{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:23:58Z","timestamp":1760059438537,"version":"build-2065373602"},"reference-count":60,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>This case report examines the impact of robotic-assisted therapy (Lokomat) on functional recovery in a 28-year-old male patient with acute dermatomyositis (DM), an autoimmune inflammatory myopathy causing progressive muscle weakness and disability. The patient underwent 21 sessions of robotic therapy combined with physical therapy, and occupational therapy over seven weeks. Assessments were conducted at baseline, week 10, and week 21 using standardized measures for balance, muscle strength, and functionality. Results demonstrated significant improvements across all domains: balance scores progressed from severe impairment (4\/56 Berg, 0\/28 Tinetti) to near-normal function (55\/56, 24\/28, respectively); muscle strength increased from grade 1\/5 to 4\/5 (MMT-8) in all tested muscle groups; and functionality improved from moderate dependence (59\/126 FIM) to complete independence (126\/126). The trunk functionality scores showed remarkable recovery from 12\/100 to 100\/100 (TCT), indicating restored trunk control. Lokomat-assisted therapy combined with conventional rehabilitation effectively improves proximal weakness and postural instability in DM. Robotic therapy enhances motor learning via repetitive movements and reduces therapist workload. Though limited by a single-case design, this study offers preliminary evidence for robotic rehabilitation in DM, previously unexplored. Controlled studies are needed to standardize protocols and validate results in larger cohorts. Advanced technologies show promise for functional recovery in inflammatory myopathies.<\/jats:p>","DOI":"10.3390\/brainsci15060650","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T05:52:47Z","timestamp":1750139567000},"page":"650","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Robotic-Assisted Gait Training Combined with Multimodal Rehabilitation for Functional Recovery in Acute Dermatomyositis: A Case Report"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3504-9990","authenticated-orcid":false,"given":"Wilmer","family":"Esparza","sequence":"first","affiliation":[{"name":"Facultad de Ciencias de la Salud y Bienestar Humano, Carrera de Medicina, Universidad Tecnol\u00f3gica Indoam\u00e9rica, Ambato 180202, Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebeca","family":"Benalcazar-Aguilar","sequence":"additional","affiliation":[{"name":"Maestr\u00eda en Neurorrehabilitaci\u00f3n, Facultad de Posgrados de Ciencias de la Salud, Universidad de Las Am\u00e9ricas (UDLA), Quito 170124, Ecuador"},{"name":"Departamento de Fisioterapia, Hospital Carlos Andrade Mar\u00edn, Quito 170136, Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriela","family":"Moreno-Andrade","sequence":"additional","affiliation":[{"name":"Maestr\u00eda en Neurorrehabilitaci\u00f3n, Facultad de Posgrados de Ciencias de la Salud, Universidad de Las Am\u00e9ricas (UDLA), Quito 170124, Ecuador"},{"name":"Departamento de Fisioterapia, Hospital Carlos Andrade Mar\u00edn, Quito 170136, Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0677-0356","authenticated-orcid":false,"given":"Israel","family":"Vinueza-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Center for Research on Health in Latin America (CISeAL), Pontificia Universidad Cat\u00f3lica del Ecuador, Quito 170143, Ecuador"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,17]]},"reference":[{"key":"ref_1","first-page":"255","article-title":"Dermatomyositis\u2014Part 1: Definition, epidemiology, etiology and pathogenesis, and clinics","volume":"14","author":"Pinto","year":"2016","journal-title":"SKINmed"},{"key":"ref_2","first-page":"245","article-title":"Epidemiology and clinical features of dermatomyositis in adults: A retrospective study","volume":"37","author":"Parato","year":"2019","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_3","first-page":"102","article-title":"Prevalence and clinical characteristics of dermatomyositis in adult populations: A systematic review","volume":"112","author":"Huang","year":"2023","journal-title":"J. Autoimmun."},{"key":"ref_4","first-page":"145","article-title":"Incidence of dermatomyositis in adult populations: A population-based study","volume":"33","author":"Niedzielska","year":"2023","journal-title":"Eur. J. Dermatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.jaad.2019.06.1309","article-title":"Dermatomyositis: Clinical features and pathogenesis","volume":"82","author":"DeWane","year":"2020","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_6","first-page":"e33034","article-title":"Rehabilitation and exercise in dermatomyositis: A case report and narrative review of the literature","volume":"14","author":"Calado","year":"2022","journal-title":"Cureus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1590\/S0365-05962008000300010","article-title":"Dermatomiosite","volume":"83","author":"Ortigosa","year":"2008","journal-title":"An. Bras. Dermatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"538","DOI":"10.3899\/jrheum.161183","article-title":"Muscle strength and muscle endurance during the first year of treatment of polymyositis and dermatomyositis: A prospective study","volume":"45","author":"Alexanderson","year":"2018","journal-title":"J. Rheumatol."},{"key":"ref_9","first-page":"1","article-title":"Myostatin and markers of bone metabolism in dermatomyositis","volume":"22","author":"Gruther","year":"2021","journal-title":"BMC Musculoskelet. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e944564-1","DOI":"10.12659\/MSM.944564","article-title":"Pharmacological Strategies in Dermatomyositis: Current Treatments and Future Directions","volume":"30","author":"Guo","year":"2024","journal-title":"Med. Sci. Monit."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1959","DOI":"10.1002\/acr.22068","article-title":"Improvement in health and possible reduction in disease activity using endurance exercise in patients with established polymyositis and dermatomyositis: A multicenter randomized controlled trial with a 1-year open extension follow-up","volume":"65","author":"Dastmalchi","year":"2013","journal-title":"Arthritis Care Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"101547","DOI":"10.1016\/j.berh.2020.101547","article-title":"Exercise therapy in patients with idiopathic inflammatory myopathies and systemic lupus erythematosus\u2014A systematic literature review","volume":"34","author":"Alexanderson","year":"2020","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_13","first-page":"701","article-title":"Abnormal lactate levels in patients with polymyositis and dermatomyositis: The benefits of a specific rehabilitative program","volume":"50","author":"Bertolucci","year":"2014","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e042815","DOI":"10.1136\/bmjopen-2020-043793","article-title":"High-intensity strength training in patients with idiopathic inflammatory myopathies: A randomised controlled trial protocol","volume":"11","author":"Jensen","year":"2021","journal-title":"BMJ Open"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/j.neuron.2020.01.039","article-title":"Advanced neurotechnologies for the restoration of motor function","volume":"105","author":"Micera","year":"2020","journal-title":"Neuron"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1007\/s10072-016-2474-4","article-title":"Robotic gait rehabilitation and substitution devices in neurological disorders: Where are we now?","volume":"37","author":"Cacciola","year":"2016","journal-title":"Neurol. Sci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1016\/S0140-6736(11)60325-5","article-title":"Stroke rehabilitation","volume":"377","author":"Langhorne","year":"2011","journal-title":"Lancet"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Loro, A., Borg, M.B., Battaglia, M., Amico, A.P., Antenucci, R., Benanti, P., Bertoni, M., Bissolotti, L., Boldrini, P., and Bonaiuti, D. (2023). Balance rehabilitation through robot-assisted gait training in post-stroke patients: A systematic review and meta-analysis. Brain Sci., 13.","DOI":"10.3390\/brainsci13010092"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1186\/s12984-024-01463-1","article-title":"Efficacy of robot-assisted gait training on lower extremity function in subacute stroke patients: A systematic review and meta-analysis","volume":"21","author":"Hu","year":"2024","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s12984-022-01031-5","article-title":"Effects of control strategies on gait in robot-assisted post-stroke lower limb rehabilitation: A systematic review","volume":"19","author":"Campagnini","year":"2022","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Marchal-Crespo, L., and Riener, R. (2018). Robot-assisted gait training. Rehabilitation Robotics, Elsevier.","DOI":"10.1016\/B978-0-12-811995-2.00016-3"},{"key":"ref_22","first-page":"483","article-title":"Robot-assisted gait training promotes brain reorganization after stroke: A randomized controlled pilot study","volume":"46","author":"Kim","year":"2020","journal-title":"NeuroRehabilitation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.11124\/JBISRIR-2017-003635","article-title":"The economic cost of robotic rehabilitation for adult stroke patients: A systematic review protocol","volume":"16","author":"Lo","year":"2018","journal-title":"JBI Database Syst. Rev. Implement. Rep."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Wu, L., Xu, G., and Wu, Q. (2023). The effect of the Lokomat\u00ae robotic-orthosis system on lower extremity rehabilitation in patients with stroke: A systematic review and meta-analysis. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1260652"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Banyai, A.D., and Bri\u0219an, C. (2024). Robotics in physical rehabilitation: Systematic Review. Healthcare, 12.","DOI":"10.20944\/preprints202406.2007.v1"},{"key":"ref_26","first-page":"21","article-title":"Neuromuscular electrical stimulation in dermatomyositis rehabilitation: A randomized controlled trial","volume":"11","author":"Calado","year":"2022","journal-title":"Neurol. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.jocn.2024.01.010","article-title":"Effects of robotic-assisted gait training on physical capacity, and quality of life among chronic stroke patients: A randomized controlled study","volume":"120","year":"2024","journal-title":"J. Clin. Neurosci."},{"key":"ref_28","unstructured":"Berg, K. (2024). Berg Balance Scale (BBS). Occupational Therapy Assessments for Older Adults: 100 Instruments for Measuring Occupational Performance, Routledge."},{"key":"ref_29","first-page":"202","article-title":"Use of Berg Balance Scale in elderly populations at risk of falls","volume":"40","author":"Haripriya","year":"2017","journal-title":"J. Geriatr. Phys. Ther."},{"key":"ref_30","first-page":"343","article-title":"Assessment tools for balance and gait disorders: Reliability and clinical value","volume":"260","author":"Straube","year":"2013","journal-title":"J. Neurol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"559","DOI":"10.2522\/ptj.20070205","article-title":"Usefulness of the Berg Balance Scale in stroke rehabilitation: A systematic review","volume":"88","author":"Blum","year":"2008","journal-title":"Phys. Ther."},{"key":"ref_32","first-page":"58","article-title":"Reliability and internal consistency of the Berg Balance Scale in stroke patients","volume":"24","author":"Castro","year":"2020","journal-title":"Braz. J. Phys. Ther."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.2522\/ptj.20060343","article-title":"Berg Balance Scale: Intrarater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities","volume":"87","author":"Conradsson","year":"2007","journal-title":"Phys. Ther."},{"key":"ref_34","first-page":"150","article-title":"Clinimetric properties of the Tinetti Mobility Test in Parkinson\u2019s disease","volume":"34","author":"Kloos","year":"2010","journal-title":"J. Neurol. Phys. Ther."},{"key":"ref_35","first-page":"1129","article-title":"Tools for assessing mobility in elderly populations","volume":"58","author":"King","year":"2010","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_36","first-page":"113","article-title":"Reliability and validity of the Tinetti POMA in older Chinese adults","volume":"18","author":"Yang","year":"2023","journal-title":"Clin. Interv. Aging"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1097\/NPT.0b013e318283ffcc","article-title":"Test-retest reliability and construct validity of the Tinetti performance-oriented mobility assessment in people with stroke","volume":"37","author":"Canbek","year":"2013","journal-title":"J. Neurol. Phys. Ther."},{"key":"ref_38","first-page":"259","article-title":"Manual Muscle Testing (MMT-8) in juvenile dermatomyositis: Reliability and correlation with functional ability and disease activity","volume":"40","author":"Rosina","year":"2020","journal-title":"Rheumatol. Int."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Bittmann, F.N., Dech, S., Aehle, M., and Schaefer, L.V. (2020). Manual muscle testing\u2014Force profiles and their reproducibility. Diagnostics, 10.","DOI":"10.20944\/preprints202011.0064.v1"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Bortnick, K. (2024). Occupational Therapy Assessments for Older Adults: 100 Instruments for Measuring Occupational Performance, Routledge.","DOI":"10.4324\/9781003525288"},{"key":"ref_41","first-page":"1600","article-title":"Functional status and discharge outcomes in geriatric trauma patients: A comparison of the Barthel Index and the Functional Independence Measure","volume":"98","author":"Fletcher","year":"2017","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_42","first-page":"389","article-title":"Cross-cultural validation and reliability of the Functional Independence Measure in a Spanish population with acquired brain injury","volume":"52","author":"Colomer","year":"2023","journal-title":"NeuroRehabilitation"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1111\/j.1600-0404.2005.00404.x","article-title":"Scoring alternatives for FIM in neurological disorders applying Rasch analysis","volume":"111","author":"Nilsson","year":"2005","journal-title":"Acta Neurol. Scand."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2624","DOI":"10.1016\/j.ridd.2011.06.012","article-title":"Clinical characteristics of the trunk control measurement scale in children with cerebral palsy","volume":"32","author":"Heyrman","year":"2011","journal-title":"Res. Dev. Disabil."},{"key":"ref_45","first-page":"233","article-title":"Reliability and validity of trunk control test in patients with neuromuscular disease","volume":"37","author":"Yildirim","year":"2015","journal-title":"NeuroRehabilitation"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Xie, R., Zhang, Y., Jin, H., Yang, F., Feng, Y., and Pan, Y. (2023). Effects of soft robotic exoskeleton for gait training on clinical and biomechanical gait outcomes in patients with sub-acute stroke: A randomized controlled pilot study. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1296102"},{"key":"ref_47","unstructured":"(2011). Lokomat\u00ae User Manual, Hocoma AG."},{"key":"ref_48","first-page":"31","article-title":"Feasibility and effects of patient-cooperative robotics with body-weight support on dynamic perturbations during walking","volume":"9","author":"Vallery","year":"2012","journal-title":"J. NeuroEng. Rehabil."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Baronchelli, F., Zucchella, C., Serrao, M., Intiso, D., and Bartolo, M. (2021). The effect of robotic-assisted gait training with Lokomat\u00ae on balance control after stroke: Systematic review and meta-analysis. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.661815"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1161\/01.STR.0000254607.48765.cb","article-title":"Effects of locomotion training with assistance of a robot-driven gait orthosis in hemiparetic patients after stroke: A randomized controlled pilot study","volume":"38","author":"Husemann","year":"2007","journal-title":"Stroke"},{"key":"ref_51","first-page":"634","article-title":"Robot-assisted gait training in dermatomyositis: A case-control study","volume":"114","author":"Stoller","year":"2012","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Nizamis, K., Athanasiou, A., Almpani, S., Dimitrousis, C., and Astaras, A. (2021). Converging robotic technologies in targeted neural rehabilitation: A review of emerging solutions and challenges. Sensors, 21.","DOI":"10.3390\/s21062084"},{"key":"ref_53","first-page":"e52873","article-title":"Targeting weakness with a combination of isotonic exercises in dermatomyositis with polyneuropathy: A case report","volume":"16","author":"Waghe","year":"2024","journal-title":"Cureus"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Lee, J., Kunanbayev, K., Jang, D., and Kim, D.S. (2024). Comparing effects of wearable robot-assisted gait training on functional changes and neuroplasticity: A preliminary study. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0315145"},{"key":"ref_55","first-page":"225","article-title":"Re-Evaluating the Role of Robotic Gait Training in Post-Stroke Balance","volume":"15","year":"2025","journal-title":"Brain Sci"},{"key":"ref_56","first-page":"92","article-title":"Myositis-specific autoantibodies in clinical practice: Diagnostic and prognostic implications","volume":"14","author":"Chirila","year":"2021","journal-title":"J. Med. Life"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1186\/s12984-016-0162-5","article-title":"Powered robotic exoskeletons in post-stroke rehabilitation of gait: A scoping review","volume":"13","author":"Louie","year":"2016","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Fasano, A., Mauro, M.C., Beani, E., Nicora, G., Germanotta, M., Falchini, F., Pavan, A., Habib, V., Quaglini, S., and Sgandurra, G. (2025). Towards the Identification of Patients\u2019 Needs for Promoting Robotics and Allied Digital Technologies in Rehabilitation: A Systematic Review. Healthcare, 13.","DOI":"10.3390\/healthcare13070828"},{"key":"ref_59","first-page":"1053","article-title":"Age-related differences in recovery following neurological rehabilitation: Mechanisms and implications","volume":"37","author":"Andrews","year":"2015","journal-title":"Disabil. Rehabil."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1177\/105477380201100105","article-title":"The effect of social support on exercise behavior in older adults","volume":"11","author":"Resnick","year":"2002","journal-title":"Clin. Nurs. Res."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/6\/650\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:53:27Z","timestamp":1760032407000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/6\/650"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,17]]},"references-count":60,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["brainsci15060650"],"URL":"https:\/\/doi.org\/10.3390\/brainsci15060650","relation":{},"ISSN":["2076-3425"],"issn-type":[{"type":"electronic","value":"2076-3425"}],"subject":[],"published":{"date-parts":[[2025,6,17]]}}}