Skip to main content

Advertisement

Table 2 Summary of studies included in the review

From: Powered robotic exoskeletons in post-stroke rehabilitation of gait: a scoping review

Study & Design Participants Exoskeleton & Training Period Training Protocol Walking outcomes & Results
Subacute Stroke
Watanabe et al. (2014) [31]
Unblinded RCT
Sub-acute stroke
1 – 2 person assist ambulation (HAL group
n = 11, mean 58.9 days post-stroke
Conventional group
n = 11, mean 50.6 days post-stroke)
HAL – Unilateral
12 sessions over 4 weeks
20 minute sessions
HAL group – gait training while wearing HAL, facilitating improvements in walking ability, partial BWS if needed; progress as able from complete assistance by device to assist-as-needed through bioelectric signal detection
Conventional group – facilitate improvements in walking ability, customized to functional level; speed and duration of walking gradually increased
1) TUG – No significant difference in improvement between groups
2) 6MWT – No significant difference in improvement between groups
3) Gait speed – No significant difference in improvement between groups
4) FAC – HAL group improved significantly (p = 0.04) more than Conventional group (change of +1.1 for HAL group; change of +0.6 for Conventional group)
Nilsson et al. (2014) [32]
Pre-post study
Sub-acute stroke
1 – 2 person assist ambulation
(n = 8, 6 – 46 days post-stroke)
HAL – Bilateral
5 sessions/week, median 17 sessions
25 minutes training
Progression from weight shift control to bioelectric signalling control, training with BWS on treadmill; progression of speed and BWS as tolerated 1) 10MWT – median change of +0.24 m/s, 4 previously non-ambulatory progressed to ambulatory
2) FAC – median change of +1.5 (from 0 to 1.5)
Fukuda et al. (2015) [33]
Pre-post study
Sub-acute stroke (n = 53, 12 non-ambulatory, 41 ambulatory) HAL – Uni/bilateral
2 sessions/week, mean 3.9 sessions
Walking on treadmill in exoskeleton, progress from complete control to bioelectric signalling 1) 10MWT – change of +0.1 m/s for Brunnstrom stage III (greater severity with lower stage) (n = 12); no change for Brunnstrom stage IV (n = 7); change of +0.1 m/s for Brunnstrom stage V (n = 12); change of +0.4 m/s for Brunnstrom stage VI (N = 10)
Maeshima et al. (2011) [34]
Pre-post study
Sub-acute stroke
1 – 2 person assist ambulation (n = 16, 27 – 116 days post-stroke)
HAL – Bilateral
Single session
Walking and stair practice after standing practice in exoskeleton 1) 10MWT – positive change for 14 of 16 patients (values not provided)
Chronic Stroke
Buesing et al. (2015) [35]
Single-blind RCT
Chronic stroke Limited community ambulation (SMA group – n = 25, mean 7.1 years post-stroke
Functional task specific training group – n = 25, mean 5.4 years post-stroke)
SMA – Bilateral
18 sessions over 6 – 8 weeks
45 minute sessions
SMA group – 30 minutes of high intensity overground walking with SMA (12-16 RPE or 75 % HR max) and 15 minutes of dynamic functional gait training with SMA (varied surfaces, multi-directional stepping, stair climbing, obstacles, community mobility)
Functional task specific training group – 15 minutes of high intensity overground walking training and 30 minutes of functional goal-based mobility training
1) Gait speed – No significant difference in improvement between groups
Stein et al. (2014) [36]
Single-blind RCT
Chronic stroke
Independent ambulation (AlterG group n = 12, mean 49.1 months post-stroke
Exercise group n = 12, mean 88.5 months post-stroke)
AlterG – Unilateral
18 sessions over 6 weeks
60 minute sessions
AlterG group – standardized overground functional tasks including transfers, stepping, turning, reaching, gait training, stairs and curbs while wearing exoskeleton
Exercise group – group exercises including relaxation, meditation, self-stretching, active range of motion of upper and lower limbs, minimal gait training (5 min/session)
1) TUG – No significant difference between groups
2) 6MWT – No significant difference in improvements between groups
3) 10MWT – No significant difference in improvement between groups
Yoshimoto et al. (2015) [37]
Non-randomized controlled trial
Chronic stroke
Independent ambulation (HAL group n = 9, mean 92.4 months post-stroke
Conventional PT group n = 9, mean 80.5 months post-stroke)
HAL – Unilateral
8 sessions over 8 weeks
60 minute sessions
HAL group – 20 minutes of HAL walking per session, with some BWS, walking at speed 1.5-1.7 times max walking speed without device
Conventional PT group – exercise to improve walking ability including static and dynamic postural tasks, range of motion, and 20 minutes of overground walking training
1) TUG – HAL group improved significantly compared to Conventional PT group (change of -11.5 s for HAL group; change of +0.1 s for Conventional PT group)
2) 10MWT – HAL group improved significantly compared to Conventional PT group (change of +0.21 m/s for HAL group; change of -0.02 m/s for Conventional PT group)
Kawamoto et al. (2013) [38]
Pre-post study
Chronic stroke (n = 16, 1 – 11 years post-stroke, 8 dependent ambulatory, 8 independent ambulatory) HAL – Bilateral
16 sessions over 8 weeks
20 – 30 minutes training
Overground walking with overhead harness for safety and partial BWS; gradual progression from sit-to-stand to walking (gradually increased intensity by changing speed, duration, BWS, and HAL control mechanism) 1) TUG – mean change of -1.1 s
2) 10MWT – mean change of +0.04 m/s
Bortole et al. (2015) [39]
Pre-post study
Chronic stroke Independent ambulation
(n = 3; 60, 6, 11 months post-stroke)
H2 – Bilateral
12 sessions over 4 weeks
30 minute sessions
Overground walking over a linear track
Participants in charge of speed and encouraged to walk as much as possible, with breaks
1) TUG – change of +1.7 s, -2.5 s,
-2.5 s
2) 6MWT – change of -115 m, +16 m, +103 m
Byl et al. (2012) [40]
Pre-post study
Chronic stroke Independent ambulation
(n = 3; 6, 1.3, 10 years post-stroke)
AlterG – Unilateral
2 – 4 sessions/week over 4 weeks
90 minute sessions
Walking practice, with sit-to-stand transfers, squatting, and stepping activities; obstacle clearance, uneven terrain, community ambulation, stair climbing 1) TUG – change of -6.9 s, +1.9 s, -0.2 s
2) 6MWT – change of +37 m, +47 m, +29 m
3) 10MWT – change of +0.21 m/s, +0.14 m/s, +0.20 m/s
Wong et al. (2011) [41]
Pre-post study
Chronic stroke
Independent ambulation
(n = 3; 37, 26, 40 months post-stroke)
AlterG – Unilateral
18 sessions over 6 weeks
60 minute sessions
45 minutes while wearing device, standardized weight-bearing functional mobility activities, sit-to-stand transfers, balance exercises, gait practice at various speeds on different surfaces, functional task practice 1) TUG – change of
-11.7 s, -2.3 s, -4.2 s
2) 6MWT – change of +17 m, +14 m, +15 m
3) 10MWT – change of -0.01 m/s, +0.05 m/s, +0.13 m/s
  1. 6MWT six-minute walk test, 10MWT ten meter walk test, BWS body weight support, FAC functional ambulation category, H2 H2 exoskeleton, HAL hybrid assistive limb, HR heart rate, SMA stride management assist system, PT physical therapy, RCT randomized controlled trial, RPE rate of perceived exertion, TUG timed up and go
  2. Bold indicates value surpasses established meaningful change score detailed in Table 1