Stroke Gait Rehabilitation: A Comparison of End-Effector, Overground Exoskeleton, and Conventional Gait Training

Gait recovery is one of the main goals of post-stroke rehabilitation and Robot-Assisted Gait Training (RAGT) has shown positive outcomes. However, there is a lack of studies in the literature comparing the effects of different devices. This paper aims to study the effects, in terms of clinical and gait outcomes, of treadmill-based and overground RAGT, compared to conventional gait training in stroke subjects. The results showed a significant improvement of clinical outcomes in both robotic treatments and in conventional therapy. The performance of locomotor tasks was clinically significant in the robotic groups only. The spatio-temporal gait parameters did not reveal any significant difference. Results suggest future multicentre studies on a larger number of subjects.

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Efficacy of End-Effector Robot-Assisted Gait Training Combined With Robotic Balance Training in Subacute Stroke Patients

Case Medical Research ◽

10.31525/ct1-nct04162197 ◽

2019 ◽

Author(s):

Keyword(s):

Balance Training ◽

Gait Training ◽

Stroke Patients ◽

Robot Assisted ◽

End Effector ◽

Subacute Stroke

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Robot-Assisted Gait Training in Patients with Multiple Sclerosis: A Randomized Controlled Crossover Trial

Medicina ◽

10.3390/medicina57070713 ◽

2021 ◽

Vol 57 (7) ◽

pp. 713

Author(s):

Cristiano Sconza ◽

Francesco Negrini ◽

Berardo Di Matteo ◽

Alberto Borboni ◽

Gennaro Boccia ◽

...

Keyword(s):

Crossover Trial ◽

Gait Training ◽

Treatment Session ◽

Control Group ◽

Walk Test ◽

Robot Assisted ◽

Randomized Controlled ◽

Gait Parameters ◽

Before And After

Background and Objectives: Gait disorders represent one of the most disabling aspects in multiple sclerosis (MS) that strongly influence patient quality of life. The improvement of walking ability is a primary goal for rehabilitation treatment. The aim of this study is to evaluate the effectiveness of robot-assisted gait training (RAGT) in association with physiotherapy treatment in patients affected by MS in comparison with ground conventional gait training. Study design: Randomized controlled crossover trial. Materials and Methods: Twenty-seven participants affected by MS with EDSS scores between 3.5 and 7 were enrolled, of whom seventeen completed the study. They received five training sessions per week over five weeks of conventional gait training with (experimental group) or without (control group) the inclusion of RAGT. The patients were prospectively evaluated before and after the first treatment session and, after the crossover phase, before and after the second treatment session. The evaluation was based on the 25-foot walk test (25FW, main outcome), 6 min walk test (6MWT), Tinetti Test, Modified Ashworth Scale, and modified Motricity Index for lower limbs. We also measured disability parameters using Functional Independence Measure and Quality of Life Index, and instrumental kinematic and gait parameters: knee extensor strength, double-time support, step length ratio; 17 patients reached the final evaluation. Results: Both groups significantly improved on gait parameters, motor abilities, and autonomy recovery in daily living activities with generally better results of RAGT over control treatment. In particular, the RAGT group improved more than control group in the 25FW (p = 0.004) and the 6MWT (p = 0.022). Conclusions: RAGT is a valid treatment option that in association with physiotherapy could induce positive effects in MS-correlated gait disorders. Our results showed greater effectiveness in recovering gait speed and resistance than conventional gait training.

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Clinical Efficacy of a New Robot-assisted Gait Training System for Acute Stroke Patients

Journal of Medical and Biological Engineering ◽

10.1007/s40846-020-00590-z ◽

2021 ◽

Author(s):

Andy Chien ◽

Fei-Chun Chang ◽

Nai-Hsin Meng ◽

Pei-Yu Yang ◽

Ching Huang ◽

...

Keyword(s):

Sleep Quality ◽

Acute Stroke ◽

Quality Index ◽

Pittsburgh Sleep Quality Index ◽

Gait Training ◽

Training System ◽

Control Group ◽

Stroke Patients ◽

Robot Assisted ◽

Significant Difference

Abstract Purpose Robot-assisted gait rehabilitation has been proposed as a plausible supplementary rehabilitation strategy in stroke rehabilitation in the last decade. However, its exact benefit over traditional rehabilitation remain sparse and unclear. It is therefore the purpose of the current study to comparatively investigate the clinical benefits of the additional robot-assisted training in acute stroke patients compared to standard hospital rehabilitation alone. Methods Ninety acute stroke patients (< 3 month) were recruited. All participants received the standard hospital neurorehabilitation comprises 45–60 min sessions daily for 3 weeks. Sixty patients also received an additional 30 min of robot-assisted gait training with the HIWIN MRG-P100 gait training system after each of the standard neurorehabilitation session. Outcome measures included: 1. Berg Balance Scale (BBS); 2. Brunnstrom Stage; 3. Pittsburgh Sleep Quality Index and 4. Taiwanese Depression Questionnaire (TDQ) which were assessed pre-treatment and then after every five training sessions. Results Both groups demonstrated significant improvement pre- and post-treatment for the BBS (robotic group p = 0.023; control group p = 0.033) but no significant difference (p > 0.1) between the groups were found. However, the robotic training group had more participants demonstrating larger BBS points of improvement as well as greater Brunnstrom stage of improvement, when compared to the control group. No significant within and between group statistical differences (p > 0.3) were found for Pittsburgh Sleep Quality Index and Taiwanese Depression Questionnaire. Conclusion The addition of robotic gait training on top of standard hospital neurorehabilitation for acute stroke patients appear to produce a slightly greater improvement in clinical functional outcomes, which is not transferred to psychological status.

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Gait rehabilitation in subacute hemiparetic stroke: Robot-assisted gait training versus conventional physical therapy

Journal of the Neurological Sciences ◽

10.1016/j.jns.2013.07.2009 ◽

2013 ◽

Vol 333 ◽

pp. e574 ◽

Cited By ~ 2

Author(s):

R. Chanubol ◽

P. Wongphaet ◽

C. Werner ◽

N. Chavanich ◽

L. Panichareon

Keyword(s):

Physical Therapy ◽

Gait Training ◽

Gait Rehabilitation ◽

Robot Assisted ◽

Hemiparetic Stroke

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Comparative Efficacy of Open-chain Kinematics and Closed-chain Kinematics on Walking Proficiency and Societal Integration in Post-stroke Individuals: a Pretest- Post-test Experimental Study

10.21203/rs.3.rs-990536/v1 ◽

2021 ◽

Author(s):

Obianuju Nwaedozie ◽

Caleb Gbiri ◽

Olajide Olawale ◽

Ukamaka Mgbeojedo ◽

Caleb Adeagbo

Keyword(s):

Experimental Study ◽

Bicycle Ergometer ◽

Stroke Survivors ◽

Walking Ability ◽

Open Chain ◽

Post Stroke ◽

Gait Parameters ◽

Closed Chain ◽

Significant Difference ◽

Spatio Temporal

Abstract Background Post-stroke hemiplegic gait is a mixture of deviations and compensatory motion dictated by residual function. To improve stroke survivors' walking ability, it is necessary to evaluate different rehabilitation approaches and identify those that have a greater effect on locomotor recovery of stroke patients. Objectives This study was designed to compare the effect of open-chain kinematics (bicycle ergometry) and closed-chain kinematics (treadmill) on walking proficiency in post-stroke individuals and their societal integration. Methods This was a pretest- posttest- experimental study involving 35 ambulatory hemiplegic stroke survivors (18males and 17 females) with a mean age of 53.77±10.95 undergoing rehabilitation at the two Teaching Hospitals in Lagos. Patients went through a 10-week rehabilitation and were randomly assigned to two intervention groups. Spatio-temporal gait parameters were measured by the six-metre walkway and community integrated questionnaire was used to examine home integration, social integration and productive activities. Data were subjected to inferential and descriptive statistics. The level of significance was set at p<0.05. Results Results showed significant difference between baseline and post intervention scores for all the gait parameters in the bicycle ergometer group except for stride length (p = 0.078). There was also a significant difference in the mean change in cadence between the treadmill and bicycle ergometer group (p = 0.04). Conclusions Both open-chain and closed-chain kinematics are effective, but closed- chain is most effective in re-educating ambulation and re-gaining spatio-temporal gait parameters after stroke and should be structured into the patients’ treatment regimen to effectively improve functional capability in post-stroke individuals.

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Efficacy of end-effector robot-assisted gait training combined with robotic balance training in sub-acute stroke patients: preliminary results

Gait & Posture ◽

10.1016/j.gaitpost.2019.07.475 ◽

2019 ◽

Vol 74 ◽

pp. 22-23

Author(s):

C. Iacovelli ◽

L. Castelli ◽

C. Pecchioli ◽

I. Aprile

Keyword(s):

Acute Stroke ◽

Balance Training ◽

Gait Training ◽

Stroke Patients ◽

Robot Assisted ◽

End Effector ◽

Preliminary Results

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Effect of robot-assisted gait training on motor functions in adolescent and young adult patients with bilateral spastic cerebral palsy: A randomized controlled trial

Neurorehabilitation ◽

10.3233/nre-203102 ◽

2020 ◽

Vol 47 (4) ◽

pp. 495-508

Author(s):

Stanislava Klobucká ◽

Robert Klobucký ◽

Branislav Kollár

Keyword(s):

Cerebral Palsy ◽

Motor Function ◽

Conventional Therapy ◽

Gait Training ◽

Adult Patients ◽

Robot Assisted ◽

Gross Motor ◽

Motor Functions ◽

Gross Motor Function ◽

Significant Difference

BACKGROUND: Robot-assisted gait training (RAGT) allows an intensive gait training in patients with cerebral palsy (CP). There are few evidences on the effectiveness of RAGT in adults with CP. OBJECTIVE: To assess the effect of RAGT on gross motor function in adolescent and adult patients with bilateral spastic CP and to compare the effect of RAGT with conventional kinesiotherapy. METHODS: Forty-seven patients (mean age 21.2±5.33 years) with bilateral spastic CP were divided into two groups. Twenty-one patients underwent 20 therapeutic units of RAGT and 26 patients underwent 20 therapeutic units of conventional therapy/training (CON). The following parameters were evaluated before (V1) and after the therapy (V2): dimension A (lying and rolling), B (sitting), C (crawling and kneeling), D (standing), E (walking, running and jumping) of the Gross Motor Function Measure (GMFM-88). In patients in the experimental RAGT group, these parameters were also evaluated 3–4 months later (V3). RESULTS: Comparing the mean improvements in endpoints in both groups (RAGT vs. CON) after 20 TUs, we observed the statistically significant difference (p < 0.001) and large effect size in all GMFM dimensions and total GMFM improvement in favour of the RAGT group. In RAGT patients, the improvement persisted even 3–4 months after RAGT (p < 0.001). CONCLUSION: We demonstrated that the intensive RAGT regimen is more effective than conventional therapy in terms of improvements in gross motor functions in adolescent and adult patients with bilateral spastic CP.

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