The Novel Use Of Robot-Assisted Gait Training In The Treatment Of Functional Neurological Disorder: A Case Report

Sam Smith

University of Canberra Hospital, Australia

Biography :

Sam Smith, is a Senior Rehabili­tation Physiotherapist at the Uni­versity of Canberra Hospital in Canberra, Australia with 6 years experience working in inpatient rehabilitation and 4 years ex­perience working in profession­al sport. He is a graduate of the Bachelor of Physiotherapy pro­gram at the University of Canber­ra and is currently completing his Master of Sports Medicine at the University of Melbourne.

Abstract :

Introduction: Functional Neurological Disorder (FND) is a condition defined by motor and sensory symptoms with clin­ical features that cannot be explained by other neurological or medical diagnoses but can result in significant functional impairment including total loss of mobility. There is evidence supporting the use of robotics in other neurological condi­tions such as stroke and spinal cord injury, but there is cur­rently no published evidence for its use in the treatment of FND. This case using the Hocoma Lokomat robotic exoskele­ton device represents the first known case of robot-assisted gait training in the treatment of FND.

Aim: To determine if robot-assisted gait training could be a viable treatment option to improve mobility for patients with FND.

Methods: Over 9 weeks, the 34-year-old patient complet­ed 15 robot-assisted gait training sessions. Outcome mea­sures included the Functional Ambulation Category (FAC), Functional Independence Measure (FIM), 10-metre walk test (10MWT) and Oxford manual muscle strength testing (MMT).

Results: At the conclusion of the robot-assisted gait training program the patient had achieved independent walking: FAC improved from 0/5 to 5/5, FIM Locomotion improved from 1/7 to 7/7, FIM Total had improved from 56 to 123 and the 10MWT was completed in 37.45 seconds. The patient’s muscle strength improved from 0/5 to 5/5 in all lower limb muscle groups (MMT). At six months post intervention, the patient reported zero FND relapses or functional impairments.

Conclusions: Robot-assisted gait training can be considered a potential intervention option in FND, specifically in cases with gait impairments, and can be associated with dramatic improvements in strength and mobility.

Impact: This is the first case of a patient with FND success­fully completing robot-assisted gait training in the treatment of gait-related impairments. Studies exploring feasibility and patient acceptability of this novel therapy in FND are now warranted.