Gait Improvement in Chronic Stroke Survivors by Using an Innovative Gait Training Machine: A Randomized Controlled Trial

Abstract

Chronic stroke leads to the impairment of lower limb function and gait performance. After in-hospital rehabilitation, most individuals lack continuous gait training because of the limited number of physical therapists. This study aimed to evaluate the effects of a newly invented gait training machine (I-Walk) on lower limb function and gait performance in chronic stroke individuals. Thirty community-dwelling chronic stroke individuals were allocated to the I-Walk machine group (n = 15) or the overground gait training (control) group (n = 15). Both groups received 30 min of upper limb and hand movement and sit-to-stand training. After that, the I-Walk group received 30 min of I-Walk training, while the control followed a 30-minute overground training program. All the individuals were trained 3 days/week for 8 weeks. The primary outcome of the motor recovery of lower limb impairment was measured using the Fugl–Meyer Assessment (FMA). The secondary outcomes for gait performance were the 6-minute walk test (6 MWT), the 10-meter walk test (10 MWT), and the Timed Up and Go (TUG). The two-way mixed-model ANOVA with the Bonferroni test was used to compare means within and between groups. The post-intervention motor and sensory subscales of the FMA significantly increased compared to the baseline in both groups. Moreover, the 6 MWT and 10 MWT values also improved in both groups. In addition, the mean difference of TUG in the I-Walk was higher than the control. The efficiency of I-Walk training was comparable to overground training and might be applied for chronic stroke gait training in the community.

A rehabilitative approach beyond the acute stroke event: a scoping review about functional recovery perspectives in the chronic hemiplegic patient

“…In Calabrò et al work, the protocol with Ekso, an exoskeleton, showed a significant improvement at 10 Meter Walking Test (10MWT), Cortico-Spinal Excitability (CSE) and Sensory-Motor Integration (SMI) in the affected side, overall gait quality, hip and knee muscle activation and Frontoparietal Effective Connectivity (FPEC) ( 28 ). Similar results in walking speed were seen in Kooncumchoo et al study where they compared an innovative end effector robot (I-Walk) to overground gait training ( 29 ). Instead, Wu et al analyzed if there were differences between a robotic resistance training and a robotic assistance training.…”

“…In this way, the patient learns to control new movements with normal biomechanics and to use less energy when performing tasks. In contrast, the repetitions in the conventional PT group were possibly inadequate to control precise movement but the sensory stimulation by the physical therapist provided a more effective patient response and range of motion ( 28 , 29 ).…”

Effect of robot-assisted gait training on improving cardiopulmonary function in stroke patients: a meta-analysis

“…One study only included male participants [21]. In the control group, one study used treadmill training [22], while routine gait training was reported in another eight studies [23][24][25][26][27][28][29][30], Other studies used routine rehabilitation therapy [13,14,21,[31][32][33][34][35]. Most of the subjects were in the subacute phase (two weeks to six months).…”

“…Most of the subjects were in the subacute phase (two weeks to six months). Four studies involved investigations after six months of stroke [21,22,27,28] and another study involved investigating patients with acute stroke (within 48 h after stroke) [14]. The intervention time ranged from 20 min to 60 min, most of which lasted for 30 min.…”

“…Overall, fourteen studies [13,[21][22][23][24][25][26][27][28][29][30][32][33][34] evaluated baseline data and post-treatment results of the 6MWT in 582 patients. The heterogeneity between the studies was low (I 2 = 0%, p = 0.70), and the fixed effect model was used.…”