Gait training with a wearable curara® robot for cerebellar ataxia: a single-arm study

Abstract Background: Ataxic gait is one of the most common and problematic symptoms in people with degenerative cerebellar ataxia. Intensive and well-coordinated inpatient rehabilitation has been shown to improve ataxic gait. In addition to therapist-assisted gait training, robot-assisted gait training has been introduced for several neurological disorders; however, only a small number of trials have been conducted for degenerative cerebellar ataxia. We aimed to validate the rehabilitation effect of a wearable “curara®” robot we developed in a single-arm study of people with degenerative cerebellar ataxia.Methods: Twenty participants with spinocerebellar ataxia or multiple system atrophy with predominant cerebellar ataxia were enrolled. The clinical trial period was 15 days. We used a curara® type 4 wearable robot for gait training. We measured the following items on days 0, 7, and 14: Scale for the Assessment and Rating of Ataxia, 10-m walking time (10mWT), 6-min walking distance (6MWD), and timed up and go test. Gait parameters (i.e., stride duration and length, standard deviation of stride duration and length, cadence, ratio of the stance/swing phases, minimum/maximum knee joint angle, and minimum/maximum hip joint angle) were obtained using a RehaGait®. On the other days (days 1–6 and 8–13), the participants were instructed to conduct gait training for 30 ± 5 min with curara®. We calculated the improvement rate as the difference of values between days 14 and 0 divided by the value on day 0. Differences in the gait parameters were analyzed using a generalized linear mixed model with Bonferroni’s correction.Results: Eighteen participants were analyzed. The mean improvement rate of the 10mWT and 6MWD was 19.0% and 29.0%, respectively. All gait parameters, except the standard deviation of stride duration and length, improved on day 14.Conclusions: The wearable curara® robot has the potential to facilitate gait training in people with degenerative cerebellar ataxia.Trial registration: jRCT, jRCTs032180164. Registered 27 February 2019 - Retrospectively registered, https://jrct.niph.go.jp/en-latest-detail/jRCTs032180164