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

Abstract

Introduction Practicality of implementation and dosing of supplemental gait training in an acute stroke inpatient rehabilitation setting are not well studied but can have positive impact on outcomes. Objectives To determine the feasibility of early, intense supplemental gait training in inpatient stroke rehabilitation, compare functional outcomes and the specific mode of delivery. Design and setting Assessor blinded, randomized controlled trial in a tertiary Inpatient Rehabilitation Facility. Participants Thirty acute post-stroke patients with unilateral hemiparesis (≥ 18 years of age with a lower limb MAS ≤ 3). Intervention Lokomat® or conventional gait training (CGT) in addition to standard mandated therapy time. Main outcome measures Number of therapy sessions; adverse events; functional independence measure (FIM motor); functional ambulation category (FAC); passive range of motion (PROM); modified Ashworth scale (MAS); 5 times sit-to-stand (5x-STS); 10-m walk test (10MWT); 2-min walk test (2MWT) were assessed before (pre) and after training (post). Results The desired supplemental therapy was implemented during normal care delivery hours and the patients generally tolerated the sessions well. Both groups improved markedly on several measures; the CGT group obtained nearly 45% more supplemental sessions (12.8) than the Lokomat® group (8.9). Both groups showed greater FIM improvement scores (discharge – admission) than those from a reference group receiving no supplemental therapy. An overarching statistical comparison between methods was skewed towards a differential benefit (but not significant) in the Lokomat® group with medium effect sizes. By observation, the robotic group completed a greater number of steps, on average. These results provide some evidence for Lokomat® being a more efficient tool for gait retraining by providing a more optimal therapy “dose”. Conclusions With careful planning, supplemental therapy was possible with minimal intrusion to schedules and was well tolerated. Participants showed meaningful functional improvement with relatively little supplemental therapy over a relatively short time in study.

A Comprehensive Review: Robot-Assisted Treatments for Gait Rehabilitation in Stroke Patients

“…When comparing the effects of RAGT and traditional walking training over 4 weeks and 6 weeks, a significant difference in walking ability was observed between the two groups [16,[22][23][24][25][26][27][28]30,[40][41][42]. However, interestingly, as the duration of training increased, the difference between the groups diminished considerably [26].…”

“…Based on Table 2's comprehensive overview of research characteristics by robot type, we can derive critical insights into the effectiveness and application of RAGT across various studies. This analysis highlights the differences in outcomes related to end-effector robots [19,22,23,32], fixed exoskeletons [20,[24][25][26][27][28][29][30]33,[39][40][41][42][43], wearable exoskeletons [34][35][36]38,44,45], and the combination of end-effector and fixed exoskeleton robots in the rehabilitation of individuals with mobility impairments [31]. Studies involving end-effector robots show significant improvements in functional ambulation categories, balance [22,32], muscle strength [32], and walking tests among participants.…”

“…The systematic review encompasses a wide array of randomized controlled trials evaluating the efficacy of various RAGT devices in improving mobility outcomes for patients following a stroke. A total of 27 studies were included, employing diverse robotic systems such as the Morning Walk [22][23][24], Lokomat [25][26][27][28][29][30][31], G-EO System Evolution [16,31,32], and others, to facilitate gait rehabilitation. These studies vary in sample size, interventions, control conditions, and outcome assessments, providing a comprehensive overview of the current state of research in this field (Table 1).…”

Analysis of Kinetic Signal Undergoing Gait Training with the Lokomat Exoskeleton after Complete Spinal Cord Injury

“…Using exoskeleton robots for assisted walking is the best way for patients with complete spinal cord injury to walk under normal gait conditions. In previous studies, the Lokomat exoskeleton developed by Hocoma has been used during the rehabilitation training of patients with spinal cord injury [15], demonstrating effective rehabilitation outcomes for children with cerebral palsy and patients with spinal cord injuries, Parkinson's disease, and other neurological disorders [16][17][18][19]. Because of the complete loss of lower limb motor functions in these patients, only passive movement modes were used on the Lokomat.…”

Robot- and Technology-Boosting Neuroplasticity-Dependent Motor-Cognitive Functional Recovery: Looking towards the Future of Neurorehabilitation

“…Conventional rehabilitation usually allows a small proportion of patients suffering from neurological disabilities to completely recover independent walking or functional grasping, and other activities of daily living [1]. For these reasons, an increasing number of research studies and randomized clinical trials are pursuing the use of new robots and technologies to improve the efficacy of rehabilitation [2][3][4][5][6]. They have become more usable and widespread every year, thanks to new principles of neuroscience translated into clinical practice through technological innovations.…”