Effect of combined home-based, overground robotic-assisted gait training and usual physiotherapy on clinical functional outcomes in people with chronic stroke: A randomized controlled trial

Abstract

Objectives: To assess the effect of a home-based over-ground robotic-assisted gait training program using the AlterG Bionic Leg orthosis on clinical functional outcomes in people with chronic stroke. Design: Randomized controlled trial. Setting: Home. Participants: Thirty-four ambulatory chronic stroke patients who recieve usual physiotherapy. Intervention: Usual physiotherapy plus either (1)10-week over-ground robotic-assisted gait training program ( n = 16), using the device for ⩾30 minutes per day, or (2) control group ( n = 18), 30 minutes of physical activity per day. Measurements: The primary outcome was the Six-Minute Walk Test. Secondary outcomes included: Timed-Up-and-Go, Functional Ambulation Categories, Dynamic Gait Index and Berg Balance Scale. Physical activity and sedentary time were assessed using accelerometry. All measurements were completed at baseline, 10 and 22 weeks after baseline. Results: Significant increases in walking distance were observed for the Six-Minute Walk Test between baseline and 10 weeks for over-ground robotic-assisted gait training (135 ± 81 m vs 158 ± 93 m, respectively; P ⩽ 0.001) but not for control (122 ± 92 m vs 119 ± 84 m, respectively). Findings were similar for Functional Ambulation Categories, Dynamic Gait Index and Berg Balance Scale (all P ⩽ 0.01). For over-ground robotic-assisted gait training, there were increases in time spent stepping, number of steps taken, number of sit-to-stand transitions, and reductions in time spent sitting/supine between baseline and 10 weeks (all P < 0.05). The differences observed in all of the aforementioned outcome measures were maintained at 22 weeks, 12 weeks after completing the intervention (all P > 0.05). Conclusion: Over-ground robotic-assisted gait training combined with physiotherapy in chronic stroke patients led to significant improvements in clinical functional outcomes and physical activity compared to the control group. Improvements were maintained at 22 weeks.

Hybrid Robot-Assisted Gait Training for Motor Function in Subacute Stroke: A Single-Blind Randomized Controlled Trial

“…According to previous studies evaluating the effect of RAGT as an add-on to conventional physiotherapy, patients with (subacute or chronic) stroke exhibited improved ambulation function, lower-extremity motor function, balance, and gait performance both immediately postintervention and at follow-up, and these improvements were superior to those conventional physiotherapy [14,16,17,19,21,22,24,25,33]. By contrast, some studies have shown that training effects in locomotion function, activities of daily living, and gait were not superior to those of conventional stroke training in patients with subacute stroke [15,18,20,23].…”

“…Recently, several studies have evaluated the effects of RAGT in patients with stroke [20][21][22][23][24][25]. A Cochrane review proposed that RAGT combined with physiotherapy increased gait velocity and odds of participants being able to walk independently [21].…”

“…A Cochrane review proposed that RAGT combined with physiotherapy increased gait velocity and odds of participants being able to walk independently [21]. However, some studies have reported that the improvement was not superior to that of conventional treatment, even when delivered as an add-on to routine rehabilitation in the subacute phase of stroke [20,23], whereas others have demonstrated bene cial effects compared with physiotherapy alone on clinical functional outcomes and gait pattern [22,24,25]. Our group previously demonstrated changes in the Fugl-Meyer Assessment (FMA), Postural Assessment Scale for Stroke (PASS), BBS, and Barthel Index (BI) scores after an RAGT intervention, indicating substantial improvements in neurological status, balance, and the activities of daily living [26].…”

Robotic Home-Based Rehabilitation Systems Design: From a Literature Review to a Conceptual Framework for Community-Based Remote Therapy During COVID-19 Pandemic

“… Robotic devices for in-home walking training: (A) AlterG Bionic Leg ( Wright et al, 2020 ), (B) HAL lower-limb exoskeleton (Anneli Nilsson et al, 2014 ), and (C) SMA ( Buesing et al, 2015 ). …”

“…The AlterG Bionic Leg ( AlterG, 2015 ; AlterG, n.d ), a portable dynamic battery-operated over-ground wearable lower extremity orthosis, provides adjustable progressive mobility training by supplementing existing muscle strength, providing audio-sensory feedback and mobility assistance during rehabilitation ( Stein et al, 2014 ; Iida et al, 2017 ; Wright et al, 2020 ). This dynamic orthosis supports knee mobility when standing or walking by providing external support to the lower extremity and assisting the patient in aid of weight shifts and knee movement and can be worn in a manner similar to an orthopedic knee brace.…”