Effects of dynamic tilt-table with integrated robotic stepping associated with functional electrical stimulation in acute stroke: a pilot study

Objective: The aim of this study was to investigate the short-term effects of orthostatic training on a robotic-system in patients with acquired brain injury (ABI). Materials: Two patients (age 70,5°6,7 years; 38,5°5 days/post-stroke) with ABI were subjected to an orthostatic training using a dynamic tilt-table with integrated robotic-stepping [1], combined with a step-synchronized functional-electrical stimulation (FES) to assist leg movements [2,3]. Methods: Eleven 30-minutes treatments were performed, with and without FES on alternate days. The treatment (in addition to conventional physiotherapy) involved a tilting to 30° in the first 5-minutes, increasing to a maximum of 80° according to patient’s clinical condition. Blood pressure (BP), heart rate (HR) and oximetry were recorded at the baseline and every 5-minutes during treatment. Muscle tone was assessed before and after each session using the Modified-Ashworth scale (MAS). Results: Subjects completed 10 and 5 sessions, showing an improvement of clinical measures (BP: form 122°5 /86°3 to 132°2 / 89°1 mmHg, systolic/diastolic; HR: from 90°4 to 86°2 beats/min), furthermore muscle tone decreased in the lower limbs (from 1+ to 0, MAS). There was no difference between treatment with and without FES. Discussion: Patients showed an improvement of salient vital parameters; the amount of incomplete training was consistent with previous studies [3]. Conclusion: Dynamic tilt-table training may improve the orthostatic tolerance and decrease spasticity in the short term period. Our results seem promising, further studies are needed to determine whether these findings are generalizable to all ABI patients and if the results remain stable over time.