Effectiveness and Safety of Robotic Mechanotherapy with FES and VR in Restoring Gait and Balance in the Acute and Early Rehabilitation Period of Ischemic Stroke: Prospective Randomized Comparative Study

摘要

INTRODUCTION. Impaired gait and balance after a stroke significantly affect patients' daily activities and quality of life. Robotic mechanotherapy and virtual reality technologies are actively studied and used to restore lower limb muscle strength, balance and gait pattern. AIM. To assess the effectiveness and safety of rehabilitation using robotic mechanotherapy (exoskeleton) with functional electrical stimulation (FES) and virtual reality (VR) technology with plantar stimulation in the restoration of gait and balance disorders in patients in acute and early recovery periods of ischemic stroke. MATERIAL AND METHODS. Men and women aged 39 to 75 with ischemic stroke in acute and early recovery periods with gait impairment and lower limb paresis from 0 to 4 MRC scores. The patients were randomized using the envelope method into 4 groups: Group 1 (33 people) — exoskeleton with FES, Group 2 (32 people) — combined application of robotic mechanotherapy with FES and VR with plantar stimulation, Group 3 (35 people) — VR with plantar stimulation, Control group (30 people) — conventional training. RESULTS. Group 2 and 3 had significantly greater increases in muscle strength in the hip extensors, tibia flexors and flexors of the foot compared to the control group. Patients in the main groups also had a significant improvement in Tinetti Walking and balance Scale at follow-up. The analysis of the stabilometry results on the first and last day of the study revealed a decrease in the area of the statokinesiogram in the main groups both in the intragroup comparison and in the comparison with the control group. DISCUSSION AND CONCLUSION. Exoskeleton gait training with FES and exercises on a VR with plantar stimulation, as well as combined use of these techniques allowed to achieve better recovery of lower limb muscle strength, walking functions and balance in patients in acute and early rehabilitation periods of stroke. This is probably due to the large number of steps or their imitation performed by the patient during rehabilitation sessions, which leads to activation of neuroplasticity and better recovery. The study demonstrated the safety and efficacy of an exoskeleton interval training system that prevents the development of orthostatic hypotension in patients in the acute period of ischemic stroke.