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European Journal of Physical and Rehabilitation Medicine 2021 June;57(3):472-7

DOI: 10.23736/S1973-9087.21.06939-2


language: English

Effects of robot-assisted gait training on postural instability in Parkinson’s disease: a systematic review

Alessandro PICELLI 1 , Marianna CAPECCI 2, Mirko FILIPPETTI 1, Valentina VARALTA 1, Cristina FONTE 1, Rita DI CENSO 1, Alessandro ZADRA 1, Irene CHIGNOLA 1, Stefano SCARPA 1, Angelo P. AMICO 3, Roberto ANTENUCCI 4, Alessio BARICICH 5, Paolo BENANTI 6, Luciano BISSOLOTTI 7, Paolo BOLDRINI 8, Donatella BONAIUTI 8, Enrico CASTELLI 9, Loredana CAVALLI 10, Giuseppina DI STEFANO 8, Francesco DRAICCHIO 11, Vincenzo FALABELLA 12, Silvia GALERI 13, Francesca GIMIGLIANO 14, Mauro GRIGIONI 15, Johanna JONSDOTTIR 13, Carmelo LENTINO 16, Perla MASSAI 17, Stefano MAZZOLENI 18, 19, Stefano MAZZON 20, Franco MOLTENI 21, Sandra MORELLI 15, Giovanni MORONE 22, Daniele PANZERI 23, Maurizio PETRARCA 9, Federico POSTERARO 24, Michele SENATORE 25, Elisa TAGLIONE 26, Giuseppe TURCHETTI 27, Thomas BOWMAN 13, 19, Antonio NARDONE 28, 29

1 Unit of Neurorehabilitation, Department of Neuroscience, Biomedicine, and Movement Sciences, University Hospital of Verona, University of Verona, Verona, Italy; 2 Università Politecnica delle Marche (UNIVPM), Ancona, Italy; 3 Polyclinic of Bari, Bari, Italy; 4 Castel San Giovanni Hospital, Piacenza, Italy; 5 University of Eastern Piedmont, Novara, Italy; 6 Pontifical Gregorian University, Rome, Italy; 7 Casa di Cura Domus Salutis, Fondazione Teresa Camplani, Brescia, Italy; 8 Italian Society of Physical and Rehabilitative Medicine, Rome, Italy; 9 Bambino Gesù Children’s Hospital, Rome, Italy; 10 Centro Giusti, Florence, Italy; 11 INAIL, Rome, Italy; 12 Italian Federation of Persons with Spinal Cord Injuries, Rome, Italy; 13 IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy; 14 Luigi Vanvitelli University of Campania, Naples, Italy; 15 Italian National Institute of Health, Rome, Italy; 16 Santa Corona Hospital, Pietra Ligure, Savona, Italy; 17 Tuscany Rehabilitation Clinic, Montevarchi, Arezzo, Italy; 18 Polytechnic University of Bari, Bari, Italy; 19 The BioRobotics Institute, Scuola Superiore Sant’Anna, Pontedera, Pisa, Italy; 20 ULSS 6 Euganea, Padua, Italy; 21 Valduce Villa Beretta Hospital, Costa Masnaga, Lecco, Italy; 22 Santa Lucia Foundation IRCCS, Rome, Italy; 23 IRCCS Eugenio Medea, Bosisio Parini, Italy; 24 Versilia Hospital, Camaiore, Lucca, Italy; 25 Italian Association of Occupational Therapists (AITO), Rome, Italy; 26 INAIL, Volterra, Pisa, Italy; 27 Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy; 28 University of Pavia, Pavia, Italy; 29 ICS Maugeri SPA SB (IRCCS), Pavia, Italy

INTRODUCTION: Postural instability is a cardinal feature of Parkinson’s disease, together with rest tremor, rigidity and bradykinesia. It is a highly disabling symptom that becomes increasingly common with disease progression and represents a major source of reduced quality of life in patients with Parkinson’s disease. Rehabilitation aims to enable patients with Parkinson’s disease to maintain their maximum level of mobility, activity and independence. To date, a wide range of rehabilitation approaches has been employed to treat postural instability in Parkinson’s disease, including robotic training. Our main aim was to conduct a systematic review of current literature about the effects of robot-assisted gait training on postural instability in patients with Parkinson’s disease.
EVIDENCE ACQUISITION: A systematic search using the following MeSH terms “Parkinson disease,” “postural balance,” “robotics,” “rehabilitation” AND string “robotics [mh]” OR “robot-assisted” OR “electromechanical” AND “rehabilitation [mh]” OR “training” AND “postural balance [mh]” was conducted on PubMed, Cochrane Library and Pedro electronic databases. Full text articles in English published up to December 2020 were included. Data about patient characteristics, robotic devices, treatment procedures and outcome measures were considered. Every included article got checked for quality. Level of evidence was defined for all studies.
EVIDENCE SYNTHESIS: Three authors independently extracted and verified data. In total, 18 articles (2 systematic reviews, 9 randomized controlled trials, 4 uncontrolled studies and 3 case series/case reports) were included. Both end-effector and exoskeleton devices were investigated as to robot-assisted gait training modalities. No clear relationship between treatment parameters and clinical conditions was observed. We found a high level of evidence about the effects of robot-assisted gait training on balance and freezing of gait in patients with Parkinson’s disease.
CONCLUSIONS: This systematic review provides to the reader a complete overview of current literature and levels of evidence about the effects of robot-assisted gait training on postural instability issues (static and dynamic balance, freezing of gait, falls, confidence in activities of daily living and gait parameters related to balance skills) in patients with Parkinson’s disease.

KEY WORDS: Parkinson disease; Postural balance; Robotics; Rehabilitation

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