While a variety of robot-assisted gait training systems have been widely applied for locomotor rehabilitation in stroke patients, the best supporting evidence for robot-assisted gait training systems remains unknown. The purpose of this study was to provide the best robot-assisted gait training and clinical evidence by comparing the effects of exoskeleton and end-effector type robot-assisted gait training in stroke rehabilitation. The present study underwent a review of the literature to determine the best clinical evidence of the most commonly utilized robot-assisted gait training paradigms (end-effector and exoskeleton types) in stroke gait rehabilitation. The review corroborates the compelling evidence that combined robot-assisted gait training was advantageous in stroke rehabilitation, as it offers additive special therapeutic effects that were not afforded by conventional therapy alone. Most importantly, the robot-assisted gait training paradigm provided more intensive, repetitive, accurate kinematic feedback and symmetrical gait practice, while reducing therapist labor, which is often not affordable in current stroke rehabilitation care. Both the robot-assisted gait training with either the end-effector type or exoskeleton type was beneficial for improving motor recovery, gait function, and balance in stroke patients when it was combined with the conventional physical therapy. The robot-assisted gait training should be used as an augmented gait intervention for stroke population.

Link to study

The aim of the study was to quantitatively compare the effects, on walking performance, of end-effector robotic locomotor training (G-EO System) versus intensive training with a treadmill in patients with Parkinson’s disease (PD).
Fifty patients with PD were randomly divided into two groups: 25 were assigned to the robot-assisted therapy group (RG) and 25 to the intensive treadmill therapy group (IG).
Measurement at onset (T0) and at the end (T1).
Spatio-temporal parameters: % stance, mean velocity, step length, step width, cadence; kinematics: gait profile score (GPS) and gait variable scores (GVS) were assessed.
The G-EO group significantly improved various spatio-temporal parameters (mean velocity, step length and cadence) whereas the treadmill group only improved the step length.
The G-EO group showed significant improvements in GVS (Pelvic obliquity and Hip Ab-Adduction) whereas the treadmill group did not show any improvements in kinematics.

Link to study

Until now studies reported inconclusive results in regards to the effectiveness of the exclusive use of robot-assisted training and clinical indications in stroke patients. To evaluate the feasibility of robot-assisted end-effector-based gait training (G-EO System) only in chronic stroke subjects in terms of gait performance and related parameters. Five rehabilitation centres participated and one hundred chronic post-stroke patients were recruited. Patients underwent robot-assisted end-effector-based gait training as the only treatment. 6 Minute Walking Test, 10 Meter Walk Test, Timed Up and Go Test, Modified Ashworth Scale, Motricity Index, Functional Ambulation Classification (FAC) and Walking Handicap Scale were used to measure the clinical outcome. Patients were divided into two groups: Those assessed as FAC < 3 (Group 1) and as FAC ≥ 3 (Group 2). Statistically significant changes were observed in each clinical outcome measure. Significant changes were observed in Group 1 and in Group 2. Significant percentages of patients achieved MCID in 6MWT in Group 2 and TUG in Group 1. Chronic stroke patients exposed to gait training with G-EO System only, showed significant improvements in global motor performances, gait endurance, balance and coordination, lower limbs strength and even spasticity reduction.

Link to study

The aim of this research was to quantify the effects of an end-effector robotic rehabilitation locomotion training (G-EO System) in a group of Parkinson’s Disease (PD) patients using a 3D gait analysis system (GA).
23 patients in stable doses of Parkinson’s medication with independent walking ability were assessed. The therapy consisted of 45 minutes of robot-assisted gait training for five days a week for 4 weeks (therapy speed was increased and body weight support was decreased over the therapy period).
Spatiotemporal parameters and kinematics variables by means of synthetic indexes (Gait Profile Score, GPS, and its Gait Variable Scores GVSs) were computed from GA at baseline, before the treatment (T0), and at the end of the rehabilitative program (T1). At T1 statistically significant improvements were found particularly in terms of spatio-temporal parameters (velocity, step length and cadence).
In addition by looking at the variables (GVS) some significant improvements were detected at the pelvis as well as the hip.

Link to study

This study established feasibility, together with reliability and repeatability, for augmented RASC-based CPET in able-bodied individuals. The end-effector based approach demonstrated comparable or higher peak cardiopulmonary performance variables relative to predicted values, it achieved the criteria for V′O2max, and it allowed determination of sub-maximal ventilatory thresholds. The reliability and repeatability were found to be high. There is potential for augmented RASC to be used for exercise testing and prescription in populations with neurological impairments who would benefit from repetitive task-specific training.

Link to study

This randomized controlled clinical trial was design with the intention to evaluate the effect of repetitive locomotor training on an electromechanical end effector gait trainer plus physiotherapy in subacute stroke patients. Primary outcome variables were gait ability and basic ADL, assessed before study onset, at the end of the four-week treatment period and at follow-up six months after study end. The Functional Ambulation Category, a reliable and valid score, helped to assess gait ability. Over a period of 21 months, 155 patients entered the trial, 77 in the experimental group and 78 in the control group. Results have shown that intensive robotic assistive training plus physiotherapy resulted in a significantly better gait ability and daily living competence when compared to physiotherapy alone. Consistency in the results obtained was also shown at follow up time.

Download Abstract

Konzipiert wurde diese randomisierte, kontrollierte klinische Studie zur Evaluierung des Effekts von repetitivem Training des Bewegungsapparats mit einem elektromechanischen Endeffektor-Gangtrainer plus Physiotherapie bei subakuten Schlaganfallpatienten. Primäre Zielvariablen waren Gehfähigkeit und grundlegende Alltagsaktivitäten (ADL), die vor Studienbeginn beurteilt wurden, nach der vierwöchigen Behandlungsperiode und bei der Nachfolgeuntersuchung sechs Monate nach Studienende. Mithilfe des FAC-Scores (Functional Ambulation Category), einem verlässlichen und stichhaltigen Wert, konnte die Gehfähigkeit beurteilt werden. Über einen Zeitraum von 21 Monaten nahmen 155 Patienten an der Studie teil, 77 in der Versuchsgruppe und 78 in der Kontrollgruppe. Die Ergebnisse haben gezeigt, dass intensives robotergestütztes assistives Training plus Physiotherapie im Vergleich zur Physiotherapie allein eine signifikant bessere Gehfähigkeit und Alltagskompetenz zur Folge hatte. Die Einheitlichkeit der erzielten Ergebnisse zeigte sich auch zum Zeitpunkt der Nachfolgeuntersuchung.

Zusammenfassung herunterladen

The study intends to compare lower limb muscle activation patterns of hemi paretic subjects during real floor walking and stairs climbing up, and during the corresponding simulated conditions on the G-EO System. The muscle activation pattern of seven lower limb muscles of six hemi paretic patients during free and simulated walking on the floor and stair climbing was measured via dynamic electromyography. In addition a non-ambulatory sub-acute stroke patient was trained on the G-EO-Systems every workday for five weeks. Findings demonstrates that the muscle activation patterns were comparable during the real and simulated conditions, both on the floor and during stair climbing up and demonstrate a significant gait improvement on the single case analyzed after the G-EO training.

Download Abstract

Ziel der Studie ist der Vergleich der Aktivierungsmuster der unteren Gliedmassen von halbseitig gelähmten Personen bei natürlichem Gehen auf ebenem Untergrund und Treppensteigen und unter entsprechenden simulierten Bedingungen im G-EO System. Die Muskelaktivierungsmuster der sieben Muskeln der unteren Gliedmassen von sechs halbseitig gelähmten Patienten wurden mithilfe dynamischer Elektromyographie beim freien und simulierten Gehen auf dem Boden und Treppensteigen gemessen. Darüber hinaus wurde ein nicht gehfähiger, subaktiver Schlaganfallpatient fünf Wochen lang jeden Werktag mit dem G-EO System trainiert. Die Ergebnisse zeigen, dass die Muskelaktivierungsmuster in Echtzeit und unter simulierten Bedingungen sowohl auf dem Boden als auch beim Treppensteigen vergleichbar waren und bei der Analyse nach dem G-EO-Training eine signifikante Verbesserung der Gehfähigkeit in jedem einzelnen Fall erkennen lassen.

Zusammenfassung herunterladen

In this randomized controlled trial, 18 ambulatory children with diplegic or tetraplegic cerebral palsy were randomly assigned to an experimental group or a control group. The experimental group received 30 minutes of repetitive locomotor training with an applied technology (Gait Trainer GT I) plus 10 minutes of passive joint mobilization and stretching exercises and the control group received 40 minutes of conventional physiotherapy for a total of 10 treatment sessions over a 2-wk period. The experimental group showed significant 1 month post-treatment improvement on the 10-min walk test, 6-min walk test, hip kinematics, gait speed, and step length while no significant changes in performance parameters were observed in the control group.

Download Abstract