Towards a Clinical Decision-Making Algorithm Guiding Locomotor Therapy Modality in Subacute Stroke: An Exploratory Study
Date
2021
Authors
Prideaux, N.
Barr, C.
Drummond, C.
van den Berg, M.
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Journal article
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Journal of Stroke and Cerebrovascular Diseases, 2021; 30(12):106112-1-106112-9
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Nicole Prideaux, Christopher Barr, Claire Drummond, and Maayken van den Berg
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Abstract
Objectives: To propose a clinical decision-making algorithm guiding modality choice and transition from the Lokomat® robotic to body-weight supported treadmill training in subacute stroke, due to current evidence being limited, making clinical decisions difficult. Materials and Methods: For 10 adult patients with subacute stroke completing Lokomat® therapy, physiotherapist clinical judgement regarding bodyweight supported treadmill training readiness and the following objective measurements were collected; Functional Ambulation Category; sit to stand/standing ability; Lokomat® settings; maximal active hip and knee flexion in standing; and gait biomechanics during body-weight supported treadmill training. Based on observed patterns a proposed clinical decision-making algorithm was developed. Results: Clinical judgement deemed four of 10 participants ready to transition to body-weight supported treadmill training. Unlike participants judged not ready, these participants had: a) a Functional Ambulation Category of 1; b) independence with sit to stand and standing with even weight bearing; c) Lokomat®: Body- Weight Support <30%, Guidance Force <30-35%, speed >2.0kph; d) >45° standing active hip and knee flexion; e) no significant issues with physiological stepping in treadmill training or only requiring assistance from one therapist to achieve this. Conclusion: Participants judged ready for transition from the Lokomat® to bodyweight supported treadmill training presented with increased independent functional ability, more challenging Lokomat® settings, greater active volitional lowerlimb control, and less issues with physiological stepping in treadmill training, than those participants judged not ready. Results were translated into a proposed clinical decision-making algorithm guiding transition from the Lokomat® to body-weight supported treadmill training, to be further tested in clinical trials.
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© 2021 Elsevier Inc. All rights reserved.