A Comparative Study of Conventional Physiotherapy versus Robot-Assisted Gait Training Associated to Physiotherapy in Individuals with Ataxia after Stroke Conflicting results of robot-assisted versus usual gait training during postacute rehabilitation of stroke patients: a randomized clinical trial Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke: A Randomized Controlled Pilot Study Gait training in subacute non-ambulatory stroke patients using a full weight-bearing gait-assistance robot: A prospective, randomized, open, blinded-endpoint trial Improvements in Speed-Based Gait Classifications Are Meaningful Multicenter Randomized Clinical Trial Evaluating the Effectiveness of the Lokomat in Subacute Stroke Pilot study of Lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke Prospective, Blinded, Randomized Crossover Study of Gait Rehabilitation in Stroke Patients Using the Lokomat Gait Orthosis Who May Benefit From Robotic-Assisted Gait Training? Effects of robot-assisted gait training on spatiotemporal gait parameters and balance in patients with chronic stroke: A randomized controlled pilot trial. Over-ground and robotic-assisted locomotor training in adults with chronic stroke: a blinded randomized clinical trial Sensory retraining of the lower limb after acute stroke: a randomized controlled pilot trial.
Objectives To assess the influence of RAGT on balance , coordination , and functional independence in activities of daily living of chronic stroke survivors with ataxia at least one year of injury . Methods It was a r and omized controlled trial . The patients were allocated to either therapist-assisted gait training ( TAGT ) or robotic-assisted gait training ( RAGT ) . Both groups received 3 weekly sessions of physiotherapy with an estimated duration of 60 minutes each and prescribed home exercises . The following outcome measures were evaluated prior to and after the completion of the 5-month protocol treatment : BBS , TUG test , FIM , and SARA . For intragroup comparisons , the Wilcoxon test was used , and the Mann – Whitney test was used for between-group comparison . Results Nineteen stroke survivors with ataxia sequel after one year of injury were recruited . Both groups showed statistically significant improvement ( P < 0.05 ) in balance , functional independencein , and general ataxia symptoms . There were no statistically significant differences ( P < 0.05 ) for between-group comparisons both at baseline and after completion of the protocol . Conclusions Chronic stroke patients with ataxia had significant improvements in balance and independence in activities of daily living after RAGT along with conventional therapy and home exercises . This trial was registered with trial registration number 39862414.6.0000.5505 Robot gait training has the potential to increase the effectiveness of walking therapy . Clinical outcomes after robotic training are often not superior to conventional therapy . We evaluated the effectiveness of a robot training compared with a usual gait training physiotherapy during a st and ardized rehabilitation protocol in inpatient participants with poststroke hemiparesis . This was a r and omized double-blind clinical trial in a postacute physical and rehabilitation medicine hospital . Twenty-eight patients , 39.3 % women ( 72±6 years ) , with hemiparesis ( < 6 months after stroke ) receiving a conventional treatment according to the Bobath approach were assigned r and omly to an experimental or a control intervention of robot gait training to improve walking ( five sessions a week for 5 weeks ) . Outcome measures included the 6-min walk test , the 10 m walk test , Functional Independence Measure , SF-36 physical functioning and the Tinetti scale . Outcomes were collected at baseline , immediately following the intervention period and 3 months following the end of the intervention . The experimental group showed a significant increase in functional independence and gait speed ( 10 m walk test ) at the end of the treatment and follow-up , higher than the minimal detectable change . The control group showed a significant increase in the gait endurance ( 6-min walk test ) at the follow-up , higher than the minimal detectable change . Both treatments were effective in the improvement of gait performances , although the statistical analysis of functional independence showed a significant improvement in the experimental group , indicating possible advantages during generic activities of daily living compared with overground treatment Background and Purpose — The success of gait rehabilitation after stroke depends on active walking exercises . However , the disabling after-effects of stroke often make such exercises impossible at the onset of therapy . To facilitate treadmill training of paraparetic patients , a robot-driven gait orthosis ( Lokomat ) was developed . We investigated the effects of the Lokomat when used with hemiparetic patients . Methods — The authors conducted a r and omized , controlled pilot study of 30 acute stroke survivors . The treatment group received 30 minutes of robotic training daily and the control group 30 minutes of conventional physiotherapy daily in addition to 30 minutes of conventional physiotherapy for each group . Outcome measures were independence of gait , gait speed , gait parameters , and body tissue composition . Results — After 4 weeks of therapy , the walking ability of the Lokomat group and the control group expressed as the functional ambulation classification was significantly improved . The functional ambulation category ( median± interquartile range ) was at baseline 0±0 in control and 0±1 in the therapy group and increased after therapy to 1±3 in both groups significantly ( P=0.01 ) . There was no significant difference in gain of these parameters between the groups . The Lokomat group had a significantly longer single stance phase ( sec ; mean±SEM ) on the paretic leg when walking on the floor . At baseline , it was 0.19±0.17 and after therapy 0.49±0.07 ( P=0.014 ) . The control group had increased their body weight approximately 1.33±1.40 kg ( mean±SEM ; P=0.046 ) , mostly as fat mass , whereas the Lokomat group had lost fat mass approximately −2.9±1.0 kg ( mean±SEM ; P=0.016 ) and increased their muscle mass approximately 3.36±1.4 kg ( mean± SEM ; P=0.031 ) . Conclusions — This pilot study indicates that Lokomat therapy is a promising intervention for gait rehabilitation . Although there was no difference between groups in gain of functional scores , the Lokomat group showed an advantage of robotic training over conventional physiotherapy in improvement of gait abnormality and body tissue composition BACKGROUND This study was a prospect i ve , r and omized , open , blinded-endpoint trial with the aim of examining whether gait training with a gait-assistance robot ( GAR ) improves gait disturbances in subacute non-ambulatory hemiplegic stroke patients more than overground conventional gait training . The GAR adopts a robot arm control system with full weight bearing and foot pressure visual biofeedback . METHODS Twenty-six hemiplegic patients were r and omly assigned to either the  GAR-assisted gait training ( GAGT ) group or the  overground conventional gait training ( OCGT ) group . Both groups underwent 60 min of st and ard physical therapy and 20 min of GAGT or OCGT 5 days a week for 4 weeks . The primary outcome measure was the Functional Ambulation Classification ( FAC ) . The secondary outcome measures were the peak torque of the extensor muscles in the lower extremities and a 10-m walking test . The lower extremity function was evaluated using the Fugl-Meyer Assessment , and activities of daily living were assessed using the Functional Independence Measure . RESULTS The GAGT group demonstrated significantly greater improvements in FAC and peak torque on the unaffected side ( p=0.02 ) than the OCGT group . Additionally , gait speed tended to be faster ( p=0.07 ) in the GAGT group . CONCLUSIONS GAGT combined with st and ard physical therapy in subacute non-ambulatory hemiplegic patients led to significant improvements in gait and peak torque on the unaffected side compared to OCGT Background and Purpose — Gait velocity is a powerful indicator of function and prognosis after stroke . Gait velocity can be stratified into clinical ly meaningful functional ambulation classes , such as household ambulation ( < 0.4 m/s ) , limited community ambulation ( 0.4 to 0.8 m/s ) , and full community ambulation ( > 0.8 m/s ) . The purpose of the current study was to determine whether changes in velocity-based community ambulation classification were related to clinical ly meaningful changes in stroke-related function and quality of life . Methods — In subacute stroke survivors with mild to moderate deficits who participated in a r and omized clinical trial of stroke rehabilitation and had a baseline gait velocity of 0.8 m/s or less , we assessed the effect of success versus failure to achieve a transition to the next class on function and quality of life according to domains of the Stroke Impact Scale ( SIS ) . Results — Of 64 eligible participants , 19 were initially household ambulators , and 12 of them ( 68 % ) transitioned to limited community ambulation , whereas of 45 initially limited community ambulators , 17 ( 38 % ) became full community ambulators . Function and quality -of-life SIS scores after treatment were significantly higher among survivors who achieved a favorable transition compared with those who did not . Among household ambulators , those who transitioned to limited or full community ambulation had significantly better SIS scores in mobility ( P=0.0299 ) and participation ( P=0.0277 ) . Among limited community ambulators , those who achieved the transition to full community ambulatory status had significantly better scores in SIS participation ( P=0.0085 ) . Conclusions — A gait velocity gain that results in a transition to a higher class of ambulation results in better function and quality of life , especially for household ambulators . Household ambulators possibly had more severe stroke deficits , reducing the risk of “ ceiling ” effects in SIS-measured activities of daily living and instrumental activities of daily living . Outcome assessment based on transitions within a mobility classification scheme that is rooted in gait velocity yields potentially meaningful indicators of clinical benefit . Outcomes should be selected that are clinical ly meaningful for all levels of severity Objective . To compare the efficacy of robotic-assisted gait training with the Lokomat to conventional gait training in individuals with subacute stroke . Methods . A total of 63 participants < 6 months poststroke with an initial walking speed between 0.1 to 0.6 m/s completed the multicenter , r and omized clinical trial . All participants received twenty-four 1-hour sessions of either Lokomat or conventional gait training . Outcome measures were evaluated prior to training , after 12 and 24 sessions , and at a 3-month follow-up exam . Self-selected overground walking speed and distance walked in 6 minutes were the primary outcome measures , whereas secondary outcome measures included balance , mobility and function , cadence and symmetry , level of disability , and quality of life measures . Results . Participants who received conventional gait training experienced significantly greater gains in walking speed ( P = .002 ) and distance ( P = .03 ) than those trained on the Lokomat . These differences were maintained at the 3-month follow-up evaluation . Secondary measures were not different between the 2 groups , although a 2-fold greater improvement in cadence was observed in the conventional versus Lokomat group . Conclusions . For subacute stroke participants with moderate to severe gait impairments , the diversity of conventional gait training interventions appears to be more effective than robotic-assisted gait training for facilitating returns in walking ability Background While manually-assisted body-weight supported treadmill training ( BWSTT ) has revealed improved locomotor function in persons with post-stroke hemiparesis , outcomes are inconsistent and it is very labor intensive . Thus an alternate treatment approach is desirable . Objectives of this pilot study were to : 1 ) compare the efficacy of body-weight supported treadmill training ( BWSTT ) combined with the Lokomat robotic gait orthosis versus manually-assisted BWSTT for locomotor training post-stroke , and 2 ) assess effects of fast versus slow treadmill training speed . Methods Sixteen volunteers with chronic hemiparetic gait ( 0.62 ± 0.30 m/s ) post-stroke were r and omly allocated to Lokomat ( n = 8) or manual-BWSTT ( n = 8) 3 × /wk for 4 weeks . Groups were also stratified by fast ( mean 0.92 ± 0.15 m/s ) or slow ( 0.58 ± 0.12 m/s ) training speeds . The primary outcomes were self-selected overground walking speed and paretic step length ratio . Secondary outcomes included : fast overground walking speed , 6-minute walk test , and a battery of clinical measures . Results No significant differences in primary outcomes were revealed between Lokomat and manual groups as a result of training . However , within the Lokomat group , self-selected walk speed , paretic step length ratio , and four of the six secondary measures improved ( p = 0.04–0.05 , effect sizes = 0.19–0.60 ) . Within the manual group , only balance scores improved ( p = 0.02 , effect size = 0.57 ) . Group differences between fast and slow training groups were not revealed ( p ≥ 0.28 ) . Conclusion Results suggest that Lokomat training may have advantages over manual-BWSTT following a modest intervention dose in chronic hemiparetic persons and further , that our training speeds produce similar gait improvements . Suggestions for a larger r and omized controlled trial with optimal study parameters are provided Objective . Treadmill training with partial body weight support has been suggested as a useful strategy for gait rehabilitation after stroke . This prospect i ve , blinded , r and omized controlled study of gait retraining tested the feasibility and potential efficacy of using an electromechanical-driven gait orthosis ( Lokomat ) for treadmill training . Methods . Sixteen stroke patients , mostly within 3 months after onset , were r and omized into 2 treatment groups , ABA or BAB ( A = 3 weeks of Lokomat training , B = 3 weeks of conventional physical therapy ) for 9 weeks of treatment . The outcome measures were the EU-Walking Scale , Rivermead Motor Assessment Scale , 10-m timed walking speed , 6-minute timed walking distance , Motricity Index , Medical Research Council Scale of strength , and Ashworth Scale of tone . Results . The EU-Walking Scale , Rivermead Motor Assessment Scale , 6-minute timed walking distance , Medical Research Council Scale , and Ashworth Scale demonstrated significantly more improvement during the Lokomat training phase than during the conventional physical therapy phase within each 3-week interval . Conclusions . Despite the small number of patients , the present data suggest that the Lokomat robotic assistive device provides innovative possibilities for gait training in stroke rehabilitation while eliminating prolonged repetitive movements in a nonergonomic position on the part of the physical therapist Background . Robotic-assisted walking training after stroke aims to enable highly impaired patients to walk independently , but results have been mixed . Objective . The authors aim ed to identify the characteristics of patients who may be most likely to benefit . Methods . A total of 48 participants with motor and gait dysfunction following subacute stroke were stratified by the motricity index into high ( < 29 ) and low ( ≥29 ) motor impairment groups . Each arm was r and omized to a robotic or control group ( RG or CG ) at a mean of 20 days after stroke . All patients underwent 2 therapy sessions per day , 5 days per week for 3 months . Those in the RG underwent 20 sessions of robotic-assisted gait training in the first 4 weeks of inpatient therapy using controlled endpoint trajectories and abbreviated conventional therapy , whereas the CG received only conventional gait training . The primary outcome was the functional ambulation category ( FAC ) , and secondary measures were the Rivermead mobility index ( RMI ) and 6-minute walking distance , all evaluated at hospital admission and at discharge . Results . The lower motricity group assigned to an electromechanical device significantly improved in the FAC ( P < .001 ) , RMI ( P = .001 ) , and walking distance ( P = .029 ) . Conventional and robotic therapies were equivalent in the higher motricity arm . Conclusion . Robotic therapy combined with conventional therapy may be more effective than conventional therapy alone in patients with greater motor impairment during inpatient stroke rehabilitation BACKGROUND Body weight-supported treadmill training assisted by a robotic gait orthosis is a helpful tool for restoring a symmetrical gait pattern in people with gait discrepancies . OBJECTIVE This study 's aim was to compare the effects of robot-assisted gait training ( RAGT ) versus treadmill gait training ( TGT ) on spatiotemporal gait parameters , balance , and activities-specific balance confidence with stroke patients . METHODS Eighteen participants with stroke were r and omly assigned to RAGT or TGT . Each group underwent twenty sessions ( 1 h/d , 5 d/wk for 4 weeks ) . Patients were assessed with gait parameters ( gait speed , cadence , step length , and double limb support period ) using the GAITRite , the Berg Balance Scale ( BBS ) score , and the activities-specific balance confidence ( ABC ) score before and after the intervention . RESULTS Gait speed ( P = 0.003 ) , cadence ( P = 0.002 ) , step length ( P = 0.004 ) , the BBS score ( P = 0.048 ) , and the ABC score ( P = 0.017 ) were significantly higher in the RAGT group than in the TGT group , while the double limb support period was significantly lower in the RAGT group ( P = 0.043 ) . CONCLUSION RAGT using Lokomat may be more effective than TGT in improving waking ability , balance , and balance confidence in patients with chronic stroke Purpose : The purpose was to compare the effectiveness of robotic-assisted body weight supported treadmill training using the Lokomat ® to over-ground gait training ( OGT ) in adults with chronic stroke . Methods : Participants were r and omly assigned to the Lokomat ® or OGT interventions . Both protocol s included 40 sessions over 8 weeks . Primary outcome measures were the 10-meter walk test and 6-minute walk distance . Secondary measures included the Functional Independence MeasureTM locomotion score , Fugl-Meyer Lower Extremity Motor Score ( FM-LE ) , Barthel Index , and Stroke Impact Scale . Blinded assessors tested the participants at baseline , post-intervention , and 3-month follow-up . Results : Eleven Lokomat ® and nine OGT participants completed the study . Within group differences in the FM-LE score and Barthel Index occurred over time from baseline to post-intervention and baseline to 3-month follow-up . No other within group differences and no between group differences were observed . Conclusions : Although walking measures did not show significant changes between groups , LE motor function and physical functional levels improved over time within both groups . The Lokomat ® may allow aggressive locomotor training , particularly for the lower functioning patients who wish to improve walking ability  due to apparent eased therapist physical burden , when compared to OGT , although an increased risk of skin breakdown is present . Implication s for Rehabilitation Survivors of chronic stroke can continue to improve in motor recovery and functional ability after intensive over-ground or robotic-assisted locomotor training . Over-ground and robotic-assisted locomotor training appear to equivalently enhance motor recovery and functional ability in low functioning survivors of chronic stroke . Risk of skin breakdown is significant with roboticassisted locomotor training OBJECTIVE To determine the effects of a sensory retraining protocol on sensation , postural control , and gait in acute stroke subjects . DESIGN R and omized controlled pilot trial . SETTING Inpatient rehabilitation hospital . PARTICIPANTS Twenty-one subjects with sensory deficits in the feet , undergoing rehabilitation for stroke . INTERVENTION Sensory retraining of the more affected lower limb versus relaxation ( sham intervention ) . MAIN OUTCOME MEASURES Light touch at the sole of the foot ( Semmes-Weinstein monofilaments ) , proprioception ( Distal Proprioception Test ) , postural control ( Berg Balance Scale ) , and gait ( timed , Iowa Level of Assistance Scale ) . RESULTS Significant improvements ( P<.05 ) over time were found in light touch at 3 points of the feet and in postural control , timed gait , and walking aid . No significant time effects were observed in proprioception or amount of assistance required to walk . No significant differences were detected between groups in any of the outcome variables , apart from light touch at the first metatarsal . The study had poor power ( 13 % ) to detect group effects due to the small sample size . CONCLUSIONS Results of this pilot study are unable to support or refute the routine use of sensory retraining of the lower limb for people during inpatient rehabilitation after stroke . Further research with a larger sample size is required
Background : The review is intended to provide the effectiveness of robotic-assisted gait training ( RAGT ) for functional gait recovery in poststroke survivors through a systematic review and to provide evidence for gait speed improvements through the meta- analysis of r and omized controlled trials ( RCTs ) .