Table 1.
Pre-clinical and clinical research on exoskeletons in CP, TBI and stroke.
| References | Study type | Research objectives | Demographics | Intervention | Evaluation | Findings |
|---|---|---|---|---|---|---|
| Cerebral palsy (CP): Biomechanical and physiological outcomes | ||||||
| Kuroda et al. (2020) | Intervention case study with pre-post evaluation | Examine the effect of 2s-HAL RD improvement in functional and clinical gait outcomes for pediatric CP | Chronic quadriplegic CP: n = 1 Age: 11 | HAL RD, 12 sessions, 40–60 min/session for 4 weeks | Timeframe: BL-post, 1 month, 2-month, and 3-month post Functional: GS, 10MWT, 6MWT Clinical: PCI, GMFCS, COPM Biomechanical: SL and CAD | BL to post: GS, CAD, SL, 6MWT, GMFCS and COPM ↑, PCI ↓ SL peaked at 1 month, GS peaked at 2 months, CAD peaked at 3 months No significance calculated |
| Bayón et al. (2016) | Intervention study, pre-post evaluation with no control group | Evaluate CPWalker RD improvements in biomechanical outcomes for CP | Chronic spastic diplegic CP n = 3 Age: 11–18 | CPWalker RD, 10 sessions, 1 h for 5 weeks | Timeframe: BL-Post Biomechanical: Velocity, CAD, SL | BL to post: Velocity↑, CAD ↑, SL ↑ No significance calculated |
| Bayón et al. (2018) | Intervention study, pre-post evaluation with no control group | Evaluate robotic rehabilitation therapy for CP using the CPWalker | Diplegic CP n = 4 Age: 12–17 | CPWalker RD, 16 sessions, 1 h for 8 weeks | Timeframe: BL-Post Functional: 10MWT, 6MWT Clinical: PCI, Selective Control Assessment of Lower Extremity (SCALE), GMFCS Biomechanical: Isometric Strength, range of motion | BL to post: MCID reached for two patients in 10MWT and 6MWT, all patients ↓ PCI, all patients ↑ SCALE, ↑Isometric Strength, and ↑ range of motion. No significance calculated |
| Lerner et al. (2017a) | Intervention case study with pre-post evaluation | Evaluate if novel RD motorized knee extension improves biomechanical and physiological outcomes in CP | Subacute diplegic CP n = 1 Age: 6 | Novel RD, 5 sessions | Timeframe: BL-Post Conditions: with/without motor Biomechanical: HA, KA, AA, CAD, SL, SW Physiological: EMG Of RF, VL, SEMI-T, MG | BL to post in free: max AA*, CAD* BL to post in assistive: AA*, stance KF*and KE*, knee range of motion*, CAD* No motor to with motor: SEMI-T** in favor of motor condition |
| Lerner et al. (2017b) | Intervention study, pre-post evaluation with no control group | Evaluate Novel RD for treatment of flexed knee gait for children with CP | Diplegic CP n = 7 Age: 5–19 | Novel RD, 6 sessions, 2–3 h each | Timeframe: BL-post Conditions: RD with stance, swing, and with both stance-swing assist Biomechanical: KA, SL, CAD, GS Physiological: EMG activity of VL, SEMI-T | BL to post: KE in midstance* at initial contact and in stance and swing assist condition*, VL activity* and SEMI-T activity* during stance, swing, and both conditions |
| Bulea et al. (2018) | Intervention study, pre-post evaluation with no control group | Determine if Novel RD can improve variance ratio of VL and SEMI-T muscles during gait for children with CP | Chronic diplegic n = 7 Age: 5–20 | Novel RD, 6 sessions, 2–3 h each | Timeframe: BL-Post Conditions: KE assistance in stance, late-swing, or both Physiological: Variance ratio of VL, and SEMI-T from EMG | BL to post: Variance ratio of VL* and SEMI-T* |
| Fang et al. (2020) | Intervention study, pre-post evaluation with no control group | Evaluate the effects of personalized ankle plantar and dorsi flexor assistance Biomechanical and physiological outcomes CP |
Diplegic CP n = 6 Age: 9–31 | Ankle RD, 4 sessions of 2–10-minute bouts of walking around a 61-m oval track | Timeframe: BL-Post for CGT and RD walking, post CGT to post RD, BL-CGT in first session to post RD in final session Biomechanical: GS, SLL, CAD Physiological: EMG activity in SEMI-T, SO and VL | BL to post for CGT: GS*, SLL*, variability in SO* and VL* BL to post for RD: GS*, SLL*, variability in SO* and VL* Post CGT to post RD: GS* and SLL* in RD BL CGT to post RD: GS* and SLL* |
| Traumatic brain injury (TBI): Biomechanical and physiological outcomes | ||||||
| Ekso RD gait training on biomechanical outcomes | Acute TBI right sided weakness n = 1 Age: 21 | Ekso RD, 12 sessions, 30 min/session | Timeframe: BL-Post Biomechanical: KA, HA, AA, SL, lateral foot displacement, GS, total time, swing and stance time of affected side | BL to post: ↓ joint angle variability swing, SL and GS, ↑ in stance and Lateral Foot Displacement, No significance calculated | ||
| Karunakaran et al. (2019) | Intervention case study with pre-post evaluation | Evaluate the effect of Ekso RD gait training on biomechanical outcomes | Chronic TBI n = 1, Healthy Control (HC) n = 1 | Ekso RD, 12 sessions, 50 min/day | Timeframe: BL-Post Biomechanical: Total normal force (TNF), spatial-temporal symmetry, SL, GS, STT, SWT | BL to post: TNF profile similar to HC at follow-up, ↑ spatial symmetry, STT, SWT, SL, GS |
| Karunakaran et al. (2020a) | Intervention study, pre-post evaluation with no control group | Evaluate RD training effect on loading/unloading and spatial characteristics for chronic ABI | Chronic TBI: n = 4 stroke: n = 2 HC n = 1 6L/1R Age: 14–27 | Ekso RD, 12 sessions, 45 min each HC one session without RD used for reference | Timeframe: BL-Post Biomechanical: Total vertical pressure, linearity of loading (LOL), rate of LOL, GS, SL, average total time, STT, SWT, DST | BL to post: ↑Total vertical pressure, LOL*, ↑ in SL, speed, and GS, ↓ in total, stance, and DST with no significant effect |
| Traumatic brain injury (TBI): Neurological outcomes | ||||||
| Karunakaran et al. (2020b) | Intervention case study with pre-post evaluation | Examine cortical outcome in chronic TBI patients after Ekso RD intervention using fNIRS | Chronic TBI Right sided weakness: n = 1 HC: n = 1 Age: 22, 26 | Ekso RD, 50 min/day12 sessions, 6 blocks of 20 s rest and 20 s | Timeframe: BL-Post Condition: walking with and w/o RD HC participated w/o RD Cortical: fNIRS Functional: GS, 10MWT, 2MWT, TUG | BL to post: ↓ activation shown in prefrontal cortex, motor cortex, and bilateral pre-motor cortex, ↑ in speed, TUG, 2MWT. No significance was calculated |
| Stroke- Rigid exoskeletons: Functional and clinical outcomes | ||||||
| Karunakaran et al. (2021) | Interventional study comparing pre-post effects with no control group | Evaluate the differences between Ekso GT RD training and CGT on functional gait outcomes in stroke | Acute stroke: n = 14 10L/4R Age: 18–82 | Ekso GT, RD+CGT during PT session, 45 min to 90 min/session | Timeframe: BL-post Conditions: RD + CGT Functional: WD, total steps, steps per session, 10MWT, 6MWT, TUG | BL to post: TUG*, 10MWT*, 6MWT* RD to CGT: WD*, distance walked per RD session* |
| Swank et al. (2020b) | Retrospective investigation of RD with control group | Investigate Ekso RD RGT utilization and its effect on functional outcomes in stroke | Acute stroke: n = 96 38L/51R/7Bi Age avg: 62 SCI: n = 59 Age avg: 48.2 | Ekso RD, ≥5 RD sessions only included, compared to ≥1 CGT session | Timeframe: admission, discharge Conditions: CGT, RD + CGT Clinical: Stroke Rehabilitation Assessment of Movement (STREAM), FIM motor, FIM total | CGT to RD: STREAM at admission and discharge* |
| Nilsson et al. (2014) | Interventional study comparing pre-post effects with no control group. | Investigate the safety, feasibility and functional changes after HAL RD gait training in stroke | Subacute stroke: n = 8 4R/4L Age: 39–64 | HAL RD, 6–17 sessions, 1 h/session, 5 days per week | Timeframe: BL-Post Conditions: voluntary and autonomous mode Functional: GS, FIM, 10MWT, BBS, FAC, TUG, FMA-LE, NIH stroke Scale, Clinical Outcome Variable Scale-Swedish version, Falls-efficacy Scale Swedish version, BI, EQ-5D, EQ-SD visual analog scales | FAC↑ and 10MWT↑ No significance was calculated |
| Taki et al. (2020) | Retrospective study comparing pre-post effects with control group | Examine HAL RD clinical outcomes in stroke patients using propensity score matching | Acute stroke: n = 108 Age: CGT-73.8, RD 71.4 | RD, CGT 3 h/day, for 7 day/week, RD training 3 times/week for 40 min for RD group | Timeframe: BL to post Condition: RD and CGT Clinical: FIM, Brunstrom recovery stage, Modified Rankin Scale | BL to post comparison between RD and CGT: FIM RD* |
| Li et al. (2021) | Randomized clinical trial | Evaluate BEAR-HI RD training on functional, clinical, and biomechanical outcomes in subacute stroke patients | Subacute stroke: n = 37 25L/12R Age: 20–65 | BEAR-HI RD or CGT, 30 min, 5 times/week for 4 weeks | Timeframe: BL-post Conditions: RD, CGT Functional: 6MWT Clinical: FAC, FMA-LE, MAS Biomechanical: GS, CAD, SL, SLL, gait cycle duration, SWT | RD to CGT: 6MWT,* FMA-LE*, gait speed*, CAD*, SL*, and cycle duration* in RD group |
| Goffredo et al. (2019) | Interventional study comparing pre-post effects with no control group. | Investigate Ekso RD training on functional and clinical outcomes in subacute stroke | Subacute stroke: n = 46 24L/22R Age: 18–80 | Ekso RD, 12–20 total sessions per patient, 1 h/session | Timeframe: BL-Post Conditions: ambulant and non-ambulant Functional: BI, TCT, FAC, WHS, 6MWT, 10MWT Clinical: WHS, MAS, MI-AD, MI-KE, MI-HI, MI-Lower Limb, MI-Total | BL to post n = 32 ambulant: BI*, MI-AD*, MI-KE*, MI-HF*, MI-Lower Limb*, MI-Total*, TCT*, FAC*, 6MWT*, 10MWT*, WHS*, BL-post n = 14 non-ambulant: n = 8 regained ambulation: BI*, MI-AD*, MI-KE*, MI-HF*, MI-Lower Limb*, MI-Total*, TCT, FAC*, 6WT*, 10mWT*, WHS* Subset n = 6 not ambulatory at post: BI* |
| Molteni et al. (2017) | Interventional study comparing pre-post effects with no control group | Examine Ekso RD effect on functional and clinical effects in stroke | Subacute: n = 12 5L/7R Age avg: 43.8 Chronic: n = 11 7L/4R Age avg: 55.5 | Ekso RD, 12 sessions, 1 h/session, 3 times/week | Timeframe: BL-Post Conditions: chronic patients: only RD training Subacute: RD plus CGT Functional: BI, TCT, FAC, TUG, WHS, 6MWT, 10MWT (sec), 10MWT (steps), 10MWT (m/s) Clinical: MAS-H, MAS-A, MI | BL to 6 sessions subacute: MI*, FAC*, 6MWT*, 10mWT (m/s)* 6 sessions to 12 sessions subacute: MI*, TCT*, 6MWT* BL to 12 sessions subacute: MI*, TCT*, FAC*, 6MWT*, 10MWT*, WHS* BL to 6 sessions chronic: MI* 6 sessions to 12 sessions chronic: MI*, 10MWT (m/s)*, 6MWT* BL to 12 sessions chronic: MI*, FAC*, 10mWT (m/s)*, 6MWT* |
| Molteni et al. (2021) | Randomized clinical trial | Evaluate Ekso RD effect on functional and clinical outcomes for stroke | Subacute stroke: n = 75 RD: n = 38 CGT: n = 37 45L/30R Age: 18–80 | Ekso RD, CGT 15 sessions (5 sessions/week for 1 h each) | Timeframe: BL and post Conditions: RD, CGT Functional: 6MWT, TCT, FAC, 10MWT Clinical: MAS-AL, MI-Affected Limb, mBI, WHS | BL to post, RD and CGT: All outcomes showed significant improvements |
| Mizukami et al. (2016) | Interventional study comparing pre-post effects with no control group | Examine effect of HAL RD in improving functional and clinical outcomes in stroke | Subacute stroke: n = 8 5L/3R Age: 26–76 | HAL RD, 25 sessions, 20-minute HAL treatment + 40-minute regular PT training/session | Timeframe: BL-Post Functional: speed from 10MWT, GS, 2MWT, FAC, BBS Clinical: FMA | BL to post: MWS*, GS*, and 2MWT* |
| Watanabe et al. (2017) | Randomized control trial | Examine the effect of HAL RD on different outcomes between conventional and RD training in stroke patients | Subacute stroke: n = 24 RD: n = 12 5L/7R Age avg: 66.9 n = 12 CGT Age avg: 76.8 | HAL RD or CGT, 12 sessions, 20 min/session | Timeframe: BL-post, 8–12 weeks of RD/CGT Conditions: CGT, RD Functional: FAC, TUG, 6MWT, MWS Clinical: FMA Biomechanical: CAD, SLL | BL to post CGT: FAC* BL to post 8 weeks CGT: FAC* BL to post 12 weeks CGT: FAC* |
| Yeung et al. (2021) | Randomized clinical trial | Evaluate ankle robot control modes in improving functional outcomes in stroke | Subacute stroke: n = 47 23L/24R Age avg: 65.5 | Ankle RD, power-assisted ankle robot, (PAAR) and swing-controlled ankle robot (SCAR) 30 min/session, 20 sessions followed by 2 h CGT, CGT only | Timeframe: BL-post Condition: RD + CGT, CGT Functional: FAC, BBS, 10MWT | BL to post within both groups: CAD,***, speed***, FAC***, BBS***, 10MWT*** PAAR to SCAR: more stairs and faster walking in PAAR** |
| Schröder et al. (2019) | Interventional study comparing pre-post effects with control group | Examine if Ekso GT improves functional and biomechanical outcomes in stroke | Chronic stroke: n = 7 5L/2R Age avg: 53 | Ekso GT RD and CGT, both groups: 1 h, 16 sessions | Timeframe: BL-Post Condition: RD, CGT Functional: 10MWT, 6MWT Biomechanical: walking symmetry ratio | BL to post RD: 2/3 10mWT*, 3/3 6minWT* BL to post CGT: 2/4 10mWT*, 1/4 6minWT* |
| De Luca et al. (2020) | Randomized control trial | Evaluate if Ekso GT RD improves psychological wellbeing of patients, QOL, and GI function in stroke | Chronic stroke: n = 30 Age avg: 55.1 | Ekso RD, and CGT both performed 24 sessions of gait training separately, 1 h/session | Timeframe: BL-Post Condition: RD, CGT Functional: 10MWT, TUG Clinical: Hamilton Rating Scale for Depression, short form Quality of life, FIM, RMI, Constipation Scoring System (CONST) PGWI: Anxiety, depression, General Health, Vitality, Positive wellbeing, self-control Coping Orientation to Problems Experienced (COPE): Social Support, Avoidance, Positive Attitude, Problem Orientation, Tran-scendental | BL to post RD: 10MWT***, TUG***, CONST***, Hamilton Rating Scale for Depression**, PGWI**, Anxiety**, depression*, Vitality**, General Health**, Positive wellbeing***, COPE-Social Support***, Avoidance***, Positive Attitude***, Problem Orientation***, short form Quality of life***, FIM***, RMI***, CONST*** BL to post CGT: COPE Problem Orientation***, FIM***, CONST**, TUG***, RMI*** |
| Goffredo et al. (2019) | Interventional study comparing pre-post effects with control group. | Evaluate improvements of clinical and functional outcomes using Ekso RD compared to end-effector training and CGT in stroke | Subacute stroke: n = 26 11L/15R Age: 18–80 | Ekso RD, end effector and CGT 15 ± 2 sessions, 1 h/session | Timeframe: BL-Post Conditions: End-effector training, RD, CGT Functional: TUG, 10MWT, 6MWT, WHS Clinical: MI-affected limb, MAS-AIL mBI, TCT, FAC Biomechanical: Spatial-temporal characteristics | BL to post end-effector training: mBI, MI-affected Limb*, TCT*, FAC*, WHS*, TUG*, 6MWT* BL to post RD overground: mBI*, MI-affected Limb*, FAC*, WHS*, and 10MWT* BL to post CGT: mBI*, MI-affected limb*, TCT*, FAC*, WHS*, TUG* |
| Yoshimoto et al. (2015) | Interventional study comparing pre-post effects with control group | Examine HAL RD and CGT improvement in functional outcomes in chronic stroke | Chronic stroke: n = 18 9L/9R Age avg: 65.1 | HAL RD: 8 sessions, 1 h/session, CGT: training once every 1 or 2 weeks, 1 h/session | Timeframe for RD: BL → 4 sessions → post Conditions: RD, CGT Functional: GS, CAD, and # of steps from 10MWT, TUG, FRT, BBS | BL to 4 sessions in RD groups: GS**, CAD**, TUG*, BBS* BL to 8 sessions in RD: GS***, CAD**, TUG**, FRT**, BBS** |
| Tanaka et al. (2019) | Interventional study comparing pre-post effects with no control group | Examine biomechanical gait outcomes in chronic stroke using HAL RD | Chronic stroke: n = 9 7L/9R Age: 50–85 | HAL RD, 6–15 sessions, 1 h/session | Timeframe: BL-post, and 3 months post Functional: 2MWT, 10MWT, FAC, FIM, Brunstrom recovery stage, GS Biomechanical: SLL, CAD | BL to post: GS*, SL*, CAD* and 2MWT* BL to 3 months post: GS*, SLL*, CAD* and 2MWT* |
| Yoshimoto et al. (2016) | Intervention case study with pre-post evaluation | Examine functional outcomes in chronic stroke using HAL RD | Chronic stroke: n = 1 1L Age: 60–65 | HAL RD, 8 sessions, 1 h/session | Timeframe: BL, post, 2 months post Functional: 10MWT, TUG, FRT, 2 Step Test, BBS | BL to post: all outcome ↑ BL to 2 months post: 10MWT and GS ↓ No significance calculated. |
| Kawamoto et al. (2013) | Intervention study with pre-post evaluation with no control group | Invesigate if HAL RD improves functional and biomechanical outcomes in chronic stroke | Chronic stroke: n = 16 7L/9R Age avg: 61 | HAL RD, 16 sessions, 20–30 min/session | Timeframe: BL-Post Functional: CAD, # of steps, speed from 10MWT, BBS, TUG | BL to post: GS*, BBS*, CAD*, # of steps* |
| Jyräkoski et al. (2021) | Intervention study with pre-post evaluation with no control group | Evaluate Indego RD effect on functional outcomes in brain injury | Subacute and chronic stroke: n = 4 TBI: n = 1 4L/1R Age: 30–69 | Indego RD, 16 sessions, 1 h per session | Timeframe: BL-post Functional: 6MWT, 10MWT | BL to post: 10 minWT ↑, 4/4 6MWT ↑ No significance calculated |
| Bortole et al. (2015) | Intervention case series with pre-post evaluation with no control group | Examine the feasibility and safety and clinical outcomes of the H2 RD in stroke | Chronic stroke: n = 3 3L Age: 43, 45, 58 | H2 RD, 12 sessions, 40 min/session | Timeframe: BL-Post Functional: BBS, TUG, 6MWT Clinical: FMA, Functional Gait Index, BI | BL to post: Subject 1 BBS ↑, Subjects 1 and 3 Functional Gait Index ↑, Subjects 2 and 3 6MWT, TUG, and FMA ↑, Subject 2 BI ↑ No significance calculated |
| Yeung et al. (2018) | Randomized control trial | Investigate RD AFO on improving clinical and functional outcomes in stroke | Chronic stroke: n = 19 10L/9R Age: 45–70 | RD AFO, and sham 20-1 h sessions, walking tasks: overground, ascending/descending stairs | Timeframe: BL-Post Conditions: RD AFO, sham Functional: 10MWT, 6MWT, BBS, FAC, FMA, MAS | BL to post: FAC*, 10MWT*, FMA* |
| Panizzolo et al. (2021) | Intervention study with pre-post evaluation with no control group | Evaluate if Exoband passive RD improves walking distance in ABI | Neurological: n = 10 stroke: n = 4 Age avg: 68.9 ± 9.2 | Exoband passive exoskeleton, 10 sessions, 10 min/session | Timeframe: BL-post Functional: WD, 6MWT Clinical: Borg rate of perceived exertion | BL to post: WD* |
| Kovalenko et al. (2021) | Randomized control trial | Evaluate ExoAtlet RD capability of improving clinical and functional outcomes in stroke | Chronic stroke: n = 42 Age: 47–75 | ExoAtlet RD, 10 sessions, 1 h/session, botulinum neurotoxin (BNT) injection given after 10 sessions | Timeframe: BL, post-RD (day 12), post BNT (day 33) Conditions: RD, CGT Functional: 10MWT, BBS, RMI Clinical: MAS, Rankin Scale, Visual Analog Scale, TS | BL to mid RD: 10MWT*, BBS*, TS* Mid to post RD: 10MWT*, BBS*, TS* BL to post RD to CGT: 10MWT**, BBS**, TS** |
| Stroke- Rigid exoskeletons: Biomechanical and physiological outcomes | ||||||
| Høyer et al. (2020) | Exploratory study with pre-post evaluation with no control group | Examine if Ekso RD improves biomechanical, functional and clinical outcomes in stroke | Subacute stroke: n = 26 Age avg: 54.4 18 | Ekso GT RD, 1 h/session, 2–3 times a week for 3 week, | Timeframe: BL-Post (clinical), 3rd session-post (functional) Functional: WT Biomechanical: up-time, number of steps, Borg scale Clinical: MAS | BL to post clinical: MAS** Third session to post functional: WT***, up-time***, and number of steps*** |
| Rojek et al. (2020) | Randomized control trial | Investigate if Ekso GT RD improves biomechanical and functional outcomes in stroke | Chronic stroke: n = 44 24L/20R, Age: 55–85 | Ekso GT RD, CGT 5 times/week, 45 min/session plus 1 h PT | Timeframe: BL-Post Conditions: RD, CGT Biomechanical: balance, load distribution, COP PL and COP avg Velocity (eyes open and closed) Clinical: RMI, BI | BL to post RD: COP PL and VEL ↑ eyes closed BL to post CGT: COP PL ↑ eyes open BL to post RD and CGT: COP Velocity ↑ eyes open, RMI* and BI* |
| Murray et al. (2015) | Intervention case series with pre-post evaluation with no control | Evaluate Vanderbilt RD controller in biomechanical outcomes for stoke | Chronic hemiplegic n = 3 1L/2R Age: 39, 42, 69 | Vanderbilt RD, 3 sessions, 30 min/session | Timeframe: BL-Post in each session Functional: 10MWT Biomechanical: GS, SLA, and SLL | BL to post: Improvement in each session, no significance noted or calculated |
| Murray et al. (2014) | Intervention case study with pre-post evaluation | Evaluate if novel controller in Vanderbilt RD improves biomechanical outcomes in stroke | Subacute stroke: n = 1 right side weakness age: 39 | Vanderbilt RD, 3 sessions, 10-meter walk, 20–30 min/session | Timeframe: BL-post Functional: GS from 10MWT Biomechanical: SLA, SLL | BL to post: GS, SLA and SLL ↑ No significance calculated. |
| Buesing et al. (2015) | Randomized control trial | Examine the impact of Stride Management Assist RD on biomechanical gait outcomes in stroke patients | Chronic stroke: n = 50 25L/25R Age: 18–85 years | SMAS RD, CGT 18 sessions, 45 min/session | Timeframe: BL, mid, post, 3 months Conditions: RD, CGT Biomechanical: GS, CAD, ST, SL, SLL, SWT, STT, and DST, spatial asymmetry | BL-Mid RD: GS**, CAD** BL-Mid RD (Impaired): SL**, SLL**, STT**, DST** BL-Mid RD (non-impaired): ST**, SL**, SLL**, STT*, DST** BL-Post RD: GS**, CAD**, temporal sym** BL-Post RD (impaired): ST**, SL**, SLL**, SWT**. STT**, DST** BL-Post RD (non-impaired): ST**, SL**, SLL**, STT**, DST** BL-Follow up RD: GS** BL-Follow up RD (impaired): SLL**, SL**, STT**, DST** BL-Follow up RD (non-impaired): SLL**, STT**, DST** Mid-Post RD: GS* Mid-Post RD (impaired): SL**, SLL**, DST** Mid-Post RD (non-impaired): SLL**, STT**, DST** BL-Mid CGT: GS** BL-Mid CGT (impaired): SL**, SLL** BL-Mid (non-impaired): SL**, SLL** BL-Post CGT: GS**, CAD** BL-Post CGT (impaired): ST**, SL**, SLL**, STT**, DST** BL-Post CGT (non-impaired): ST**, SL**, SLL**, STT**, DST** BL-Follow up CGT: GS** BL-Follow up (impaired): SLL** BL-Follow up (non-impaired): SL**, SLL** Mid-Follow up (non-impaired): SL** |
| Tan et al. (2018) | Interventional study with no control group | Determine effect of HAL RD training in stroke | Acute stroke: n = 8 4L/4R Age: 43–80 | HAL RD, 9 sessions, 1 h/session | Timeframe: BL-post Physiological: EMG of VM, HAM, TA, GA, AD, Gmax Clinical: L-FIM, m-FIM, FMA-LE Biomechanical: GS, SL, CAD, AA, HA, KA range of motion | BL to post: lateral synergies*, FIM-Locomotion*, FIM-Motor*, FMA*, GS*, CAD* |
| Tan et al. (2020) | Interventional study with control group | Evaluate the effects of HAL RD compared to CGT muscle synergy symmetry and clinical outcomes in stroke | Subacute stroke: n = 20 10L/10R Age: 40–80 | HAL RD, 9 sessions, 20 min/session | Timeframe: BL, 4th session, 7th session, post, Conditions: RD, CGT group Physiological: VM, HAM, TA, GA, AL, Gmax Clinical: L-FIM, m-FIM, FMA | BL to post RD: muscle timing symmetry*, FIM-L* FIM-M*, and FMA* BL to post CGT: FIM-L* FIM-M*, and FMA* |
| Zhang et al. (2020) | Randomized control study | Evaluate RoboCT RD clinical outcomes in stroke | Acute and Subacute Hemiplegic stroke: n = 24 Age avg: 51 | RoboCT RD, 20 sessions, 30 min CGT, 20 sessions, 30 min | Timeframe: BL-post Conditions: RD, CGT Biomechanical: Manual Muscle Strength Test (MMT) of TA | BL to post RD: MMT* BL to post CGT: MMT* RD to CGT: MMT* for RD |
| Infarinato et al. (2021) | Interventional study with no control group | Evaluate o-RAGT RD training muscles activation patterns, functional, and clinical outcomes in subacute stroke patients | Subacute stroke: n = 8 2L/6R Age: 18–80 | Ekso RD, 15 sessions of overground RD training, 1 h/session, 5 times a week | Timeframe: BL to post Functional: 10MWT Clinical: TCT, MAS. MI, FAC Physiological: BS, Co-Contraction, and root mean square from sEMG of TA, GM, RF, and BF | BL to post: MI*, FAC*, BS* of TA |
| Kotov et al. (2021) | Randomized study | Examine if ExoAtlet RD is capable of improving functional and clinical outcomes in stroke compared to pedal trainer | Subacute and chronic stroke: n = 47 ExoAtlet RD: n = 23 MOTO pedal trainer: n = 24 18L/29R Age: 18–80 | ExoAtlet RD, 5 days/week for 2 weeks, 10–30 min/session using RD in group 1 and using Pedal Trainer in group 2 | Timeframe: BL-post Functional: 10MWT, BBS Conditions: RD, MOTO Clinical: MRC, MAS, Modified Rankin Scale, BI, Hauser Ambulation Index Physiological: EMG of TA, MG, Gmax Biomechanical: SLL, cycle duration, GS, CAD, statokinesiogram | BL to post RD: SLL*, cycle duration*, GS*, CAD*, curve in statokinesogram eyes closed*, BI* BL to post MOTO: statokinesograph length eyes closed* RD to MOTO: MRC*, BBS*, Hauser Ambulation Index*, 10MWT*, BI*, length and area of statokinesiogram eyes open* |
| Zhu et al. (2021) | Interventional study with no control group | Evaluate the effect of Ekso RD on neuromuscular co-ordination in stroke | Chronic stroke: n = 12, 5 participated in longitudinal RD study (2F/10M), HC: n = 11 (5F/6M) Age: at least 18 years | Ekso 1.1TM RD, 10–15 sessions, 50 min /session. The therapist controlled the modes throughout therapy | Timeframe: BL-post Conditions: With and Without RD, HC Functional: 10MWT, 6MWT, TUG Physiological: energy expenditure, EMG of TA, MG, VM, BF-Long head, SEMI-T, Gmax, GM, muscle synergy and motor modules Biomechanical: AA, KA, HA | stroke vs. HC: Muscle synergy pattern: 4 modules HC and non-paretic side stroke, 3 modules stroke paretic leg, BL to post RD: 10MWT*, 6MWT*, ↑ synergy pattern after training |
| Lee et al. (2019) | Randomized control trail | Evaluate the effects of GEMS RD biomechanical, physiological, clinical, and functional outcomes in stroke | Chronic stroke: n = 26 15L/11R Age avg: 62 | GEMS RD, 10 sessions treadmill or overground RD training, CGT no RD, 45 min/session | Timeframe: BL-post Conditions: RD, CGT Biomechanical: GS, CAD, SLL and BS Physiological: bilateral sEMG of RF, BF, TA, GA, MG and cardiopulmonary metabolic efficiency (CPME) Clinical: FMA, FES Functional: BBS | BL to post RD: GS*, CAD*, SLL*, gait sym ratio*, RF*, BF*, TA*, GA*, CPME* BL to post CGT: GS*, CAD*, SLL*, RF* RD to CGT: SLL*, gait sym ratio*, EMG of RF*, GS**, CAD**, BF***, TA***, GA***, CPME* for RD |
| Li et al. (2015) | Interventional study with no control group | Examine clinical, biomechanical and physiological outcomes using RLO leg in stroke patients | Chronic stroke: n = 3 1L/2R Age: 53, 61, 62 | RLO RD, 15 sessions, 1 h/session | Timeframe: BL-post Clinical: BBS, LE-FMA Physiological: EMG of RF, TA, BF, GM Biomechanical: CAD, SL, GS | BL to post: BBS, LE-FMA, CAD, SL, and GS ↑, ankle symmetry, MG and BF ↑ No significance calculated |
| Stroke- Rigid exoskeletons: Neurological outcomes | ||||||
| Calabrò et al. (2018) | Randomized clinical trial | Examine the effect of Ekso RD gait training on cortical, functional, and physiological outcomes in stroke | Chronic stroke: n = 40 22L/18R Age avg: 67 | Ekso RD, 40 sessions, 1 h/session | Timeframe: BL-post Conditions: RD +CGT, CGT Cortical: CSE and SMI Functional: 10MWT, TUG Clinical: RMI Physiological: sEMG of TA, SO, RF, and BF Biomechanical: stance/swing ratio, gait quality index, CAD, gait cycle duration | RD to CGT: activity of RF*, BF*, SO* RMI*, TUG*, stance/swing ratio**, CSE**, SMI**, FPEC**, gait quality index***, CAD***, gait cycle duration***, 10MWT***in RD |
| Molteni et al. (2020) | Randomized crossover trial | Examine the effects of short term Ekso GT RD training on neuroplastic modulation in chronic stroke | Chronic stroke n = 9 4R/5L Age: 30–75 | Ekgo GT RD training and overground CGT, 1 h/session | Timeframe: Pre-post training Condition: RD, CGT Cortical: Coherence for alpha1, alpha2, and beta frequencies. Node strength and betweenness centrality | RD to CGT: Both groups node strength ↑ in alpha1, alpha2, and beta bands, betweenness centrality ↓ in alpha2 over vertex in left hemisphere stroke In Right hemisphere stroke, node strength ↑ in alpha, alpha2 over the contralesional sensorimotor area and ipsilesional prefrontal area in RD at Post |
| Jayaraman et al. (2019) | Randomized clinical trial | Evaluate Honda Stride management assistant RD gait outcomes in stroke compared to conventional training | Chronic stroke: n = 50 25L/25R Age: 18–85 | Honda RD, 18 sessions, 45 min/session | Timeframe: BL, mid, post, and 3 months post Condition: RD, CGT Functional: 10MWT, 6MWT, BBS, Sit to Stand Test Clinical: LE-FM, Cortical: CME of paretic RF, TA, lateral hamstrings | BL-mid, post, and 3 months post RD: 10MWT*, 6MWT*, BBS*, FMA-LE*, CME of RF* (only at post) BL-mid, post, and 3 months post CGT: 10MWT*, 6MWT*, BBS*, FMA-LE*, CME of lateral hamstrings* (only at post), CME of TA* (only at post) RD to CGT: 6MWT*, BBS* |
| Stroke- Soft exoskeletons: Functional and clinical outcomes | ||||||
| Haufe et al. (2020) | Interventional study with no control group | Examine the effects of Myosuit RD functional outcomes for stroke | Chronic stroke n = 2 1L/1R SCI: n = 4 Other: n = 2 Age: 18–80 | Myosuit RD, 5 total sessions, 45 min/session | Timeframe: BL-post Functional: 10MWT GS, 2 minWT WD, Daily step count, Borg scale | BL to post: GS for 5/8 participants** |
| Monticone et al. (2013) | Randomized controlled trial | Evaluate Regent RD on improving functional and clinical outcomes between RD and CGT in stroke | Subacute stroke: n = 60 Age: 40–75 | Regent RD, CGT, 20 sessions, 30 min | Timeframe: BL-post Conditions: RD, CGT Functional: 6MWT, BBS, BI Clinical: FIM | BL to Post: 6MWT, BBS RD to CGT: 6MWT*** |
| Stroke- Soft exoskeletons: Neurological outcomes | ||||||
| Saenko et al. (2016) | Intervention study with pre-post evaluation with no control group | Examine the effects of regent RD cognitive outcomes in stroke patients | Subacute and chronic stroke: n = 14 7L/7R Age avg: 50.3 | Regent RD, 10 sessions | Timeframe: BL-post Cortical metric: fMRI Clinical metric: FMA Functional metric: 10MWT | BL to post: 10MWT*, activation zones of the IPL***↓, activation zones of the Primary sensorimotor***↑ and SMA*** ↑ |
| Poydasheva et al. (2016) | Intervention study with pre-post evaluation with no control group | Evaluate the capability of nTMS to assess changes in gait cortical control using SEC in poststroke patients | Chronic stroke: n = 14 7L/7R Age avg: 53 | Regent RD, 10 sessions | Timeframe: BL-post Cortical: nTMS Functional: 10MWT Clinical: FMA | BL to post: 10MWT*, nTMS latency of response in ankle symmetry* |
*Level of p < 0.05 significance, **level of p < 0.01 significance, ***Level of p < 0.001 significance; ↑, increase; ↓, decrease; BL, baseline.