A Comprehensive Review: Robot-Assisted Treatments for Gait Rehabilitation in Stroke Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sourse and Search Strategy
2.2. Selection Criteria
2.2.1. Study Types
2.2.2. Participant Types
2.2.3. Intervention and Control Types
2.2.4. Types of Outcome Measurements
2.3. Quality Assessment
3. Results
3.1. Literature Search
3.2. Study Characteristics
Study | Study Design | Sample Size (E/C) | Intervention | Assessment | |
---|---|---|---|---|---|
Experimental Group | Control Group | ||||
Kim (2022) [22] | RCT | 20/20 | Morning walk-assisted gait training (biometric data control group) | Morning walk-assisted gait training (therapist control group) | FAC, 10MWT, TUG, BBS |
Aprile (2022) [32] | RCT | 19/17 | G-EO system evolution (end-effector system gait/trunk group) | G-EO system evolution (end-effector system gait group) | FAC, 10MWT, 6MWT, TUG, BBS |
Kim (2020) [16] | RCT | 14/14 | G-EO system evolution | 30% body weight support and a speed of 0.8 km/h | FMA, 10MWT, TUG |
Kim (2019) [25] | RCT | 10/9 | Lokomat (RAGT + CPT 4 weeks -> CPT 4 weeks) | Lokomat (CPT 4 weeks -> RAGT + CPT 4 weeks) | FAC, 10MWT, FMA-LE |
Belas (2018) [26] | RCT | 7/8 | Lokomat + CPT | TAGT + CPT | BBS, TUG |
Tamburella (2019) [27] | RCT | 6/6 | Lokomat + EMGB | Lokomat + Rb | FAC, BBS |
Alingh (2021) [39] | RCT | 17/15 | AANmDOF Robotic (LOPESII) | CPT | 10MWT, 6MWT, TUG, FMA-LE |
Yu (2021) [40] | RCT | 27/27 | A3(NX) Gait Training and Evaluation system | Gait training | TUG, FMA |
Zhang (2023) [41] | RCT | 20/20 | MANBUZHEKANGFU (GR-A1) | CPT | FAC, 6MWT, FMA-LE, |
Lee (2022) [24] | RCT | 33/10 | Morning walk-assisted gait training (pelvic off n = 11, pelvic control n = 12, CIMT n = 10) | Treadmill + CPT | 10MWT, TUG, BBS |
Kang (2021) [42] | RCT | 15/15 | SUBAR | CPT | FAC, 10MWT, TUG, BBS |
Talaty (2023) [28] | RCT | 15/15 | Lokomat + CPT | TAGT + CPT | FAC, 10MWT |
Mustafaoglu (2020) [29] | RCT | 34/17 | Lokomat (group 1: RAGT + CPT n = 17, group 2: RAGT n = 17) | CPT | 6MWT, FMA-LE |
Meng (2022) [43] | RCT | 128/61 | Walkbot robotic (group 1: RAGT n = 62, group 2: RGAT + ELLT n = 66) | CPT | FAC, 6MWT, TUG |
Miyagawa (2023) [44] | RCT | 17/19 | Curara + OT | CPT + OT | 10MWT, 6MWT, BBS |
Yokota (2023) [34] | RCT | 12/10 | Hybrid assistive limb + CPT | CPT | FAC |
Bergqvist (2023) [35] | RCT | 27/14 | Hybrid assistive limb + CPT | CPT | FAC, 6MWT, 10MWT, BBS |
Yeung (2021) [36] | RCT | 30/17 | Dynamixel MX-106R PAAR (power-assisted ankle robot + CT n = 14, swing-controlled ankle robot + CT n = 16) | CT | 10MWT, BBS |
Palmcrantz (2021) [45] | RCT | 13/28 | Hybrid Assistive Limb | No specific training intervention | 10MWT, 6MWT, FMA, BBS |
Chang (2023) [10] | RCT | 75/75 | Angel Legs M20 + Gait training | Gait training | FAC, 10MWT, 6MWT, FMA-LE, BBS |
Louie (2020) [37] | RCT | 20/20 | EksoGT powered robotic exoskeleton + CPT | CPT | 6MWT, BBS, |
Wright (2021) [38] | RCT | 16/18 | AlterG Bionic Leg orthosis + CPT | CPT | FAC, 6MWT, TUG, BBS, DGI |
Lee (2023) [23] | RCT | 26/23 | Morning walk + CPT | CT | 10MWT, FMA-LE, BBS |
Choi (2022) [30] | RCT | 18/6 | Lokomat PRO + NDT (BWS 30% n = 6, 50% n = 6, 70% n = 6) | Treadmill + NDT | 10MWT, TUG, BBS |
Seo (2018) [33] | RCT | 6/6 | Walkbot + AAN (unaffected limb)/ FA (affected limb) | Walkbot + FA (unaffected limb)/AAN (affected limb) | FAC, FMA-LE |
Kayabinar (2021) [20] | RCT | 15/15 | VR + RoboGait (Exoskeleton) | RoboGait (Exoskeleton) | FAC, 10MWT, BBS |
Pournajaf (2022) [31] | RCT | 30/59 | End-effector (G-EO) + + Overground gait training | Exoskeleton (Lokomat) + Overground gait training | 10MWT, 6MWT, TUG |
3.3. Types of Robots Used in Treatment
3.4. Quality Assessment
4. Discussion
4.1. Main Findings
4.2. Impact of Lower Extremity Training & Optimal Clinical Application
4.3. Limitations and Suggestions for Further Studies
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Robot Type | Study | Applied Robot | Intervention Periods | Assessment Period | Outcomes |
---|---|---|---|---|---|
End-effector | Lee (2023) [23] | End-effector RAGT | 4 weeks | BF, AF | Significant improvements in all outcome measures; robot group improved more in FAC. |
Kim (2022) [22] | Morning walk | 6 weeks | BF, AF | Significant improvements in FAC, MBI, BBS, TUG, 10MWT in both groups; no significant differences between groups. | |
Aprile (2022) [32] | End-effector system | 1 month | BF, AF | Improvement in balance ability in both groups; significant improvements in lower limb muscle strength and muscle tone in GTG group. | |
Kim (2020) [16] | G-EO system evolution | 4 weeks | BF, AF | Increased activation in primary sensorimotor cortex, supplementary motor area, premotor cortex; significantly better FMA scores in E RAGT group. | |
Exoskeleton (fix) | Kim (2019) [25] | Lokomat® PRO | 4 weeks | BF, AF | Significant differences in outcomes between groups; significantly greater improvements in FMA-LE and SARA in RAGT + CPT group. |
Belas (2018) [26] | Lokomat® 5.0 | 5 months | BF, AF | Statistically significant improvements in balance, functional independence, and general ataxia symptoms in both groups; no significant between-group differences. | |
Tamburella (2019) [27] | Lokomat | 4 weeks | BF, AF | Significant improvements in gait/daily living activity independence and trunk control; EMGb more effective in reducing spasticity and improving muscle force. | |
Alingh (2021) [39] | AANmDOF Robotic (LOPESII) | 6 weeks | BF, AF, FU | Improvements in gait parameters and functional gait tasks; no significant group differences except for paretic knee flexion improvement in AANmDOF group. | |
Seo (2018) [33] | Walkbot | 10 weeks | BF, AF, FU | Clinical measurements improved in both groups; significant improvements in step length asymmetry ratio and hip maximal extension moment in group 1, and dorsiflexion angle in group 2. | |
Yu (2021) [40] | G-EO system evolution | 14 consecutive days | BF, AF, FU | Significant effect on changes in space parameters and FMA scores in RT group; no significant differences between groups. | |
Zhang (2023) [41] | MANBUZHEKANGFU (GR-A1) | 4 weeks | BF, AF | Experimental group significantly outperformed control group in various measures; significant improvement in co-contraction index of the knee in experimental group. | |
Choi (2022) [30] | Lokomat® PRO | 6 weeks | BF, AF | Robot groups showed significantly better 10MWT results and shorter TUG than non-robot group; significant improvement in BBS scores for robot group A. | |
Lee (2022) [24] | Morning walk | 4 weeks | BF, AF | Significant improvements in BBS, TUG, MI-Lower in pelvic off group; greater improvement in TUG and BBS in pelvic on group, and in 10MWT and MI-Lower in CIMT group. | |
Kang (2021) [42] | SUBAR | 3 weeks | BF, AF | Significant improvements in MAS and step length in SUBAR group; control group showed significant improvements in BBS, MAS, and stride length. | |
Talaty (2023) [28] | Lokomat | 3 weeks | BF, AF, FU | Both groups showed significant improvements in several measures. CGT group had 45% more supplemental sessions than the Lokomat group. Both groups showed greater FIM improvement scores than a reference group with no supplemental therapy. | |
Mustafaoglu (2020) [29] | Lokomat | 6 weeks | BF, AF | Significant improvements in BI, 6MWT, SS-QOL, and SCT for primary outcomes and FMA-LE, CWT, RPE for secondary outcomes, except FWT. Group 1 showed significant improvement compared to group 2 and 3. | |
Kayabinar (2021) [20] | RoboGait | 6 weeks | BF, AF | Increase in single and dual-task gait speeds and cognitive dual-task performance in the study group. No significant difference between groups in all assessments after treatment. | |
Meng (2022) [43] | Walkbot | 4 weeks | BF, AF | Significant improvements in 6MWT, FAC, TUG, DTW, Tinetti’s test, BI, SS-QOL, and gait. RAGT group performed better in several measures compared to ELLT and CRT groups. | |
Exoskeleton (wearable) | Miyagawa (2023) [44] | Curara | 15 days | BF, AF, FU | No significant difference in main outcomes between groups at the end of gait training. Significant intragroup improvements in gait speed, stride length, stride duration, and cadence. |
Yokota (2023) [34] | Hybrid assistive limb | 20 sessions (5~6 day) | BF, AF, FU | No significant differences in primary outcomes. Apathy scale showed a decreasing trend in HAL group and a slight increasing trend in CPT group. | |
Bergqvist (2023) [35] | Hybrid assistive limb | 6 weeks | BF, AF, FU | No significant associations between MoCA Vis/Ex and 6MWT in robotic gait training group. | |
Yeung (2021) [36] | Exoskeleton ankle robot (PAAR, SCAR) | 20 sessions | BF, AF | Statistically significant improvements in functional ambulatory category and walking speed for SCAR and PAAR, respectively. | |
Palmcrantz (2021) [45] | Hybrid assistive limb | 6 weeks | BF, AF, FU | HAL group walked twice as far as conventional group during intervention. Post-intervention, only the conventional group showed significant improvement compared group. | |
Wright (2021) [38] | AlterG Bionic Leg | 10 weeks | BF, AF | Significant increases in walking distance, FAC, DGI, and BBS for over-ground robotic-assisted gait training. Improvements maintained at 22 weeks. | |
Exoskeleton(fix) and End-effector | Pournajaf (2022) [31] | G-EO (End-effector) | 20 sessions | BF, AF | Robotic Group showed significant benefits in 10 MWT, 6 MWT, TUG, and MBI. Robot in gait speed, endurance, balance, and ADL. RobotEND-group improved walking speed more than RobotEXO-group. |
Study | D1a | D1b | D2 | D3 | D4 | D5 | Overall | Study | D1a | D1b | D2 | D3 | D4 | D5 | Overall |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Kim (2022) [22] | H | L | Sc | Sc | Sc | Sc | Sc | Meng (2022) [43] | Sc | L | Sc | L | Sc | L | Sc |
Aprile (2022) [31] | Sc | L | L | L | L | L | Sc | Miyagawa (2023) [44] | Sc | Sc | L | Sc | Sc | Sc | Sc |
Kim (2020) [16] | Sc | L | Sc | L | L | Sc | Sc | Yokota (2023) [34] | Sc | L | L | Sc | Sc | Sc | Sc |
Kim (2019) [25] | Sc | L | L | L | L | L | Sc | Bergqvist (2023) [35] | Sc | L | Sc | Sc | L | L | Sc |
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Park, Y.-H.; Lee, D.-H.; Lee, J.-H. A Comprehensive Review: Robot-Assisted Treatments for Gait Rehabilitation in Stroke Patients. Medicina 2024, 60, 620. https://doi.org/10.3390/medicina60040620
Park Y-H, Lee D-H, Lee J-H. A Comprehensive Review: Robot-Assisted Treatments for Gait Rehabilitation in Stroke Patients. Medicina. 2024; 60(4):620. https://doi.org/10.3390/medicina60040620
Chicago/Turabian StylePark, Yong-Hwa, Dae-Hwan Lee, and Jung-Ho Lee. 2024. "A Comprehensive Review: Robot-Assisted Treatments for Gait Rehabilitation in Stroke Patients" Medicina 60, no. 4: 620. https://doi.org/10.3390/medicina60040620