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European Journal of Physical and Rehabilitation Medicine 2021 May 05

DOI: 10.23736/S1973-9087.21.06887-8


lingua: Inglese

Robotic-assisted gait rehabilitation following stroke: a systematic review of current guidelines and practical clinical recommendations

Rocco S. CALABRÓ 1 , Gregorio SORRENTINO 2, Anna CASSIO 3, Davide MAZZOLI 4, Elisa ANDRENELLI 5, Emiliana BIZZARINI 6, Isabella CAMPANINI 7, Simona M. CARMIGNANO 8, Simona CERULLI 9, Carmelo CHISARI 10, Valentina COLOMBO 11, Stefania DALISE 10, Cira FUNDARÓ 12, Valeria GAZZOTTI 13, Daniele MAZZOLENI 14, Miryam MAZZUCCHELLI 14, Corrado MELEGARI 15, Andrea MERLO 4, 7, Giulia STAMPACCHIA 16, Paolo BOLDRINI 17, Stefano MAZZOLENI 18, Federico POSTERARO 19, Paolo BENANTI 20, Enrico CASTELLI 21, Francesco DRAICCHIO 22, Vincenzo FALABELLA 23, Silvia GALERI 24, Francesca GIMIGLIANO 25, Mauro GRIGIONI 26, Stefano MAZZON 27, Franco MOLTENI 28, Giovanni MORONE 29, Maurizio PETRARCA 30, Alessandro PICELLI 31, Michele SENATORE 32, Giuseppe TURCHETTI 33, Donatella BONAIUTI 34, on behalf of the "CICERONE" Italian Consensus Conference on Robotic in Neurorehabilitation

1 IRCCS Centro Neurolesi “Bonino-Pulejo “, Messina, Italy; 2 Department of Medicine and Rehabilitation, Policlinico di Monza, Monza, Italy; 3 Spinal Cord Unit and Intensive Rehabilitation Medicine, Villanova sull'Arda and Castel San Giovanni, AUSL Piacenza, Italy; 4 Gait & Motion Analysis Laboratory OPA Sol et Salus, Torre Pedrera, Rimini, Italy; 5 Department of Experimental and Clinical Medicine, Politecnica delle Marche University, Ancona, Italy; 6 Spinal Cord Unit, Department of Rehabilitation Medicine, Gervasutta Hospital, “Azienda Sanitaria Universitaria Friuli Centrale”, Udine, Italy; 7 LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, AUSL-IRCCS Reggio Emilia, Italy; 8 Rehabilitation Therapeutic Center, Tramutola, Potenza, Italy; 9 University Polyclinic Foundation A.Gemelli, IRCCS, Rome, Italy; 10 Neurorehabilitation Section, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; 11 Montecatone Rehabilitation Institute, Imola, Bologna, Italy; 12 Neurophysiopathology Unit of Montescano Institute, Istituti Clinici Scientifici Maugeri IRCSS, Pavia, Italy; 13 Centro Protesi Vigorso di B, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Budrio, Bologna, Italy; 14 School of Physical and Rehabilitation Medicine, Bicocca University of Milan, Milan, Italy; 15 Elias Neuroriabilitazione, Parma, Italy; 16 Spinal Cord Unit, Pisa University Hospital, Pisa, Italy; 17 Italian Society of Physical and Rehabilitation Medicine (SIMFER), Rome, Italy; 18 Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy; 19 Rehabilitation Department, ASL12, Viareggio, Lucca, Italy; 20 Pontifical Gregorian University, Rome, Italy; 21 Paediatric Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy; 22 Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy; 23 Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy; 24 IRCCS Don Gnocchi Foundation Onlus, Milan, Italy; 25 Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy; 26 National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy; 27 Rehabilitation Unit, ULSS (Local Health Authority) Euganea - Camposampiero Hospital, Padua, Italy; 28 Valduce Hospital “Villa Beretta” Rehabilitation Center, Costa Masnaga, Lecco, Italy; 29 Santa Lucia Foundation, IRCCS, Rome, Italy; 30 The Movement Analysis and Robotics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy; 31 Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; 32 AITO (Associazione Italiana Terapisti Occupazionali), Rome, Italy; 33 Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy; 34 Geriatric Institute Piero Redaelli, Milan, Italy


INTRODUCTION: Stroke is the third leading cause of adult disability world-wide, and lower extremity motor impairment is one of the major determinants of long-term disability. Although robotic therapy is becoming more and more utilized in research protocols for lower limb stroke rehabilitation, the gap between research evidence and its use in clinical practice is still significant. The aim of this study was to determine the scope, quality, and consistency of guidelines for robotic lower limb rehabilitation after stroke, in order to provide clinical recommendations.
EVIDENCE ACQUISITION: We systematically reviewed stroke rehabilitation guideline recommendations between January 1st, 2010 and October 31th, 2020. We explored electronic databases (n=4), guideline repositories and professional rehabilitation networks (n=12). Two independent reviewers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and brief syntheses were used to evaluate and compare the different recommendations, considering only the most recent version.
EVIDENCE SYNTHESIS: From the 1219 papers screened, ten eligible guidelines were identified from seven different regions/countries. Four of the included guidelines focused on stroke management, the other six on stroke rehabilitation. Robotic rehabilitation is generally recommended to improve lower limb motor function, including gait and strength. Unfortunately, there is still no consensus about the timing, frequency, training session duration and the exact characteristics of subjects who could benefit from robotics.
CONCLUSIONS: Our systematic review shows that the introduction of robotic rehabilitation in standard treatment protocols seems to be the future of stroke rehabilitation. However, robot assisted gait training (RAGT) for stroke needs to be improved with new solutions and in clinical practice guidelines, especially in terms of applicability.

KEY WORDS: Stroke; Robotic rehabilitation; Lower limb; Gait; Systematic review

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