Overground gait training with an exoskeleton is a potential intervention for patients with subacute stroke.A study suggests that robot-assisted gait training (RAGT) augmented with a wearable, torque-assisted exoskeleton yields outcomes comparable to conventional gait training (CGT) alone in improving ambulatory function in patients with subacute stroke, with greater gains in lower limb strength.
“Overground gait training using an exoskeleton was not superior to CGT for improving ambulatory function in subacute stroke patients; however, it may provide additional lower-extremity motor improvement,” the investigators said.
This study enrolled 151 patients with subacute stroke who had severe gait impairment but relatively preserved trunk control. They were randomized 1:1 to the RAGT group (30 mins of CGT + 30 mins of exoskeleton) or the control group (60 mins of CGT) five times a week for 4 weeks. A total of 127 participants (mean age 60.1 years, 55.9 percent men) completed the 4-week intervention. [Stroke 2026;57:577-586]
The primary outcome was the change in ambulatory function, assessed by the Functional Ambulation Category (FAC) before (T0) and immediately after the intervention (T1). Secondary outcomes included balance and lower limb strength. Independent ambulation was re-evaluated 3 months after the intervention (T2).
The median FAC significantly improved from T0 to T1 in both the RAGT (from 0 to 3; p<0.05) and control groups (from 1 to 2.5; p<0.05). However, the difference between groups was not significant (p=0.395).
Similar proportions of participants in the RAGT and control groups achieved independent gait at T2 (77.6 percent and 75.4 percent; p=0.769).
Compared with T0, T1 saw significant improvements in balance (TCT*, BBS**) and lower extremity motor function parameters (FMA-LE***, MI-LL#) in both the RAGT and control groups (p<0.05 for all). However, the mean between-group differences in TCT (12.9 vs 14.9), BBS (20.9 vs 20.1), and FMA-LE (6.7 vs 5.7) failed to achieve statistical significance. For MI-LL, the increase from T0 to T1 was markedly greater in the RAGT vs the control group (mean, 15.9 vs 11.1; p=0.034).
EQ-5D## also significantly improved from T0 to T1 within the RAGT and control groups (p<0.05 for both), but not between groups (mean, 0.197 vs 0.155). Similarly, both groups had significant improvements in GDS-SF### from T0 to T1 (p<0.05 for both), but the between-group difference was not significant (mean, –2.3 vs –1.1; p=0.070).
No significant adverse events or any increase in spasticity, falls, or fractures were associated with either intervention.
Gait rehab imperative post-stroke
“Impaired ambulatory function is a significant contributing factor to post-stroke disability … [G]ait rehabilitation is imperative for enhancing ambulatory function in patients with stroke,” the researchers said.
According to the investigators, the augmented strength gains in the RAGT group may facilitate further improvement of ambulatory function and were likely attributable to the nature of the gait rehabilitation robot, citing evidence showing the efficacy of RAGT in enhancing lower limb strength in stroke patients. [Brain Neurorehabil 2023;16:e24; Clin Rehabil 2019;33:516-523; Bioengineering (Basel) 2023;10:585; Front Neurorobot 2022;16:837494]
Furthermore, the exoskeleton was designed to provide assistance based on the patient’s specific torques, they added.
“[Taken together,] the results suggest that overground gait training with an exoskeleton is a potential intervention for patients with subacute stroke,” the investigators said.