Exploring Robotic-Assisted Locomotor Training in Physical Therapy with Multiple Sclerosis

Background: Multiple Sclerosis (MS) is a chronic inflammatory condition, which causes multifocal demyelination along with astrocytic gliosis and axonal demyelination in the central nervous system. This results in neurological symptoms including spasticity, resulting in gait, coordination and balance impairments which lead to fatigue and a lack of physical activity.  Traditional Physical Therapy (PT) is labor intensive for both therapist and patient, and requires high amounts of physical effort.  Robotic-assisted Locomotor Training (RALT) is an emerging PT intervention that presents new opportunity for the MS population.  RALT is the application of a robotic orthosis to facilitate gait training in a controlled and repetitive environment.  RALT allows PT’s to customize training parameters in MS to specific conditions that may potentially enhance outcomes. There is a growing body of evidence that supports the use of RALT in neurological conditions such as stroke, TBI and SCI.  The ability to create training paradigms that focus on levels of repetition and intensity lend themselves to improved outcomes due to increased specificity and, potentially, neuroplasticity.  Studies by Straudi et al (2013), Schwartz et al (2012) , and Beer et al (2008) demonstrated short term benefits following a RALT protocol, but no significant difference between RALT and conventional PT in long-term follow-ups.  Furthermore, Gandolfi et al (2014) demonstrated significant overall improvements at one month follow-up in walking, posture and balance confidence. The studies cited have all inferred that further investigation is necessary to determine the long term effect of the RALT.

Conclusions: Based on anecdotal evidence and clinical success with other neurological conditions, we feel that RALT may prove to be a viable addition to a PT protocol for patients with MS.  The customizable aspects of RALT therapy, namely controlling body weight support and guidance force, allow patients to experience increased amounts of repetitious walking prior to the onset of fatigue.  In time, this training, when paired with other techniques such as strengthening and stretching, may lead to improved long-term outcomes.  While the application of RALT in the MS population has thus far proved, if nothing else, equal to traditional PT, further research is needed to evaluate claims of improved outcomes.