinella I, Aprile I, Prosperini L, Montesano A, Jonsdottir J. Comparison of upright balance in stroke, Parkinson and multiple sclerosis. Acta Neurol Scand. 2016;133:346–54.CrossRef Cattaneo D, Carpinella I, Aprile I, Prosperini L, Montesano A, Jonsdottir J. Comparison of upright balance in stroke, Parkinson and multiple sclerosis. Acta Neurol Scand. 2016;133:346–54.CrossRef
17.
go back to reference Prosperini L, Castelli L, De Luca F, Fabiano F, Ferrante I, De Giglio L. Task-dependent deterioration of balance underpinning cognitive-postural interference in MS. Neurology. 2016;87:1085–92.CrossRef Prosperini L, Castelli L, De Luca F, Fabiano F, Ferrante I, De Giglio L. Task-dependent deterioration of balance underpinning cognitive-postural interference in MS. Neurology. 2016;87:1085–92.CrossRef
18.
go back to reference Prosperini L, Castelli L, Sellitto G, De Luca F, De Giglio L, Gurreri F, et al. Investigating the phenomenon of “cognitive-motor interference” in multiple sclerosis by means of dual-task posturography. Gait Posture. 2015;41:780–5.CrossRef Prosperini L, Castelli L, Sellitto G, De Luca F, De Giglio L, Gurreri F, et al. Investigating the phenomenon of “cognitive-motor interference” in multiple sclerosis by means of dual-task posturography. Gait Posture. 2015;41:780–5.CrossRef
19.
go back to reference Castelli L, De Luca F, Marchetti MR, Sellitto G, Fanelli F, Prosperini L. The dual task-cost of standing balance affects quality of life in mildly disabled MS people. Neurol Sci. 2016;37:673–9.PubMed Castelli L, De Luca F, Marchetti MR, Sellitto G, Fanelli F, Prosperini L. The dual task-cost of standing balance affects quality of life in mildly disabled MS people. Neurol Sci. 2016;37:673–9.PubMed
20.
go back to reference Aprile I, Conte C, Cruciani A, Pecchioli C, Castelli L, Insalaco S, et al. Efficacy of robot-assisted gait training combined with robotic balance training in subacute stroke patients: a randomized clinical trial. J Clin Med. 2022;11:5162. Aprile I, Conte C, Cruciani A, Pecchioli C, Castelli L, Insalaco S, et al. Efficacy of robot-assisted gait training combined with robotic balance training in subacute stroke patients: a randomized clinical trial. J Clin Med. 2022;11:5162.
21.
go back to reference Castelli L, de Giglio L, Haggiag S, Traini A, de Luca F, Ruggieri S, et al. Premorbid functional reserve modulates the effect of rehabilitation in multiple sclerosis. Neurol Sci. 2020;41:1251–7.CrossRef Castelli L, de Giglio L, Haggiag S, Traini A, de Luca F, Ruggieri S, et al. Premorbid functional reserve modulates the effect of rehabilitation in multiple sclerosis. Neurol Sci. 2020;41:1251–7.CrossRef
22.
go back to reference Imbimbo I, Coraci D, Santilli C, Loreti C, Piccinini G, Ricciardi D, et al. Parkinson’s disease and virtual reality rehabilitation: cognitive reserve influences the walking and balance outcome. Neurol Sci. 2021;42(11):4615-21. Imbimbo I, Coraci D, Santilli C, Loreti C, Piccinini G, Ricciardi D, et al. Parkinson’s disease and virtual reality rehabilitation: cognitive reserve influences the walking and balance outcome. Neurol Sci. 2021;42(11):4615-21.
23.
go back to reference Giovannini S, Macchi C, Liperoti R, Laudisio A, Coraci D, Loreti C, et al. Association of body fat with health-related quality of life and depression in nonagenarians: the Mugello study. J Am Med Dir Assoc. 2019;20:564–8. Giovannini S, Macchi C, Liperoti R, Laudisio A, Coraci D, Loreti C, et al. Association of body fat with health-related quality of life and depression in nonagenarians: the Mugello study. J Am Med Dir Assoc. 2019;20:564–8.
24.
go back to reference Fayazi M, Dehkordi SN, Dadgoo M, Salehi M. Test-retest reliability of Motricity Index strength assessments for lower extremity in post stroke hemiparesis. Med J Islam Repub Iran. 2012;26:27–30. Fayazi M, Dehkordi SN, Dadgoo M, Salehi M. Test-retest reliability of Motricity Index strength assessments for lower extremity in post stroke hemiparesis. Med J Islam Repub Iran. 2012;26:27–30.
25.
go back to reference Berg K, Wood-Dauphinee S, Williams JI. The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. 1995;27:27–36. Berg K, Wood-Dauphinee S, Williams JI. The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. 1995;27:27–36.
26.
go back to reference Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142–8. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39:142–8.
27.
go back to reference Volpato S, Cavalieri M, Sioulis F, Guerra G, Maraldi C, Zuliani G, et al. Predictive value of the short physical performance battery following hospitalization in older patients. J Gerontol Series A. 2011;66A:89–96. Volpato S, Cavalieri M, Sioulis F, Guerra G, Maraldi C, Zuliani G, et al. Predictive value of the short physical performance battery following hospitalization in older patients. J Gerontol Series A. 2011;66A:89–96.
28.
go back to reference Hauser SL, Dawson DM, Lehrich JR, Beal MF, Kevy S v., Propper RD, et al. Intensive immunosuppression in progressive multiple sclerosis. A randomized, three-arm study of high-dose intravenous cyclophosphamide, plasma exchange, and ACTH. N Engl J Med. 1983;308:173–80. Hauser SL, Dawson DM, Lehrich JR, Beal MF, Kevy S v., Propper RD, et al. Intensive immunosuppression in progressive multiple sclerosis. A randomized, three-arm study of high-dose intravenous cyclophosphamide, plasma exchange, and ACTH. N Engl J Med. 1983;308:173–80.
29.
go back to reference Perry J, Garrett M, Gronley JK, Mulroy SJ. Classification of walking handicap in the stroke population. Stroke. 1995;26:982–9. Perry J, Garrett M, Gronley JK, Mulroy SJ. Classification of walking handicap in the stroke population. Stroke. 1995;26:982–9.
30.
go back to reference Mehrholz J, Wagner K, Rutte K, Meißner D, Pohl M. Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Arch Phys Med Rehabil. 2007;88:1314–9. Mehrholz J, Wagner K, Rutte K, Meißner D, Pohl M. Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Arch Phys Med Rehabil. 2007;88:1314–9.
31.
go back to reference Watson MJ. Refining the ten-metre walking test for use with neurologically impaired people. Physiotherapy. 2002;88:386–97.CrossRef Watson MJ. Refining the ten-metre walking test for use with neurologically impaired people. Physiotherapy. 2002;88:386–97.CrossRef
32.
go back to reference Morales-Blanhir JE, Vidal CDP, de Jesús Rosas Romero M, Castro MMG, Villegas AL, Zamboni M. Six-minute walk test: a valuable tool for assessing pulmonary impairment. J Bras Pneumol. 2011;37:110–7. Morales-Blanhir JE, Vidal CDP, de Jesús Rosas Romero M, Castro MMG, Villegas AL, Zamboni M. Six-minute walk test: a valuable tool for assessing pulmonary impairment. J Bras Pneumol. 2011;37:110–7.
33.
go back to reference Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study. Int Disabil Stud. 1988;10:61–3. Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study. Int Disabil Stud. 1988;10:61–3.
34.
go back to reference Balestroni G, Bertolotti G. EuroQol-5D (EQ-5D): an instrument for measuring quality of life. Monaldi Arch. Chest Dis. 2012;78:155–9. Balestroni G, Bertolotti G. EuroQol-5D (EQ-5D): an instrument for measuring quality of life. Monaldi Arch. Chest Dis. 2012;78:155–9.
35.
go back to reference Hubacher M, Calabrese P, Bassetti C, Carota A, Stöcklin M, Penner IK. Assessment of post-stroke fatigue: the fatigue scale for motor and cognitive functions. Eur Neurol. 2012;67:377–84. Hubacher M, Calabrese P, Bassetti C, Carota A, Stöcklin M, Penner IK. Assessment of post-stroke fatigue: the fatigue scale for motor and cognitive functions. Eur Neurol. 2012;67:377–84.
36.
go back to reference Elbers RG, Rietberg MB, van Wegen EEH, Verhoef J, Kramer SF, Terwee CB, et al. Self-report fatigue questionnaires in multiple sclerosis, Parkinson’s disease and stroke: a systematic review of measurement properties. Qual Life Res. 2012;21:925–44. Elbers RG, Rietberg MB, van Wegen EEH, Verhoef J, Kramer SF, Terwee CB, et al. Self-report fatigue questionnaires in multiple sclerosis, Parkinson’s disease and stroke: a systematic review of measurement properties. Qual Life Res. 2012;21:925–44.
37.
go back to reference Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a Frontal Assessment Battery at bedside. Neurology. 2000;55:1621–6. Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a Frontal Assessment Battery at bedside. Neurology. 2000;55:1621–6.
38.
go back to reference Scarpina F, Tagini S. The Stroop color and word test. Front Psychol. 2017;8:557.CrossRef Scarpina F, Tagini S. The Stroop color and word test. Front Psychol. 2017;8:557.CrossRef
39.
go back to reference Amodio P, Wenin H, del Piccolo F, Mapelli D, Montagnese S, Pellegrini A, et al. Variability of trail making test, symbol digit test and line trait test in normal people. A normative study taking into account age-dependent decline and sociobiological variables. Aging Clin Exp Res. 2002;14:117–31. Amodio P, Wenin H, del Piccolo F, Mapelli D, Montagnese S, Pellegrini A, et al. Variability of trail making test, symbol digit test and line trait test in normal people. A normative study taking into account age-dependent decline and sociobiological variables. Aging Clin Exp Res. 2002;14:117–31.
40.
go back to reference Hatta T, Yoshizaki K, Ito Y, Mase M, Kabasawa H. Reliability and validity of the digit cancellation test, a brief screen of attention. Psychologia. 2012;55:246–56.CrossRef Hatta T, Yoshizaki K, Ito Y, Mase M, Kabasawa H. Reliability and validity of the digit cancellation test, a brief screen of attention. Psychologia. 2012;55:246–56.CrossRef
41.
go back to reference Pierre Gagnon M, Orrun E, Asua J, ben Abdeljelil A, Emparanza J. Using a Modified technology acceptance model to evaluate healthcare professionals’ adoption of a new telemonitoring system. Telemed J E Health. 2012;18(1):54-9. Pierre Gagnon M, Orrun E, Asua J, ben Abdeljelil A, Emparanza J. Using a Modified technology acceptance model to evaluate healthcare professionals’ adoption of a new telemonitoring system. Telemed J E Health. 2012;18(1):54-9.
42.
go back to reference Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat. 2005;4:287–91. Julious SA. Sample size of 12 per group rule of thumb for a pilot study. Pharm Stat. 2005;4:287–91.
43.
go back to reference Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.
44.
go back to reference Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.
Metadata
Title
RObotic-Assisted Rehabilitation for balance and gait in Stroke patients (ROAR-S): study protocol for a preliminary randomized controlled trial
Authors
Silvia Giovannini
Chiara Iacovelli
Fabrizio Brau
Claudia Loreti
Augusto Fusco
Pietro Caliandro
Lorenzo Biscotti
Luca Padua
Roberto Bernabei
Letizia Castelli
Publication date
01-12-2022
Publisher
BioMed Central
Keywords
Stroke
Fatigue
Published in
Trials / Issue 1/2022
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-022-06812-w

Other articles of this Issue 1/2022

Trials 1/2022 Go to the issue