Optimal Intervention Timing for Robotic-Assisted Gait Training in Hemiplegic Stroke

Abstract

This study was designed to determine the best intervention time (acute, subacute, and chronic stages) for Walkbot robot-assisted gait training (RAGT) rehabilitation to improve clinical outcomes, including sensorimotor function, balance, cognition, and activities of daily living, in hemiparetic stroke patients. Thirty-six stroke survivors (acute stage group (ASG), n = 11; subacute stage group (SSG), n = 15; chronic stage group (CSG), n = 10) consistently received Walkbot RAGT for 30 min/session, thrice a week, for 4 weeks. Six clinical outcome variables, including the Fugl–Meyer Assessment (FMA), Berg Balance Scale (BBS), Trunk Impairment Scale (TIS), Modified Barthel Index (MBI), Modified Ashworth Scale (MAS), and Mini-Mental State Examination, were examined before and after the intervention. Significant differences in the FMA, BBS, TIS, and MBI were observed between the ASG and the SSG or CSG. A significant time effect was observed for all variables, except for the MAS, in the ASG and SSG, whereas significant time effects were noted for the FMA, BBS, and TIS in the CSG. Overall, Walkbot RAGT was more favorable for acute stroke patients than for those with subacute or chronic stroke. This provides the first clinical evidence for the optimal intervention timing for RAGT in stroke.

Application of Novel Wearable Self-Balancing Exoskeleton Robot Capable for Complete Self-Support in Post-stroke Rehabilitation: A Case Study

“…The potential mechanism for patients' balance improvement may be that the robot provides feedback on weight support, repetitive movement, and proprioception during rehabilitation training [ 12 ]. Additionally, it helps maintain trunk stability and symmetry during mobility [ 13 ], which is conducive to enhancing motor control and coordination of patients' lower limbs [ 14 ].…”

Randomized Controlled Trial of Robot-Assisted Gait Training versus Therapist-Assisted Treadmill Gait Training as Add-on Therapy in Early Subacute Stroke Patients: The GAITFAST Study Protocol

“…It was previously proven that intensive RTGT starting in the acute stage (<1 week after stroke onset) improves, in addition to other functions, sensorimotor function more effectively than in the subacute or chronic stages after stroke [ 51 ]. Moreover, if greater improvements in motion execution are made early during the subacute stage, better outcomes may be expected during the chronic stages of recovery [ 12 , 13 , 51 , 52 , 53 ]. The training intensity may be effectively increased by robot-assisted gait training in stroke survivors classified as dependent walkers with higher motor impairment [ 17 , 22 , 24 , 47 , 48 ].…”

Structural design and research of a novel lower limb rehabilitation robot for human–robot coupling

“…1 According to neuroplasticity, the post-stroke rehabilitation process is divided into three main phases: acute, subacute, and chronic, of which the acute phase has the best rehabilitation effect. 2 The subacute phase is the most effective, but it is also the most difficult phase to treat. 3 Comprehensive rehabilitation is required during the chronic phase, especially for the lower extremities, as it determines the patient's quality of life.…”