Effect of exoskeleton robot-assisted training on gait function in chronic stroke survivors: a systematic review of randomised controlled trials

Abstract

ObjectivesNumbers of research have reported the usage of robot-assisted gait training for walking restoration post-stroke. However, no consistent conclusion has been reached yet about the efficacy of exoskeleton robot-assisted training (ERAT) on gait function of stroke survivors, especially during the chronic period. We conducted a systematic review to investigate the efficacy of ERAT on gait function for chronic stroke survivors.DesignThis review followed the Participant, Intervention, Comparison and Outcome principle.Data sourcesPubMed, Cochrane Library, Web of Science, Embase and Cumulative Index to Nursing and Allied Health Literature databases were systematically searched until December 2022.Eligibility criteriaOnly randomised controlled trials (RCTs) were included and these RCTs took patients who had a chronic stroke as participants, exoskeleton robot-assisted gait training as intervention, regular rehabilitation therapy as comparison and gait-related functional assessments as outcomes.Data extraction and synthesisData extraction and synthesis used the reporting checklist for systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias and methodological quality of included studies were evaluated by two independent investigators under the guidance of Cochrane risk of bias.ResultsOut of 278 studies, a total of 10 studies (n=323, mean age 57.6 years, 63.2% males) were identified in this systematic review. According to the Cochrane risk of bias, the quality of these studies was assessed as low risk. Six studies reported favourable effects of ERAT on gait function involving gait performance, balance function and physical endurance, and the ERAT group was significantly superior when compared with the control group. In contrast, the other four trials showed equal or negative effects of ERAT considering different study designs. All the included studies did not claim any serious adverse events.ConclusionERAT could be an efficient intervention to improve gait function for individuals who had a chronic stroke. However, more rigorously designed trials are required to draw more solid evidence.PROSPERO registration numberCRD42023410796.

Effects of a Gait Training Program on Spinal Cord Injury Patients: A Single-Group Prospective Cohort Study

“…Taking into account the number of scientific articles that relate gait training to the use of new rehabilitation methods, it can be inferred that the attention given to conventional gait training methods is scarce, but not the same for those articles that focus on the use of new technologies [23][24][25][26][27].…”

Robotic exoskeleton-assisted walking rehabilitation for stroke patients: a bibliometric and visual analysis

“…Traditional rehabilitation is delivered by therapists or nurses, but the rising incidence of stroke has led to a shortage of qualified professionals (Mehrholz et al, 2020). The advent of rehabilitation robotics offers a novel solution to this issue, as these devices can assist in performing repetitive and standardized rehabilitation tasks (Riener et al, 2005), thereby alleviating the burden on rehabilitation workers (Yang et al, 2023). In recent years, due to advancements in chemical material sciences, control technologies, and the integration of artificial intelligence, there has been a rapid development of exoskeletal robotic devices (Yi and Yubing, 2024).…”

“…Technological investigations are concentrated on the biomimetic design of exoskeletal mechanisms, the detection of movement intention, and the motor control within human-machine hybrid systems. The efficacy dimension focuses on the assessment of patient gait restoration, the consequent effects on neuroplasticity, and the overall impact on the patients' self-care capabilities and quality of life (Koenig et al, 2011;Loro et al, 2023;Pournajaf et al, 2023;Yang et al, 2023). Some scholars have provided comprehensive reviews on the effectiveness of RE in rehabilitative treatments for stroke survivors (Yang et al, 2023).…”

“…The efficacy dimension focuses on the assessment of patient gait restoration, the consequent effects on neuroplasticity, and the overall impact on the patients' self-care capabilities and quality of life (Koenig et al, 2011;Loro et al, 2023;Pournajaf et al, 2023;Yang et al, 2023). Some scholars have provided comprehensive reviews on the effectiveness of RE in rehabilitative treatments for stroke survivors (Yang et al, 2023). However, traditional reviews or systematic reviews prioritize the synthesis and critical appraisal of literature, aiming to address specific questions within a given field (Yu et al, 2017).…”

Knowledge and attitudes toward artificial intelligence in nursing among various categories of professionals in China: a cross-sectional study

“…For discharged patients with disabilities or walking disabilities, compared with walking aids, mobility robots can sense the surrounding environment and the user’s intention, flexibly assisting walking and reducing the occurrence of adverse events ( 11 , 12 ). Exoskeleton robots can help stroke patients improve their gait and facilitate their rehabilitation ( 13 ). In addition, socially assistive robots can promote social interactions among home-bound older adults, reduce their sense of loneliness, and enhance their sense of well-being ( 14 ).…”