An observational report of intensive robotic and manual gait training in sub-acute stroke

Abstract

Background: The use of automated electromechanical devices for gait training in neurological patients is increasing, yet the functional outcomes of well-defined training programs using these devices and the characteristics of patients that would most benefit are seldom reported in the literature. In an observational study of functional outcomes, we aimed to provide a benchmark for expected change in gait function in early stroke patients, from an intensive inpatient rehabilitation program including both robotic and manual gait training.

Methods: We followed 103 sub-acute stroke patients who met the clinical inclusion criteria for Body Weight Supported Robotic Gait Training (BWSRGT). Patients completed an intensive 8-week gait-training program comprising robotic gait training (weeks 0-4) followed by manual gait training (weeks 4-8). A change in clinical function was determined by the following assessments taken at 0, 4 and 8 weeks (baseline, mid-point and end-point respectively): Functional Ambulatory Categories (FAC), 10 m Walking Test (10 MWT), and Tinetti Gait and Balance Scales.

Results: Over half of the patients made a clinically meaningful improvement on the Tinetti Gait Scale (> 3 points) and Tinetti Balance Scale (> 5 points), while over 80% of the patients increased at least 1 point on the FAC scale (0-5) and improved walking speed by more than 0.2 m/s. Patients responded positively in gait function regardless of variables gender, age, aetiology (hemorrhagic/ischemic), and affected hemisphere. The most robust and significant change was observed for patients in the FAC categories two and three. The therapy was well tolerated and no patients withdrew for factors related to the type or intensity of training.

Conclusions: Eight-weeks of intensive rehabilitation including robotic and manual gait training was well tolerated by early stroke patients, and was associated with significant gains in function. Patients with mid-level gait dysfunction showed the most robust improvement following robotic training.

Figure 1

Schematic of the intensive rehabilitation program. The rehabilitation period comprised 8 weeks (5 hrs/day, 5 days/week); the first 4 weeks with Body-Weight-Supported-Robotic-Gait Training (BWSRGT) and the last 4 weeks Manual Gait Training. (*) Depending on patient individual needs and clinical goals.

Figure 2

A sub-acute stroke patient during the Robotic Gait training session. During the Body-Weight-Supported-Robotic-Gait Training (BWSRGT) the body weight is slightly unloaded via the use of a harness, while the fixed foot placement on the device ensures a set pattern that mimics human gait with alternate stance and swing phase.

Figure 3

Functional outcome results. Improvement in functional outcome across the robotic and manual training period (mean ± SD). For each outcome: (a) FAC (b) walking speed (c) Tinetti Gait and (d) Tinetti Balance, there was a significant increase following the robotic training, and further consolidation from the follow-up manual gait training.