Optimal Intervention Timing for Robotic-Assisted Gait Training in Hemiplegic Stroke

BACKGROUND

Previous clinical studies have reported inconsistent results for RAGT in the acute, subacute, and chronic stages of stroke rehabilitation.

Chang et al. observed that exoskeleton-device-based RAGT has positive effects

on sensorimotor function (16.18%) in 20 acute hemiparetic stroke patients, whereas Taveggia et al. showed no significant effects on gait in the 6-min walk test in 13 subacute stroke patients. Michiel et al. reported that exoskeleton-device-based RAGT has more positive effects on balance (38.75%) and ambulation ability (52.00%) in the FAC than CPT alone in the chronic stage.

However, whether such treadmill-based stationary exoskeletal RAGT has any differences in the recovery of the sensorimotor function, balance, gait, and ADL performance between the acute, subacute, and chronic stages in stroke patients are unknown. Hence, the clinical decisions upon which stage of recovery RAGT should be prescribed and implemented to obtain optimal results remain controversial.

OBJECTIVES

This study was designed to determine the best intervention time (acute, subacute, and chronic stages) for Walkbot robot-assisted gait training (RAGT) rehabilitation to improve clinical outcomes, including sensorimotor function, balance, cognition, and activities of daily living, in hemiparetic stroke patients.

METHODS

This retrospective study was designed to determine the clinical outcomes before and after the Walkbot RAGT intervention in the acute stage group (ASG) (<1 week), subacute stage group (SSG) (2–24 weeks), and chronic stage group (CSG) (>24 weeks).

RESULTS

The exoskeletal Walkbot RAGT produced more notable improvements in the recovery of sensorimotor function, balance, ADL performance, and trunk coordination in the acute stage than in the other two stages. Most importantly, the FMA, BBS, TIS, and MBI clinical outcomes were statistically different between the ASG and the other two groups.

Simultaneously, the pre–post comparison showed that patients in the ASG and SSG demonstrated statistically significant improvements in all variables, except for the MAS, after the Walkbot RAGT intervention.

In contrast, patients in the CSG only showed statistically significant improvements in three outcome measures after the RAGT intervention, namely, the FMA, BBS, and TIS.