Background and Purpose— The purpose of this study was to investigate the effects of gait training with a newly developed wearable hip-assist robot on locomotor function and efficiency in patients with chronic stroke. Methods— Twenty-eight patients with stroke with hemiparesis were initially enrolled, and 26 patients completed the randomized controlled trial (14 in the experimental and 12 in the control groups). The experimental group participated in a gait training program over a total of 10 sessions, including 5 treadmill sessions and 5 over-ground gait training sessions while wearing a hip-assist robot, the Gait Enhancing and Motivating System (GEMS, Samsung Advanced Institute of Technology, Suwon, Republic of Korea). The control group received gait training without Gait Enhancing and Motivating System. Primary outcome measured locomotor function and cardiopulmonary metabolic energy efficiency. Also, secondary outcome measured motor function and balance parameter. Results— Compared with the control group, the experimental group had significantly greater improvement in spatiotemporal gait parameters and muscle efforts after the training intervention ( P <0.05). The net cardiopulmonary metabolic energy cost (mL·kg −1 ·min − 1 ) was also reduced by 14.71% in the experimental group after the intervention ( P <0.01). Significant group×time interactions were observed for all parameters ( P <0.05). Cardiopulmonary metabolic efficiency was strongly correlated with gait symmetry ratio in the experimental group ( P <0.01). Conclusions— Gait training with Gait Enhancing and Motivating System was effective for improving locomotor function and cardiopulmonary metabolic energy efficiency during walking in patients with stroke. These findings suggest that robotic locomotor training can be adopted for rehabilitation of patients with stroke with gait disorders. Clinical Trial Registration— URL: https://clinicaltrials.gov . Unique identifier: NCT02843828.

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Background Despite the benefits of physical activity for healthy physical and cognitive aging, 35% of adults over the age of 75 in the United States are inactive. Robotic exoskeleton-based exercise studies have shown benefits in improving walking function, but most are conducted in clinical settings with a neurologically impaired population. Emerging technology is starting to enable easy-to-use, lightweight, wearable robots, but their impact in the otherwise healthy older adult population remains mostly unknown. For the first time, this study investigates the feasibility and efficacy of using a lightweight, modular hip exoskeleton for in-community gait training in the older adult population to improve walking function. Methods Twelve adults over the age of 65 were enrolled in a gait training intervention involving twelve 30-min sessions using the Gait Enhancing and Motivating System for Hip in their own senior living community. Results Performance-based outcome measures suggest clinically significant improvements in balance, gait speed, and endurance following the exoskeleton training, and the device was safe and well tolerated. Gait speed below 1.0 m/s is an indicator of fall risk, and two out of the four participants below this threshold increased their self-selected gait speed over 1.0 m/s after intervention. Time spent in sedentary behavior also decreased significantly. Conclusions This intervention resulted in greater improvements in speed and endurance than traditional exercise programs, in significantly less time. Together, our results demonstrated that exoskeleton-based gait training is an effective intervention and novel approach to encouraging older adults to exercise and reduce sedentary time, while improving walking function. Future work will focus on whether the device can be used independently long-term by older adults as an everyday exercise and community-use personal mobility device. Trial registration This study was retrospectively registered with ClinicalTrials.gov (ID: NCT05197127).

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