Effects of robot-assisted gait training on the balance and gait of chronic stroke patients: focus on dependent ambulators

Abstract

[Purpose] The purpose of this study was to confirm the effect of robot-assisted gait training on the balance and gait ability of stroke patients who were dependent ambulators. [Subjects and Methods] Twenty stroke patients participated in this study. The participants were allocated to either group 1, which received robot-assisted gait training for 4 weeks followed by conventional physical therapy for 4 weeks, or group 2, which received the same treatments in the reverse order. Robot-assisted gait training was conducted for 30 min, 3 times a week for 4 weeks. The Berg Balance Scale, Modified Functional Reach Test, Functional Ambulation Category, Modified Ashworth Scale, Fugl-Meyer Assessment, Motricity Index, and Modified Barthel Index were assessed before and after treatment. To confirm the characteristics of patients who showed a significant increase in Berg Balance Scale after robot-assisted gait training as compared with physical therapy, subgroup analysis was conducted. [Results] Only lateral reaching and the Functional Ambulation Category were significantly increased following robot-assisted gait training. Subscale analyses identified 3 patient subgroups that responded well to robot-assisted gait training: a subgroup with hemiplegia, a subgroup in which the guidance force needed to be decreased to needed to be decreased to ≤45%, and a subgroup in which weight bearing was decreased to ≤21%. [Conclusion] The present study showed that robot-assisted gait training is not only effective in improving balance and gait performance but also improves trunk balance and motor skills required by high-severity stroke patients to perform activities daily living. Moreover, subscale analyses identified subgroups that responded well to robot-assisted gait training.

Sustained effects of once-a-week gait training with hybrid assistive limb for rehabilitation in chronic stroke: case study

“…Unlike other robotic devices that provide automatic passive motion generated by a robot7 ) , HAL receives and interprets muscle activity, enabling the user to control movements; this facilitates motor learning. Previous studies on patients with chronic stroke used HAL training, twice a week in total 16 sessions, and indicated benefits in restitution of walking function8, 9 ) .…”

Physical fitness interventions for nonambulatory stroke survivors: A mixed‐methods systematic review and meta‐analysis

“…Thirty‐four reports, representing 33 studies (Batcho, Stoquart, & Thonnard, ; Chang, Kim, Huh, Lee, & Kim, ; Cho, Park, Lee, Park, & Kim, ; Dean et al., ; Demers & McKinley, ; Franceschini et al., ; Hesse, Bardeleben, Werner, & Waldner, ; Hesse, Bertelt, Schaffrin, Malezic, & Mauritz, ; Hesse, Waldner, & Tomelleri, ; Hesse et al., ; Husemann, Muller, Krewer, Heller, & Koenig, ; Lennon, Carey, Gaffney, Stephenson, & Blake, ; Leroux, ; Mayr et al., ; Mehrholz, Rutte, & Pohl, ; Morone et al., ; Ng, Tong, & Li, ; Ochi, Wada, Saeki, & Hachisuka, ; Plummer et al., ; Potempa et al., ; Richards et al., ; Rosendahl et al., ; Shea & Moriello, ; Stoller et al., ; Teixeira da Cunha Filho et al., , ; Tong, Ng, & Li, ; Tsaih, Shih, & Hu, ; Vidoni, Tull, & Kluding, ; Wang, Wang, Fan, Lu, & Wang, ; Wang, Wang, Fan, Wenjun, et al., ; White, Bynon, Marquez, Sweetapple, & Pollack, ; Yagura, Hatakenaka, & Miyai, ; Yang et al., ), were included in the review (Figure ).…”

“…Of the 33 studies included, 31 were quantitative, of which 18 were RCTs (Chang et al., ; Dean et al., ; Franceschini et al., ; Husemann et al., ; Lennon et al., ; Morone et al., ; Ng et al., ; Ochi et al., ; Potempa et al., ; Richards et al., ; Rosendahl et al., ; Stoller et al., ; Teixeira da Cunha Filho et al., , ; Tong et al., ; Tsaih et al., ; Wang et al., , ; Yagura et al., ), three were randomized crossover studies (Cho et al., ; Mayr et al., ; Yang et al., ), four were cohort studies (Batcho et al., ; Hesse et al., ; Leroux, ; Plummer et al., ), and five were case studies (Hesse et al., , ; Mehrholz et al., ; Shea & Moriello, ; Vidoni et al., ). Hesse et al.…”

“…Of the 31 quantitative studies, nine (29%) were classified as “strong” (Chang et al., ; Franceschini et al., ; Hesse et al., ; Ng et al., ; Ochi et al., ; Stoller et al., ; Wang et al., , ; Yang et al., ) and 14 (45%) as “moderate” (Batcho et al., ; Cho et al., ; Dean et al., ; Hesse et al., , ; Husemann et al., ; Lennon et al., ; Leroux, ; Mayr et al., ; Mehrholz et al., ; Morone et al., ; Plummer et al., ; Rosendahl et al., ; Teixeira da Cunha Filho et al., , ), while eight (26%) were rated as “weak” (Hesse et al., ; Potempa et al., ; Richards et al., ; Shea & Moriello, ; Tong et al., ; Tsaih et al., ; Vidoni et al., ; Yagura et al., ; Table ). Of the 18 RCTs, 11 used an intention‐to‐treat (ITT) analysis (Dean et al., ; Franceschini et al., ; Husemann et al., ; Lennon et al., ; Morone et al., ; Ng et al., ; Ochi et al., ; Rosendahl et al., ; Stoller et al., ; Tong et al., ; Wang et al., ) and six did not (Chang et al., ; Richards et al., ; Teixeira da Cunha Filho et al., , ; Tsaih et al., ; Wang et al., ; Yagura et al., ), while reporting was unclear in one RCT (Potempa et al., ).…”

Untitled

“…Other interesting work is that of Cho, Park, Lee, Park & Kim (2015), where they conduct a robotassisted gait training intervention and analyze its effects. For this, they divided 20 participants into two groups: one group received four weeks of robotic-assisted gait training intervention 30 minutes per day, three times per week, followed by four weeks of conventional physiotherapy, while the other group received the same intervention in a reverse order.…”