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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