Study protocol – robot-assisted gait therapy using Lokomat Pro FreeD in patients in the subacute phase of ischemic stroke

Cíl: Roboticky asistovaný trénink chůze představuje moderní koncept neurorehabilitace u pacientů po CMP. Cílem naší randomizované intervenční studie je zhodnotit přídatný efekt robotické rehabilitace chůze u pacientů v subakutní fázi ischemické CMP a porovnání s kohortou pacientů absolvujících standardní (protokolem definovanou) ústavní rehabilitaci. Primárním sledovaným parametrem je úroveň funkční kategorizace chůze. Sekundárními sledovanými parametry jsou časové parametry chůze (10metrový test chůze, Timed Up and Go), změny tělesného složení, modifikovaná Rankinova škála, index Barthelové, balanční škála Bergové a dotazník Subjektivní hodnocení strachu z pádů. Radiologická substudie sleduje dynamiku vývoje strukturálních změn a atrofie mozkové tkáně pomocí MR. Metody: Prospektivní randomizovaná otevřená monocentrická studie zařazující pacienty do 6 týdnů od první ischemické CMP. Konvenční rehabilitací (fyzioterapie, ergoterapie a mechanoterapie) jsou léčeny obě skupiny po dobu 60 min 5× týdně, celkem 15× po dobu 3–4 týdnů (celkem 1 200 min). Intervenční skupina navíc absolvuje roboticky asistovaný trénink chůze pomocí přístroje Lokomat 20–50 min 5× týdně, celkem 15× po dobu 3–4 týdnů (celkem 1 800 min). Sběr dat probíhá ve čtyřech časových obdobích: před zahájením intervence (T0), v polovině intervence (T1; 8. den), hodnocení po ukončení rehabilitace (T2; 15. den) a 3 měsíce po ukončení (T3).Aim: Robot-assisted gait training represents a modern concept of neurorehabilitation in stroke patients. Our randomized interventional study aims to assess the additive effect of robot-assisted gait rehabilitation in subacute ischemic stroke patients and to compare its effect with patients undergoing standard institutional protocol-defined rehabilitation. The primary endpoint is the functional ambulation category. The secondary endpoints include gait time parameters (10 Meter Walk Test, Timed Up and Go), changes in body composition, modified Rankin scale, Barthel index, Berg balance scale, and a questionnaire Falls Efficacy Scale – International. Radiological sub-study evaluates the dynamics of brain structural changes and atrophy using MRI. Methods: This is a prospective randomized open monocentric study enrolling patients within 6 weeks from the onset of the firs ischemic stroke. Both groups are treated with conventional rehabilitation (physiotherapy, occupational therapy and mechanotherapy) for 60 min 5 times a week, a total of 15 times for 3 to 4 weeks (a total of 1,200 min). The Lokomat group undergoes robot-assisted gait training using the interventional exoskeleton for 20-50 minutes 5 times a week for a total of 15 times for 3 to 4 weeks (a total of 1,800 min). Data collection takes place over four time periods: pre-intervention (T0), mid-intervention (T1; day 8), post-rehabilitation assessment (T2; day 15), and 3 months post-intervention (T3).Web of Science84436636

Mechanical thrombectomy performs similarly in real world practice: a 2016 nationwide study from the Czech Republic

Background Randomized clinical trials have proven mechanical thrombectomy (MT) to be a highly effective and safe treatment in acute stroke. The purpose of this study was to compare neurothrombectomy data from the Czech Republic (CR) with data from the HERMES meta-analysis. Methods Available nationwide data for the CR from 2016 from the Safe Implementation of Treatments in Stroke–Thrombectomy (SITS-TBY) registry for patients with terminal internal carotid artery (ICA) and/or middle cerebral artery (MCA) occlusions were compared with data from HERMES. CR and HERMES patients were comparable in age, sex, and baseline National Institutes of Health Stroke Scale scores. Results From a total of 1053 MTs performed in the CR, 845 (80%) were reported in the SITS-TBY. From these, 604 (72%) were included in this study. Occlusion locations were as follows (CR vs HERMES): ICA 22% versus 21% (P=0.16), M1 MCA 62% versus 69% (P=0.004), and M2 MCA 16% versus 8% (P<0.0001). Intravenous thrombolysis was given to 76% versus 83% of patients, respectively (P=0.003). Median onset to reperfusion times were comparable: 232 versus 285 min, respectively (P=0.66). A modified Thrombolysis in Cerebral Infarction score of 2b/3 was achieved in 74% (433/584) versus 71% (390/549) of patients, respectively (OR 1.17, 95% CI 0.90–1.5, P=0.24). There was no statistically significant difference in the percentage of parenchymalhematoma type 2 (OR 1.12, 95% CI 0.66–1.90, P=0.68). A modified Rankin Scale score of 0–2 at 3 months was achieved in 48% (184/268) versus 46% (291/633) of patients, respectively (OR 0.92, 95% CI 0.71–1.18, P=0.48). Conclusions Data on efficacy, safety, and logistics of MT from the CR were similar to data from the HERMES collaboration