Table 2 Summary of studies included in the review

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)

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