gait therapy Archives

FEATURED EXPERT
DR KOK CHIN YONG
Consultant Neurologist and Internal Medicine Physician
Sunway Medical Centre Velocity

FIRST, LET’S TAKE A LOOK AT STROKE

Stroke is a medical emergency caused by the disruption of blood flow to your brain.

Without enough oxygen, your brain will stop working properly. This is why stroke is often considered the brain’s version of a heart attack.

Ischaemic stroke

This occurs when there is blood flow disruption to the brain. This can occur when the blood vessels in your brain are blocked by blood clots or other substances.

This is the most common type of stroke and is often linked to poorly controlled type 2 diabetes, high blood pressure, and/or high blood cholesterol levels.

Haemorrhagic stroke

This type of stroke occurs when there is internal bleeding in the brain. Accumulated blood in certain areas of the brain can exert pressure to brain tissues in these areas and damage these tissues.

While not as common as ischaemic stroke, this type of stroke is especially dangerous because the affected person’s symptoms can get worse very quickly and urgent medical attention is needed to prevent permanent brain damage and even death.

MOST STROKE SURVIVORS EXPERIENCE GAIT DISABILITY

Stroke is one of the main causes of disability.

2005 statistics from the American Heart Association revealed that more than 80% of stroke survivors suffer from gait disability—the loss of mobility due to impaired ability to walk normally.

Gait disability can affect the survivor’s quality of life.

However, there are also other repercussions of this disability on the person: the person’s confidence and sense of independence can be compromised.

Furthermore, gait disability is linked to increased risks of cardiovascular diseases and death in people approaching 80.

Because of this, gait therapy is an important aspect of rehabilitation for a stroke survivor.

ALL IS NOT LOST, AS THE BRAIN HAS A CHANCE TO ADAPT & RECOVER

The brain is an amazing organ. The network of nerves and other tissues involved in brain function can adapt to changes by reorganizing themselves, or ‘rewire’ in response to these changes.

“This can happen after a stroke,” Dr Kok explains, “as the brain begins to compensate for the damage caused by the stroke.”

This process, called brain neuroplasticity, can involve the formation of new connections between remaining healthy nerves and ‘recruiting’ other parts of the brain to take over the functions that were handled by the now-damaged part of the brain.

Much research is being done on the neuroplasticity of the brain to explore possible ways to improve the rehabilitation process of people that had a stroke or other brain injuries that affect their normal day-to-day function.

Currently, research data increasingly suggests that techniques that can stimulate the part of the brain affected by stroke can help improve the rehabilitation of the lost function linked to that part of the brain.

HENCE, GAIT THERAPY IS AN ESSENTIAL COMPONENT OF A STROKE SURVIVOR’S REHABILITATION

Dr Kok Chin Yong mentions that the restoration of a stroke survivor’s ability to walk can be a complex process.

The stroke survivor’s inability to walk normally is usually due to the stroke disrupting the function of the nerve pathways in the region of the brain that plans and controls movement called the motor cortex.

Furthermore, the stroke survivor also often suffers from other debilitations that make it harder for them to walk, such as changes in their muscle tone and strength as well as impaired heart function.

Additionally, the more gait therapy is delayed, the harder it is to achieve a good outcome because the organs involved in walking will further weaken and waste away due to lack of use.

Hence, gait therapy should be prioritized as soon as it is feasible to do so.

ROBOTICS-ASSISTED GAIT THERAPY CAN BENEFIT STROKE SURVIVORS CONSIDERABLY

If you have not read Dr Foong Chee Chong’s explanation of what robotic-assisted gait therapy is, you can do so by clicking here. Have a read, and then hit the back button to come back here and continue reading—it will help you better understand the rest of this article!

Dr Kok explains that the first line of rehabilitation is conventional physiotherapy.

“During this stage, we will assess the patient’s suitability for robotics-assisted gait therapy,” he explains, adding that the criteria for suitability are similar to those explained by his colleague Dr Foong is the above-linked article.

“The main benefit of the use of robotics is that many patients can regain their normal physiological walking at a faster rate than conventional physiotherapy,” he shares.

He elaborates that this is due to the robotic exoskeleton stimulating the neuroplasticity of the patient’s brain, helping it to relearn how to order and control the movement of the patient’s lower limbs at a much faster rate.

He reiterates that such outcome is more likely achieved when the robotics-assisted gait therapy is initiated as early as it is feasible to do so.

Hence, he encourages stroke survivors to consult their doctors further on whether such a therapy is suitable for them.

THIS IS THE SECOND PART OF THE SERIES LEARNING TO WALK AGAIN

Below are the articles in this series:

A Rehab Specialist Explains How a Robot Can Help You to Learn Safely & Successfully to Walk Again
How Robotics Can Help a Stroke Survivor’s Brain to Relearn How to Walk at a Faster Rate (you’re reading this article now)

References:

Duncan, P. W., Zorowitz, R., Bates, B., Choi, J. Y., Glasberg, J. J., Graham, G. D., Katz, R. C., Lamberty, K., & Reker, D. (2005). Management of adult stroke rehabilitation care: A clinical practice guideline. Stroke, 36(9), e100–e143. https://doi.org/10.1161/01.STR.0000180861.54180.FF
Newman, A. B., Simonsick, E. M., Naydeck, B. L., Boudreau, R. M., Kritchevsky, S. B., Nevitt, M. C., Pahor, M., Satterfield, S., Brach, J. S., Studenski, S. A., & Harris, T. B. (2006). Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA, 295(17), 2018–2026. https://doi.org/10.1001/jama.295.17.2018
Su, F., & Xu, W. (2020). Enhancing brain plasticity to promote stroke recovery. Frontiers in neurology, 11, 554089. https://doi.org/10.3389/fneur.2020.554089
Selves, C., Stoquart, G., & Lejeune, T. (2020). Gait rehabilitation after stroke: review of the evidence of predictors, clinical outcomes and timing for interventions. Acta neurologica Belgica, 120(4), 783–790. https://doi.org/10.1007/s13760-020-01320-7

WORDS LIM TECK CHOON

FEATURED EXPERT
DR FOONG CHEE CHOONG
Consultant Rehabilitation Medicine Specialist
Sunway Medical Centre Velocity

FIRST, LET’S TAKE A LOOK AT GAIT THERAPY

Gait therapy is a form of physical therapy to help improve one’s ability to walk.

COMMON HEALTH ISSUES THAT LEAVE ONE WITH DIFFICULTIES IN WALKING

Stroke
Osteoarthritis
Cerebral palsy
Parkinson’s disease
Joint replacement surgery
Lower limb paralysis
Multiple sclerosis
Traumatic brain injury
Muscle weakness due to long periods of inactivity or immobilization

Gait therapy is typically conducted by a rehabilitation medicine specialist together with a physiotherapist and assisting personnel such as nurses.

If the affected person needs counselling or experiences mental issues such as depression due to their inability to walk normally, a counselor or psychiatrist will also be involved.

INTRODUCING ROBOTIC-ASSISTED GAIT THERAPY

Consultant rehabilitation medicine specialist Dr Foong Chee Chong reveals that this technology has been around for the last decade or so, and it is increasingly adopted in Malaysia as part of gait therapy.

It’s a bit like Tony Stark and the Iron Man suit!

Dr Foong shares that in robotic-assisted gait therapy, the robotic device used is a wearable robotic exoskeleton.

There are a few different types of robotic exoskeletons available, and the specific way each works may vary from other types.

However, they generally work in the following manner:

There is a control panel, placed usually at the back of the exoskeleton, that allows the physiotherapist to adjust the settings to the level of assistance needed by the patient. Such adjustment is based on the patient’s current abilities and needs.
The robotic exoskeleton is a lightweight frame that will be strapped onto the patient’s torso and legs.
Once activated, the robotic exoskeleton will provide powered assistance to the patient’s hips and knees, assisting the patient in performing walking and standing motions.
The entire session will be supervised closely by the physiotherapist and their assistant, who will always remain close to the patient.
Should the patient do something wrong, the robotic exoskeleton will emit a sound that will alert the supervising physiotherapist, so that they can tend to the patient and provide necessary advice and assistance.

What’s the benefit of using a robotic exoskeleton?

Improved rehabilitation. Studies have found that robotic-assisted gait therapy can lead to clinically significant improvements in lower-limb movements among stroke survivors and people with spinal cord injuries, when compared to conventional gait therapy.

Shorter rehabilitation period. Dr Foong points out that, unlike the human eye, the robotic exoskeleton is more precise in detecting issues faced by the patient as they try to walk during gait therapy.

Furthermore, data from each session is tracked to allow the physiotherapist and rehabilitation medicine specialist to review the patient’s progress and identity areas for improvement.

As a result, the patient’s gait recovery from their robotic-assisted gait therapy is usually faster than those that do not use this technology.

Less resources are needed. Conventional gait therapy requires more personnel to assist the patient. For example, Dr Foong mentions that an assistant may be needed to support each of the patient’s arms, while another will guide the movement of the patient’s legs.

With the use of the robotic exoskeleton, fewer personnel are needed.

CAN I SIGN UP FOR ROBOTIC-ASSISTED GAIT THERAPY?

Dr Foong points out that a person will need to meet certain criteria to be considered for such therapy.

The person can sit upright and stand without experiencing dizziness and other issues. “They need to be able to do these actions at least 30 to 45 minutes without experiencing dizziness and other issues,” Dr Fong explains.

The person’s joints and bones are supple and strong enough to move without experiencing fractures. Dr Foong says that, typically, medical examination and muscle strength assessment will be conducted first to determine whether a patient is suitable to put on the robotic exoskeleton.

The person’s mind is sharp enough. They need to have a sound mind and be able to follow instructions from the physiotherapist.

The person is within the stipulated height and weight limit. A robotic exoskeleton can only support a person up to a certain weight and is within the recommended height range.

For the Ekso machine, for example, it can fit patients under 100 kg and between 1.5 m and 1.9 m.

HOW LONG IS EACH SESSION?

“Each session is usually between 30 and 45 minutes,” Dr Foong says.

The number of sessions is determined on a case-by-case basis.

WILL I BE ABLE TO WALK LIKE I USED TO?

“It will depend on a few factors,” Dr Foong says. “The most important factor is the severity of the stroke. However, majority of stroke survivors will regain some form of movement or ambulation after undergoing robotic rehabilitation.”

He adds that one’s walking ability typically declines over time due to age-related issues such as loss of muscle strength. Hence, it’s possible that one may need to undergo periodic gait training to improve their walking ability.

Additionally, Dr Foong recommends staying active to ensure that the improvements developed after gait therapy will persist for as long as example. For example, one can go for walks around the neighbourhood in the evenings.

THIS IS THE FIRST PART OF THE SERIES LEARNING TO WALK AGAIN