Effect of early integrated robot-assisted gait training on motor and balance in patients with acute ischemic stroke: a single-blinded randomized controlled trial

Abstract

Background: Gait disruption is a common poststroke problem. Robot-assisted gait training (RAGT) might improve motor function, balance, and activities of daily living. Objective: We compared the clinical effectiveness of early integrated RAGT using the Walkbot robotic gym with an intensity-matched enhanced lower limb therapy (ELLT) program and with conventional rehabilitation therapy (CRT) in patients with acute ischemic stroke. Methods: A total of 192 patients with acute ischemic stroke were randomly assigned (1:1:1) to receive RAGT, ELLT, or CRT. All three groups received 45 min of training daily, 3 days a week, for 4 weeks consecutively. Before and after the 4-week treatment, the patients were assessed based on a 6-minute walking test (6MWT), functional ambulation classification (FAC), timed up and go (TUG) test, dual-task walking (DTW) test, Tinetti’s test, Barthel’s index (BI), stroke-specific quality of life (SS-QOL) scale, and gait analysis parameters. Results: After the 4-week intervention, the results of the 6MWT, FAC, TUG, DTW, Tinetti’s test, BI, SS-QOL, and gait in the three groups significantly improved. Compared with ELLT and CRT groups, participants in the RAGT group had a better performance in 6MWT (199.11 ± 60.72 versus 182.47 ± 59.72 versus 173.69 ± 40.58, p = 0.035), FAC (4.10 ± 0.91 versus 3.69 ± 0.88 versus 3.58 ± 0.81, p = 0.044), DTW (10.29 ± 2.38 versus 12.92 ± 2.64 versus 13.89 ± 2.62, p = 0.031), SS-QOL (184.46 ± 20.53 versus 165.39 ± 20.49 versus 150.72 ± 20.59, p = 0.012), velocity (0.66 ± 0.22 versus 0.55 ± 0.23 versus 0.51 ± 0.20, p = 0.008), cycle duration (1.38 ± 0.40 versus 1.50 ± 0.38 versus 1.61 ± 0.30, p = 0.040), and swing phase symmetry ratio (SPSR, 1.10 ± 0.33 versus 1.21 ± 0.22 versus 1.48 ± 0.25, p = 0.021). The TUG, Tinetti’s test, BI, and RMT results were similar, however. Conclusion: In the acute stroke phase, early integrated RAGT showed greater performance in gait rehabilitation than CRT and ELLT. Registration: ChiCTR1900026225

One-Leg Robotic-Assisted Gait Training Efficiently Improves Gait Independence for Acute Stroke Hemiplegic Patients

“…Previous studies started training 22.0–25.9 days after the onset of stroke, whereas the start of training was 7.9 days after stroke onset in the current study. Previous studies examining the efficacy of RAGT from the early phase after stroke onset reported that the time required to achieve beneficial results was shortened by early RAGT 17–20 . Therefore, we believe that early Welwalk training was no less efficient for inducing gait improvement compared with starting training in the subacute phase and shortened the time required to regain gait independence.…”

“…Previous studies examining the efficacy of RAGT from the early phase after stroke onset reported that the time required to achieve beneficial results was shortened by early RAGT. [17][18][19][20] Therefore, we believe that early Welwalk training was no less efficient for inducing gait improvement compared with starting training in the subacute phase and shortened the time required to regain gait independence. However, because this study did not have a control group and used different robotic devices than those used in previous studies, [17][18][19][20] this conclusion cannot be drawn conclusively from the current results.…”

“…[17][18][19][20] Therefore, we believe that early Welwalk training was no less efficient for inducing gait improvement compared with starting training in the subacute phase and shortened the time required to regain gait independence. However, because this study did not have a control group and used different robotic devices than those used in previous studies, [17][18][19][20] this conclusion cannot be drawn conclusively from the current results. In addition, the overall benefit of early Welwalk training did not show superiority over other Welwalk studies.…”

Effect of robot-assisted gait training on quality of life and depression in neurological impairment: A systematic review and meta-analysis

“…A total of 13 interventional studies reported data on quality of life/physical health quality of life for both interventional and control groups. 12,15,17,34,41,54 Pooling these studies, intervention using an exoskeleton appeared to improve the quality of life/physical health quality of life of participants (adjusted Hedges’g 0.58, 95% CI 0.28, 0.88; Figure 4).…”

Feasibility and outcomes of supplemental gait training by robotic and conventional means in acute stroke rehabilitation

“…Recent work, including reviews and meta-analyses of a moderate body of previous work also suggests but does not clearly indicate differential benefits of robotic training for patients in the acute and subacute phases of stroke [ 21 , 29 – 32 ]. There appears to be more support for robotic therapy assisting non-ambulatory acute stroke patients [ 21 , 32 , 33 ] or generally more impaired patients [ 34 , 35 ] or favoring acute/sub-acute as opposed to chronic stroke patients [ 30 , 31 , 36 ] although limited evidence exists that higher functioning ambulatory patients can benefit [ 8 ]. Our results add evidence to further the idea that robotic based training is helpful earlier post-stroke but even for patients who are ambulatory at baseline.…”