Robotic Exoskeleton Gait Training During Acute Stroke Inpatient Rehabilitation

Abstract

Stroke is the leading cause of severe disability in adults resulting in mobility, balance, and coordination deficits. Robotic exoskeletons (REs) for stroke rehabilitation can provide the user with consistent, high dose repetition of movement, as well as balance and stability. The goal of this intervention study is to evaluate the ability of a RE to provide high dose gait therapy and the resulting effect on functional recovery for individuals with acute stroke. The investigation included a total of 44 participants. Twenty-two participants received RE gait training during inpatient rehabilitation (RE+SOC Group), and a matched sample of 22 individuals admitted to the same inpatient rehabilitation facility-receiving conventional standard of care treatment (SOC group). The effect of RE training was quantified using total distance walked during inpatient rehabilitation and functional independence measure (FIM). The total distance walked during inpatient rehabilitation showed a significant difference between the SOC and RE+SOC groups. RE+SOC walked twice the distance as SOC during the same duration (time spent in inpatient rehabilitation) of training. In addition, the average change in motor FIM showed a significant difference between the SOC and RE+SOC groups, where the average difference in motor FIM was higher in RE+SOC compared to the SOC group. The results suggest that RE provided increased dosing of gait training without increasing the duration of training during acute stroke rehabilitation. The RE+SOC group increased their motor FIM score (change from admission to discharge) compared to SOC group, both groups were matched for admission motor FIM scores suggesting that increased dosing may have improved motor function.

Gait Recovery with an Overground Powered Exoskeleton: A Randomized Controlled Trial on Subacute Stroke Subjects

“…A significant number of subjects improving their functional ambulation was registered in both groups. A similar result was found in other studies [ 16 , 18 , 19 , 22 ]. The maximum velocity walked on a pathway 10 m long (10MWT) registered a significant time effect and no group effect, similar to the 6MWT.…”

“…On the other hand, subacute stroke subjects have received limited attention [ 17 ], even though rehabilitation in this phase has been identified as an important prognostic factor for a positive clinical outcome, and early verticalization and gait training seem to enhance beneficial neuroplasticity and cognitive and functional recovery. Encouraging preliminary results on o-RAGT in subacute stroke subjects were found in terms of the recovery of independent walking [ 18 , 19 ] and locomotor functions [ 20 , 21 , 22 ]. However, the WPEs are increasingly being used in clinical practice, and their efficacy needs to be studied.…”

Predictors of Functional Outcome in a Cohort of Hispanic Patients Using Exoskeleton Rehabilitation for Cerebrovascular Accidents and Traumatic Brain Injury

“…Our study also highlights the need for specific attention into the diabetic patient population such as a need for swift admission into a comprehensive rehabilitation program that includes the option of RE rehabilitation. Taken together, our findings support previous findings showing that the use of RE enhances dosing during motor rehabilitation (Nolan et al, 2020 ), and that early interventions may produce the most benefit to the recovery of patients.…”

“…The first studies that examined the acceptance of robotics in patients after CVA started in the nineties (Dijkers et al, 1991 ). Consensus suggests that robotic-assisted gait training in patients after suffering a CVA is more likely to recover independent walking than those who did not use the robotic devices (Mehrholz et al, 2017 ; Bruni et al, 2018 ; Nolan et al, 2020 ). Studies also suggest that the use of robotics in rehabilitation could result in motor skills improvement and transfer into other daily living domains that require similar activities (Fasoli and Adans-Dester, 2019 ), hence improving cognitive domains.…”

Control System Design of an Underactuated Dynamic Body Weight Support System Using Its Stability

“…In recent years, more and more research results have confirmed the effectiveness of the use of exoskeletons in rehabilitation practice [ 15 ]. Guidelines and efficient exercise programs have also been developed [ 16 , 17 ]. An important advantage of exoskeletons is the fact that they stimulate the patients to move in compliance with the correct gait patterns and force them to be active [ 18 ].…”