Table 2.
Literature summary
| Author, year Study design | Participants | Participants' walking ability at baseline | Training period and protocol (duration of the intervention, session) | Apparatus and its setting | Outcome |
|---|---|---|---|---|---|
| Hornby et al. (2008) [35] RCT | 48 patients with chronic stroke IG: robotic LT group (n = 24) CG: therapist-assisted LT group (n = 24) | > 10 min overground without assistance at WS ≤ 0.8 m/s at SSV, using assistive device | IG: with guided symmetrical locomotor assistance by robot CG: with guided symmetrical locomotor assistance by therapist manually 12 sessions 30 min per session | Device: Lokomat BWS: weight support% is 25 ± 6.7% for robotic- assisted and 21 ± 7.5% for therapist-assisted WS: up to 3.0 kmph decreased throughout training | Outcome measures: WS (SSV and FV), 6MD at SSV, mEFAP, BBS, SF-36, MMT, MAS, CES-D Result: In therapist-assisted LT, greater improvements in speed and single limb stance time on the impaired leg compared with those in the robotic LT group were found |
| Belas Dos Santos et al. (2018) [36] RCT | 15 patients with chronic stroke IG: n = 7 CG: n = 8 | Baseline and outcome evaluation: BBS, FIM, TUG | IG: 2 sessions of PT and 1 session of RAGT CG: 2 sessions of PT and 1 session of TAGT 60 min per session 5-month protocol | Device: Lokomat BWS: gradually reduced from 50% of patient weight at the start of the protocol treatment until a minimum of 10% at the end WS: low speed between 0.8 kph and 1.5 kph | Outcome measures: BBS, TUG, FIM, SARA Functional scale scores mean values differed significantly between groups. No significant difference for the between-group comparison at both baseline and after treatment |
| Seo et al (2018) [37] RCT | 12 patients with chronic stroke IG: n = 6 CG: n = 6 | Able to walk at least 10 m independently Asymmetrical gait with a step length asymmetry ratio > 1.1 FAC Group 1: 3.3 ± 0 Group 2: 3 3.7 ± 0.2 | IG: assist-as-needed RAGT for the unaffected limb and fully assisted RAGT for the affected limb CG: assist-as-needed RAGT for the affected limb and fully assisted RAGT for the unaffected limb 20 sessions 2 times per week 45 min per session | Device: Walkbot BWS: bodyweight support was reduced as the subject's function improved (no clear description present) WS: the treadmill speed was increased to a maximum of 2.2 km/h as the subject's function improved | Outcome measures: NIHSS, FMLE, FAC, MI, and the TCT Assessed at the baseline (T0) and after 10 (T1) and 20 (T2) training sessions Result: In IG, FMLE, FAC, and MI scores significantly improved at T2 compared to T0. The unaffected limb's step length asymmetry ratio and hip maximal extension moment significantly improved In CG, only FMLE score improved significantly at T2 compared to T0 No significant differences in the between groups analysis was found |
| Lewek et al. (2009) [38] RCT | 19 participants with chronic stroke IG: therapist-assisted LT (n = 9) CG: robotic-assisted LT (n = 10) | Able to walk at least 10 min overground without assistance and at SSV of 0.8 m/s | IG: therapist-assisted LT CG: robotic-assisted LT 12 sessions 3 times per week 60 min per session | Device: Lokomat BWS: 40% BWS at the first session and reduced as tolerated WS: speed was gradually increased during the first session, remaining at 3.0 km/h (0.83 m/s) for the duration of the intervention | Outcome measures: Maximum joint angles, Excursions of the hip, knee, and ankle joints, Hip and knee ACC Result: Robotic-assisted LT did not demonstrate a significant increase in SSV, hip and knee ACC. Therapist assisted LT resulted in significant improvements in both outcome measures |
| Westlake et al. (2009) [39] RCT | 16 volunteers with chronic stroke IG: Lokomat (n = 8) CG: manual BWSTT (n = 8) | At least unlimited household ambulators (WS > 0.3 m/s) | IG: RAGT with Lokomat CG: manual BWSTT The fast WS group and slow WS group were assigned to the IG and CG, respectively 12 sessions 3 times per week ≤ 60 min per session | Device: Lokomat BWS: 35% at first, reduced in increments of 5% as long as gait quality was maintained WS: maintained below 0.69 m/s (2.5 km/h) in the slow groups and above 0.83 m/s (3 km/h) in the fast groups | Outcome measures: SSV, paretic step length ratio, FV, 6MD Result: IG group, SSV and paretic step length ratio, and four of the six secondary measures improved. Group differences between fast and slow training groups were not stated |
| Danzl et al. (2013) [40] RCT | 8 subjects with chronic stroke IG: active tDCS with RGO CG: sham tDCS with RGO | N/A | IG: active tDCS with identical locomotor training with a robotic gait orthosis (RGO) CG: sham tDCS with identical locomotor training with a robotic gait orthosis (RGO) 12 sessions 3 times per week | Device: Lokomat BWS: 40–50% at the beginning of session and then reduced to 20% at the end of protocol training WS: Initially at comfortable speed, followed by progressive, rapid decrease to a speed slow enough to allow subject to initiate movement, thereby increasing engagement with the task and appropriate attentional demands | Outcome measures: 10MWT, BBS, FAC, SIS-16 Result: the active tDCS group showed greater improvement than the sham group in all measures except BBS |
| Bae et al. (2014) [41] RCT | 20 subjects with chronic stroke IG: RAGT with FES (n = 10) CG: RAGT only (n = 10) | Able to walk for 10 m with or without an assistive device | IG: robot-assisted gait training and functional electrical stimulation on the ankle dorsiflexor of the affected side CG: robot-assisted gait training only 15 sessions 3 times per week 30 min per session with regular 30-min PT session in both groups | Device: Lokomat BWS: reduced from 40 to 0% according to the patient’s gait pattern WS: from 1.2 km/h up to the maximum speed at which patients could adapt | Outcome measures: MMAS, TUG, BBS, gait parameters, WS, cadence, step length, stride length, double support, pelvic, hip, knee, ankle joint angle Result: In IG, Step length and maximal knee extension were significantly greater than those before training and Maximal Knee flexion showed a significant difference between the in IG. The MMAS, BBS, and TUG scores improved significantly after training compared with before training in both groups |
| Ogino et al (2020) [42] RCT | 19 patients with chronic stroke IG: GEAR group (n = 8) CG: treadmill group (n = 11) | All subjects were required to walk on the ground or a treadmill without physical assistance using assistive devices | IG: GEAR training CG: using only the treadmill function of GEAR 20 sessions 5 times per week 60 min per session Visual and audio feedback was used when needed | Device: GEAR system (Welwalk) BWS: - WS: the treadmill speed was increased from overground maximum speed. The treadmill speed was increased by 10% in the next session, if it was judged safe to do so, and reduced by 10% if it was not | Outcome measures: Abnormal gait pattern, Spatiotemporal gait parameters Result: In IG, step length and maximal knee extension were significantly greater than those before training Maximal knee flexion showed a significant difference between the experimental and control groups |
| Ogino et al. (2020) [43] | 19 participants IG: GEAR group (n = 8) CG: treadmill group (n = 11) | Independent gait overground without physical assistance, using assistive devices, and bracing below the knee as needed | IG: GEAR training CG: The treadmill group performed gait training using only the treadmill function of GEAR 20 sessions 5 times per week 60 min per session Visual and audio feedback was used when needed | Device: GEAR system (Welwalk) BWS: - WS: the treadmill speed was increased from overground maximum speed. The treadmill speed was increased by 10% in the next session, if it was judged safe to do so, and reduced by 10% if it was not | Outcome measures: 10MWT, TUG, 6MD, SF-8, and GRC scales Result: In both groups, the MMAS, BBS, and TUG scores showed significant difference before and after training. In IG, WS was significantly increased at completion of training and 1-mo follow-up compared with baseline and GRC scales were significantly increased at completion of training, 1 month follow-up, and 3-month follow-up compared with baseline TUG and 6 min walk were significantly greater in IG than CG at completion of training compared to baseline |
| Bae et al. (2016) [44] RCT | 34 patients IG: HRR-guided high-intensity RAGT group (n = 17) CG: RPE-guided high-intensity RAGT group (n = 17) | Able to walk but with difficulty | IG: HRR-guided high-intensity RAGT; RAGT at 70% of HRR CG: RPE-guided high-intensity RAGT group; RAGT at RPE of 15 All participants: additional regular 30-min PT 18 sessions 3 days per week 30 min per session, | Lokomat BWS: from 40 to 0% according to individual ability WS: controlled gait speed (from 1.2 km/h up to) | Outcome measures: FMLE, 10MWT, gait parameters (walking speed, cadence, step length, stride length, swing time, stance time, double, support rate, single support rate, and symmetrical ratio index) Result: The FMLE was significantly higher than that before the intervention in both groups. IG improved significantly more than CG. The value of 10 MWT was significantly higher than that before the intervention in both groups |
| Erbil et al. (2018) [45] RCT | IG: RAT (n = 29) CG: control (n = 14) | Ambulatory patients with or without assistive devices and patients with BBS score ≥ 20 points | IG: 30 min of RAT (RoboGait®) plus 60 min of PT CG: 90 min of PT 3 weeks during weekdays In both groups, BoNT‐A injections were applied | Device: RAT (RoboGait®) BWS: Body weight support range 0 to approximately 100 kg (220.5 lbs), continuously adjustable without training interruption WS:0.2–3.2 km/h | Outcome measures: MAS and Tardieu Scale, BBS, TUG, and RVGA Result: In both groups significant improvements were determined regarding spasticity, balance, and gait functions In IG, at post‐treatment Weeks 6 and 12, change from baseline TUG, BBS, RVGA were significantly higher than CG |
BBS Berg balance scale, BSW body weight support, BWSTT Body-Weight Supported Treadmill Training, CG control group, FAC Family Assistance Centre, FIM Functional Independence Measure, FMLE Functional Mobilisation Lower Extremities, IG intervention group, MMAS Modified Motor Assessment Scale, NIHSS National Institutes of Health Stroke Scale, PT Physiotherapy, SSV Self-Selected Velocity, SARA Scale for Assessment and Rating of Ataxia, TUG Timed Up and Go, RAGT Robot assisted gait training, RVGA Rivermead Visual Gait Assessment, WS walking speed