Updates on robotics-based vs. conventional gait training

A multi-centre controlled comparative clinical trial to investigate the effectiveness of interventions.

Jakob Tiebel

Although stroke survivors may benefit from robotic gait rehabilitation, inpatient robotic gait training needs further investigation. In this work, the researchers investigated the effectiveness of this approach (using an exoskeleton or an end-effector robot) compared to conventional gait training in subacute stroke survivors.

In a multi-centre, controlled clinical trial, 89 patients in the subacute stage after a stroke completed twenty sessions of robot-assisted (robot group) or conventional gait training (control group) in addition to standard daily therapy. Robotic training was performed with an exoskeleton (Robo- tEXO group) or an end effector (RobotEND group). Clinical outcomes were assessed before and after treatment. Walking speed during the 10-metre walk test (10 MWT) was the primary outcome in this study and secondary outcomes were the 6-minute walk test (6 MWT), the timed up and go test (TUG) and the modified Barthel index (mBI).

he characteristics studied in the robot and control groups did not differ at the start of the study. At the end of the study period, a significant advan- tage in the 10 MWT was observed in the robot group. A benefit was also observed in the following parameters: 6 MWT, TUG and mBI. In addition, the patients in the robot group outperformed those in the control group in walking speed, endurance, balance and ADL. Patients in the RobotEND group improved their walking speed more than those in the RobotEXO group.

The researchers conclude that inpatient robot-as- sisted training improves walking ability in subacute stroke survivors more than conventional training. These results suggest that people with subacute stroke may benefit from robotic training to improve walking speed and endurance. The results also suggest that end-effector robots are superior to exoskeleton robots in improving gait speed.

The results also suggest that end-effector robots are superior to exoskeleton robots in improving gait speed.

A well-structured new study from January 2023 supports previous findings from reviews. The suit- ably high number of cases underlines the quality and significance. In particular, the study high- lights that end-effector robots seem to be more promising than exoskeletons in improving walking speed. Although it still cannot be ruled out that the results are distorted by different stages of the disease and degrees of functional impairment, it should be noted that people with subacute stroke who are unable to move around independently benefit considerably from inpatient robot-assisted gait training. Further large, controlled studies are needed to compare outcomes between the two device types in more homogeneous populations and to determine the optimal protocol design for maximum efficacy. The conditions that influence effectiveness still need to be better understood.

SOURCES:

Pournajaf S, Calabrò RS, Naro A, Goffredo M, Aprile I, Tamburella F, Filoni S, Waldner A, Mazzoleni S, Focacci A, Ferraro F, Bonaiuti D, Franceschini M, TreadStroke Group. Robotic versus Conventional Overground Gait Training in Subacute Stroke Survivors: A Multicenter Controlled Clinical Trial. J Clin Med. 2023 Jan 5;12(2):439. doi: 10.3390/ jcm12020439. PMID: 36675371; PMCID: PMC9861649.