The effects of robot-assisted gait training combined with non-invasive brain stimulation on lower limb function in patients with stroke and spinal cord injury: A systematic review and meta-analysis

Abstract

Objective:This study aimed to investigate the effect of robot-assisted gait training (RAGT) therapy combined with non-invasive brain stimulation (NIBS) on lower limb function in patients with stroke and spinal cord injury (SCI).Data sourcesPubMed, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Web of Science were searched.Study selectionRandomized controlled trials (RCTs) published as of 3 March 2021. RCTs evaluating RAGT combined with NIBS, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), for lower limb function (e.g., Fugl-Meyer assessment for patients with stroke) and activities (i.e., gait velocity) in patients with stroke and SCI were included.Data extractionTwo reviewers independently screened the records, extracted the data, and assessed the risk of bias.Data synthesisA meta-analysis of five studies (104 participants) and risk of bias were conducted. Pooled estimates demonstrated that RAGT combined with NIBS significantly improved lower limb function [standardized mean difference (SMD) = 0.52; 95% confidence interval (CI) = 0.06–0.99] but not lower limb activities (SMD = −0.13; 95% CI = −0.63–0.38). Subgroup analyses also failed to find a greater improvement in lower limb function of RAGT with tDCS compared to sham stimulation. No significant differences between participant characteristics or types of NIBS were observed.ConclusionThis meta-analysis demonstrated that RAGT therapy in combination with NIBS was effective in patients with stroke and SCI. However, a greater improvement in lower limb function and activities were not observed using RAGT with tDCS compared to sham stimulation.

Transcranial Direct Current Stimulation in the Treatment of Gait Disturbance in Post-Stroke Patients: An Overview of Systematic Reviews

“…Only one study was rated with "High" confidence [12], although it did not justify this study design decision. While 7 studies were rated with "Critically Low" confidence [4,14,18,[20][21][22]29], the remaining 5 studies were classified with "Low" confidence. [13,15,19,23,24].…”

“…Studies were screened by title and abstract to check that they met the previously established inclusion criteria. Finally, 13 reviews were included [4,[12][13][14][15][18][19][20][21][22][23][24]29] for a total of 195 randomised controlled trials (RCT). The selection process is shown in the flow chart (Figure 1) with a list of excluded studies, reasons, and funding (Table S1).…”

The effect of robot-assisted gait training for patients with spinal cord injury: a systematic review and meta-analysis

“…The utilization of neuro-rehabilitation robots in rehabilitation has demonstrated promising clinical outcomes ( Hu et al, 2015 ; Qian et al, 2017 ; Rong et al, 2017 ; Demofonti et al, 2021 ; Selph et al, 2021 ). Robot-assisted gait training has been shown to enhance neuroplasticity, whereby injured nerves gradually regain their functionality through repetitive training and stimulation ( Kuwahara et al, 2022 ). Secondly, this type of training can enhance the patient’s muscle strength and stability, improve the efficiency and safety of walking ( Mıdık et al, 2020 ).…”

Exploring the Therapeutic Effects and Mechanisms of Transcranial Alternating Current Stimulation on Improving Walking Ability in Stroke Patients via Modulating Cerebellar Gamma Frequency Band—a Narrative Review

“…Long-term potentiation (LTP) or long-term depression (LTD) regulates cortical metabolism and electrophysiological activity by modulating cortical excitability [3], which has been used in treating various neurological diseases [4]. The primary motor cortex has been primarily targeted in recent studies of NIBS interventions for lower extremity dysfunction following stroke, but the effects are uneven [5][6][7][8].…”