Electromechanical Gait Research Articles

Comparison of high-intensive and low-intensive electromechanical-assisted gait training by Exowalk® in patients over 3-month post-stroke

BackgroundThis study was conducted to assess the effect of electromechanical-assisted gait training intensity on walking ability in patients over 3-month post-stroke.MethodsData from two randomized controlled trials (RCTs) were collected under the same study design of assessment and intervention, excluding intervention time per session. After matching the inclusion criteria of two RCTs, the experimental groups of each RCT were defined as low-intensive (LI) and high-intensive (HI) group according to the intervention time per session. Primary outcome was the difference of the change in Functional Ambulatory Categories (FAC) between LI and HI gait training. Secondary outcomes were the difference of changes in mobility, walking speed, walking capacity, leg-muscle strength, balance and daily activity evaluated with Rivermead Mobility Index (RMI), 10 m walk test (10MWT), 6-min walk test (6MWT), Motricity Index (MI), Berg Balance Scale (BBS) and Modified Barthel Index (MBI) respectively.ResultsThe FAC improved after gait training in both groups. The secondary outcomes also improved in both groups except RMI and MI in HI group. The change of all outcomes were not different between groups except RMI. The change of RMI in the LI group was greater than that in the HI group statistically, but it did not meet minimal clinically important difference.ConclusionsThe improvement of walking ability after LI or HI gait training was not different if providing the same total gait training time. By providing the electromechanical gait training intensively, we could shorten the gait training period to improve walking ability and customize the training program according to the patient training abilities.Trial registrationName of the registry: Clinical Research Information Service. Trial registration number: No. KCT0002195(RCT1), No. KCT0002552(RCT2). Date of registration: 10/04/2016(RCT1), 10/05/2017(RCT2). URL of the trial registry record: https://cris.nih.go.kr/cris/search

Efficacy of electromechanical-assisted gait training on clinical walking function and gait symmetry after brain injury of stroke: a randomized controlled trial

Electromechanical-assisted gait training may be an effective intervention to promote motor recovery after brain injury. However, many studies still have difficulties in clarifying the difference between electromechanical-assisted gait training and conventional gait training. To evaluate the effectiveness of electromechanical-assisted gait training compared to that of conventional gait training on clinical walking function and gait symmetry of stroke patients. We randomly assigned patients with stroke (n = 144) to a control group (physical therapist-assisted gait training) and an experimental group (electromechanical gait training). Both types of gait training were done for 30 min each day, 5 days a week for 4 weeks. The primary endpoint was the change in functional ambulatory category (FAC). Secondary endpoints were clinical walking functions and gait symmetries of swing time and step length. All outcomes were measured at baseline (pre-intervention) and at 4 weeks after the baseline (post-intervention). FAC showed significant improvement after the intervention, as did clinical walking functions, in both groups. The step-length asymmetry improved in the control group, but that in the experimental group and the swing-time asymmetry in both groups did not show significant improvement. In the subgroup analysis of stroke duration of 90 days, FAC and clinical walking functions showed more significant improvement in the subacute group than in the chronic group. However, gait symmetries did not show any significant changes in either the subacute or the chronic group. Electromechanically assisted gait training by EXOWALK was as effective as conventional gait training with a physiotherapist. Although clinical walking function in the subacute group improved more than in the chronic group, gait asymmetry did not improve for either group after gait training.Trial registration: KCT0003411 Clinical Research Information Service (CRIS), Republic of Korea.

A randomized controlled study incorporating an electromechanical gait machine, the Hybrid Assistive Limb, in gait training of patients with severe limitations in walking in the subacute phase after stroke.

Early onset, intensive and repetitive, gait training may improve outcome after stroke but for patients with severe limitations in walking, rehabilitation is a challenge. The Hybrid Assistive Limb (HAL) is a gait machine that captures voluntary actions and support gait motions. Previous studies of HAL indicate beneficial effects on walking, but these results need to be confirmed in blinded, randomized controlled studies. This study aimed to explore effects of incorporating gait training with HAL as part of an inpatient rehabilitation program after stroke. Thirty-two subacute stroke patients with severe limitations in walking were randomized to incorporated HAL training (4 days/week for 4 weeks) or conventional gait training only. Blinded assessments were carried out at baseline, after the intervention, and at 6 months post stroke. The primary outcome was walking independence according to the Functional Ambulation Categories. Secondary outcomes were the Fugl-Meyer Assessment, 2-Minute Walk Test, Berg Balance Scale, and the Barthel Index. No significant between-group differences were found regarding any primary or secondary outcomes. At 6 months, two thirds of all patients were independent in walking. Prediction of independent walking at 6 months was not influenced by treatment group, but by age (OR 0.848, CI 0.719-0.998, p = 0.048). This study found no difference between groups for any outcomes despite the extra resources required for the HAL training, but highlights the substantial improvements in walking seen when evidence-based rehabilitation is provided to patients, with severe limitations in walking in the subacute stage after stroke. In future studies potential subgroups of patients who will benefit the most from electromechanically-assisted gait training should be explored.

Effects of Electromechanical Exoskeleton-Assisted Gait Training on Walking Ability of Stroke Patients: A Randomized Controlled Trial

ObjectiveTo assess the efficacy of electromechanical exoskeleton-assisted gait training on walking ability of stroke patients based on ambulatory function, muscle strength, balance, gait speed, and capacity. DesignRandomized controlled trial. SettingUniversity rehabilitation hospital. ParticipantsIndividuals (N=40) with stroke who could stand alone. InterventionsPatients were randomly assigned to control and experimental groups. The control group underwent physical therapist-assisted gait training by conventional method. The experimental group underwent electromechanical gait training assisted by an exoskeleton device. Both types of gait training were performed for 30 minutes each day. The therapeutic interventions were provided for 5 days a week for a period of 4 weeks in both groups. Main Outcome MeasuresFunctional ambulatory category (FAC) before and after gait training. Changes in FAC were the primary outcomes to evaluate the efficacy of electromechanical exoskeleton-assisted gait training. Changes in mobility, walking speed, walking capacity, leg muscle strength, daily activity, and balance were secondary outcomes. ResultsFAC in the control group was 2.44±1.55 in the pretraining and 2.75±1.53 in the post-training. FAC in the experimental group was 3.22±1.31 in the pretraining and 3.78±1.44 in the post-training. Although FAC between pre- and post-training sessions improved in both groups, the changes in FAC were statistically significant in the experimental group alone. Most secondary outcomes in both groups also showed improvement after gait training. However, the differential outcomes were not varied between the 2 groups after adjusting the data for age and stroke duration. We did not exclude patients based on time since stroke onset. The average stroke duration was 530.11±389.21 days in the experimental group. The changes in FAC of the experimental group were negatively correlated with stroke duration. No adverse events were noticed during gait training in either group. ConclusionsElectromechanical exoskeleton-assisted gait training is as effective as conventional gait training by a physical therapist when administered by a gait trainer. As an overground walking system without harness, electromechanical exoskeleton replaced a physical therapist in assisted gait training for patients who stand alone. Because the ambulatory function of stroke patients was affected negatively by stroke duration, the effect of electromechanical-assisted gait training might decline with increased stroke duration.

Design of a Single Degree-of-Freedom, Adaptable Electromechanical Gait Trainer for People With Neurological Injury

The cost of therapy is one of the most significant barriers to recovery after neurological injury. Robotic gait trainers move the legs through repetitive, natural motions imitating gait. Recent meta-analyses conclude that such training improves walking function in neurologically impaired individuals. While robotic gait trainers promise to reduce the physical burden on therapists and allow greater patient throughput, they are prohibitively costly. Our novel approach is to design a new single degree-of-freedom (DoF) robotic trainer that maintains the key advantages of the expensive trainers but with a simplified design to reduce cost. Our primary design challenge is translating the motion of a single actuator to an array of natural gait trajectories. We address this with an eight-link Jansen mechanism that matches a generalized gait trajectory. We then optimize the mechanism to match different trajectories through link length adjustment based on nine different gait patterns obtained from gait database of 113 healthy individuals. To physically validate the range in gait patterns produced by the simulation, we tested kinematic accuracy on a motorized wooden proof-of-concept of the gait trainer. The simulation and experimental results suggested that an adjustment of two links can reasonably fit a wide range of gait patterns under typical within-subject variance. We conclude that this design could provide the basis for a low-cost, patient-based electromechanical gait trainer for neurorecovery.

Feasibility of Using Lokomat Combined with Functional Electrical Stimulation for the Rehabilitation of Foot Drop.

This study investigated the clinical feasibility of combining the electromechanical gait trainer Lokomat with functional electrical therapy (LokoFET), stimulating the common peroneal nerve during the swing phase of the gait cycle to correct foot drop as an integrated part of gait therapy. Five patients with different acquired brain injuries trained with LokoFET 2-3 times a week for 3-4 weeks. Pre- and post-intervention evaluations were performed to quantify neurophysiological changes related to the patients’ foot drop impairment during the swing phase of the gait cycle. A semi-structured interview was used to investigate the therapists’ acceptance of LokoFET in clinical practice. The patients showed a significant increase in the level of activation of the tibialis anterior muscle and the maximal dorsiflexion during the swing phase, when comparing the pre- and post-intervention evaluations. This showed an improvement of function related to the foot drop impairment. The interview revealed that the therapists perceived the combined system as a useful tool in the rehabilitation of gait. However, lack of muscle selectivity relating to the FES element of LokoFET was assessed to be critical for acceptance in clinical practice.

Efficacy of an Electromechanical Gait Trainer Poststroke in Singapore: A Randomized Controlled Trial

ObjectiveTo evaluate the longer-term effects of electromechanical gait trainers (GTs) combined with conventional physiotherapy on health status, function, and ambulation in people with subacute stroke in comparison with conventional physiotherapy given alone. DesignRandomized controlled trial with intention-to-treat analysis. SettingCommunity hospital in Singapore. ParticipantsNonambulant individuals (N=106) recruited approximately 1 month poststroke. InterventionsBoth groups received 45 minutes of physiotherapy 6 times per week for 8 weeks as follows: the GT group received 20 minutes of GT training and 5 minutes of stance/gait training in contrast with 25 minutes of stance/gait training for the control group. Both groups completed 10 minutes of standing and 10 minutes of cycling. Main Outcome MeasuresThe primary outcome was the Functional Ambulation Category (FAC). Secondary outcomes were the Barthel Index (BI), gait speed and endurance, and Stroke Impact Scale (SIS). Measures were taken at baseline and 4, 8, 12, 24, and 48 weeks. ResultsGeneralized linear model analysis showed significant improvement over time (independent of group) for the FAC, BI, and SIS physical and participation subscales. However, no significant group × time or group differences were observed for any of the outcome variables after generalized linear model analysis. ConclusionsThe use of GTs combined with conventional physiotherapy can be as effective as conventional physiotherapy applied alone for people with subacute stroke.

Cross-cultural validation of the ICOAP, physical function short forms of the HOOS, KOOS in patients with hip and knee osteoarthritis

p< 0.00001) but did not significantly increase walking velocity (mean difference (MD) = 0.04m/s, 95%CI−0.03 to 0.11; p= 0.26) or walking capacity (MD=3 metres walked in six minutes, 95% CI −29 to 35; p= 0.86). Our subgroup analysis suggests that people in the acute phase may benefit and people who are non-ambulatorymay benefit from this type of training.We found significant differences between devices in terms of walking velocity in favour of end-effector devices. Conclusion(s): Patients who receive electromechanicalassisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than people who receive gait training without these devices. Implications: There is still a need for well-designed, large-scale, multicentre studies to evaluate the benefits and harms of electromechanical-assisted gait training on walking after stroke including only non-ambulatory patients in the very early stages after stroke.Currently comparisons between different devices are also lacking. Future research should include estimates of the costs (or savings) due to electromechanical gait training. Further analyses should investigate whether non-ambulatory or ambulatory patients may profit most and trials should include outcomemeasures in the activities of daily living and quality of life domains. Future updates of this review should consider investigating the effect of different control interventions using subgroup analysis.Additionally, in the next update the effect of different duration and intensity of the treatment (e.g. less than versusmore than four weeks; five days per week versus less than five days) should be compared.

Central neuroplasticity and lower limbs functional outcome following repetitive locomotor training in stroke patients

To evaluate the efficacy of electromechanical gait training (EGT) versus treadmill training with partial body weight support (TTPBWS) on lower limb motor performance (MP) and on motor evoked potential (MEP) in patients with chronic stroke. Fifty patients (age 43–75 years) with hemiparetic stroke (7–72 months’ duration) were allocated randomly to two groups. Patients of group I (n = 25) received EGT and those of group II (n = 25) received TTPBWS (20 min/day, 6 days/week for 8 weeks). Main outcome measurements: Fugel-Meyer lower extremity (FMLE) MP test and MEP were assessed in all patients before rehabilitation (A-begin), at the end of rehabilitation (A-end), and 3 months later (A-3m). By transcranial magnetic stimulation, MEP threshold, MEP amplitude (MEPamp), and cortical latencies to the rectus femoris, tibialis anterior, and gastrocnemius (GC) muscles were assessed. Better improvement in FMLE was observed in group I compared with group II. In group I, FMLE scores improved significantly at A-3m compared with A-end. A significant reduction in GC cortical latencies and increase in GC MEPamp on the second and third follow-up were observed in group I compared with group II. Although all MEP parameters of the three lower limb muscles tested improved throughout the follow-up periods on intragroup compression, they did not reach statistically significant levels. More patients in group I (unlike group II) with unobtainable MEP at A-begin had obtainable MEP at A-end and A-3m from rectus femoris and GC muscles. The change in MEPamp was the most frequent MEP variable that correlated with the change in FMLE scores (in either group). Better improvement in MP was observed following EGT at A-3m. Therefore, one EGT rather than TTPBWS may be recommended to improve lower extremity MP in chronic ambulatory stroke patients.

Evidence of end-effector based gait machines in gait rehabilitation after CNS lesion

A task-specific repetitive approach in gait rehabilitation after CNS lesion is well accepted nowadays. To ease the therapists' and patients' physical effort, the past two decades have seen the introduction of gait machines to intensify the amount of gait practice. Two principles have emerged, an exoskeleton- and an endeffector-based approach. Both systems share the harness and the body weight support. With the end-effector-based devices, the patients' feet are positioned on two foot plates, whose movements simulate stance and swing phase. This article provides an overview on the end-effector based machine's effectiveness regarding the restoration of gait. For the electromechanical gait trainer GT I, a meta analysis identified nine controlled trials (RCT) in stroke subjects (n = 568) and were analyzed to detect differences between end-effector-based locomotion + physiotherapy and physiotherapy alone. Patients practising with the machine effected in a superior gait ability (210 out of 319 patients, 65.8% vs. 96 out of 249 patients, 38.6%, respectively, Z = 2.29, p = 0.020), due to a larger training intensity. Only single RCTs have been reported for other devices and etiologies. The introduction of end-effector based gait machines has opened a new succesful chapter in gait rehabilitation after CNS lesion.

Robotic Technologies and Rehabilitation: New Tools for Stroke Patients’ Therapy

Introduction. The role of robotics in poststroke patients' rehabilitation has been investigated intensively. This paper presents the state-of-the-art and the possible future role of robotics in poststroke rehabilitation, for both upper and lower limbs. Materials and Methods. We performed a comprehensive search of PubMed, Cochrane, and PeDRO databases using as keywords “robot AND stroke AND rehabilitation.” Results and Discussion. In upper limb robotic rehabilitation, training seems to improve arm function in activities of daily living. In addition, electromechanical gait training after stroke seems to be effective. It is still unclear whether robot-assisted arm training may improve muscle strength, and which electromechanical gait-training device may be the most effective for walking training implementation. Conclusions. In the field of robotic technologies for stroke patients' rehabilitation we identified currently relevant growing points and areas timely for developing research. Among the growing points there is the development of new easily transportable, wearable devices that could improve rehabilitation also after discharge, in an outpatient or home-based setting. For developing research, efforts are being made to establish the ideal type of treatment, the length and amount of training protocol, and the patient's characteristics to be successfully enrolled to this treatment.

Improved Gait After Repetitive Locomotor Training in Children with Cerebral Palsy

The aim of this study was to evaluate the effectiveness of repetitive locomotor training with an electromechanical gait trainer in children with cerebral palsy. In this randomized controlled trial, 18 ambulatory children with diplegic or tetraplegic cerebral palsy were randomly assigned to an experimental group or a control group. The experimental group received 30 mins of repetitive locomotor training with an applied technology (Gait Trainer GT I) plus 10 mins of passive joint mobilization and stretching exercises. The control group received 40 mins of conventional physiotherapy. Each subject underwent a total of 10 treatment sessions over a 2-wk period. Performance on the 10-m walk test, 6-min walk test, WeeFIM scale, and gait analysis was evaluated by a blinded rater before and after treatment and at 1-mo follow-up. The experimental group showed significant posttreatment improvement on the 10-m walk test, 6-min walk test, hip kinematics, gait speed, and step length, all of which were maintained at the 1-mo follow-up assessment. No significant changes in performance parameters were observed in the control group. Repetitive locomotor training with an electromechanical gait trainer may improve gait velocity, endurance, spatiotemporal, and kinematic gait parameters in patients with cerebral palsy.

Driving electromechanically assisted Gait Trainer for people with stroke

Electromechanically assisted gait training is a promising task-oriented approach for gait restoration, especially for people with subacute stroke. However, few guidelines are available for selecting the parameter values of the electromechanical Gait Trainer (GT) (Reha-Stim; Berlin, Germany) and none is tailored to a patient's motor capacity. We assessed 342 GT sessions performed by 20 people with stroke who were stratified by Functional Ambulatory Category. In the first GT session of all patients, the body-weight support (BWS) required was higher than that reported in the literature. In further sessions, we noted a slow reduction of BWS and a fast increment of walking speed for the most-affected patients. Inverse trends were observed for the less-affected patients. In all the patients, the heart rate increment was about 20 beats per minute, even for sessions in which the number of strides performed was up to 500. In addition, the effective BWS measured during GT sessions was different from that initially selected by the physiotherapist. This difference depended mainly on the position of the GT platforms during selection. Finally, harness acceleration in the anteroposterior direction proved to be higher in patients with stroke than in nondisabled subjects. Our findings are an initial step toward scientifically selecting parameters in electromechanically assisted gait training.

Mechanically assisted walking with body weight support results in more independent walking than assisted overground walking in non-ambulatory patients early after stroke: a systematic review

Does mechanically assisted walking with body weight support result in more independent walking and is it detrimental to walking speed or capacity in non-ambulatory patients early after stroke? Systematic review with meta-analysis of randomised trials. Non-ambulatory adult patients undergoing inpatient rehabilitation up to 3 months after stroke. Mechanically assisted walking (eg, treadmill, electromechanical gait trainer, robotic device, servo-motor) with body weight support (eg, harness with or without handrail, but not handrail alone) versus assisted overground walking of longer than 15 min duration. The primary outcome was the proportion of participants achieving independent walking. Secondary outcomes were walking speed measured as m/s during the 10-m Walk Test and walking capacity measured as distance in m during the 6-min Walk Test. Six studies comprising 549 participants were identified and included in meta-analyses. Mechanically assisted walking with body weight support resulted in more people walking independently at 4 weeks (RD 0.23, 95% CI 0.15 to 0.30) and at 6 months (RD 0.23, 95% CI 0.07 to 0.39), faster walking at 6 months (MD 0.12 m/s, 95% CI 0.02 to 0.21), and further walking at 6 months (MD 55 m, 95% CI 15 to 96) than assisted overground walking. Mechanically assisted walking with body weight support is more effective than overground walking at increasing independent walking in non-ambulatory patients early after stroke. Furthermore, it is not detrimental to walking speed or capacity and clinicians should therefore be confident about implementing this intervention.

Improved walking ability and reduced therapeutic stress with an electromechanical gait device

To evaluate the effectiveness of repetitive locomotor training using a newly developed electromechanical gait device compared with treadmill training/gait training with respect to patient's ambulatory motor outcome, necessary personnel resources, and discomfort experienced by therapists and patients. Randomized, controlled, cross-over trial. Sixteen non-ambulatory patients after stroke, severe brain or spinal cord injury sequentially received 2 kinds of gait training. Study intervention A: 20 treatments of locomotor training with an electromechanical gait device; control intervention B: 20 treatments of locomotor training with treadmill or task-oriented gait training. The primary variable was walking ability (Functional Ambulation Category). Secondary variables included gait velocity, Motricity-Index, Rivermead-Mobility-Index, number of therapists needed, and discomfort and effort of patients and therapists during training. Gait ability and the other motor outcome related parameters improved for all patients, but without significant difference between intervention types. However, during intervention A, significantly fewer therapists were needed, and they reported less discomfort and a lower level of effort during training sessions. Locomotor training with or without an electromechanical gait trainer leads to improved gait ability; however, using the electromechanical gait trainer requires less therapeutic assistance, and therapist discomfort is reduced.

Connecting research to the needs of patients and clinicians

Modern principles of gait rehabilitation after CNS lesions favour a task-specific repetitive approach, i.e. who wants to regain walking has to walk. Budget constrains and the required effort, e.g. to place the paretic limbs in SCI patients, limit the treatment intensity; accordingly gait machines have been introduced. One can distinguish between an exoskeleton and end-effector approach. Our group opted for the latter, less costs, faster donning and doffing as well as the potential risk of shear forces in case of a malignement between the external and internal joint axis were argumented. On the electromechanical Gait Trainer GT I, the feet are placed on plates, whose movement simulate stance and swing, the vertical and horizontal movements of the centre of mass are controlled, Functional Electrical Stimulation is optional. The HapticWalker is the next step, the foot plate trajectories are fully programmable, so that the patients can also practise stair climbing up and down. In SCI patients of traumatic and non-traumatic origin, case series including gait analysis and a single-centre study based on non-randomized SCI patients admitted to our unit within 2 years are presented. The results corresponded to those reported for the manually assisted gait training. Among the non-traumatic patient group, being elder and more frailer, less than 50% participated in the programme. The future must see controlled trials comparing the various solutions with respect to clinical practicability, effectiveness, and cost-efficiency. Also one should keep in mind that a machine will never substitute a therapist, it is an adjunctive tool.

Robot-assisted upper and lower limb rehabilitation after stroke: walking and arm/hand function.

Robots help to intensify motor rehabilitation of the upper and lower limbs after stroke. This article presents controlled studies relating to this topic, and an overview. A search was carried out for relevant randomized controlled trials, published between 1980 and 2007, on Medline (PubMed), Embase, and CINHAL. Two studies showed benefit for an electromechanical gait trainer, with significantly more patients resuming walking as compared to conventional physiotherapy. Two studies showed no evidence of benefit for an exoskeleton-based system. A pooled analysis was not conducted due to the small numbers of studies and high heterogeneity. In arm/hand rehabilitation a number of unilateral or bilateral end-effector based systems proved effective in patients with stroke, and a simple one-dimensional system and a passive exoskeleton system proved effective in patients with chronic symptoms. Robot-assisted motor rehabilitation after stroke appears promising. More trials, including comparative studies, are mandatory. The robot cannot be considered a substitute for the patient-therapist relationship.

Electromechanical-Assisted Gait Training With Physiotherapy May Improve Walking After Stroke

Graeme J. Hankey MD, FRCP Section Editor: Many patients after stroke have difficulties with walking, and improving walking is one of the main goals of rehabilitation. Electromechanical and robotic-assisted gait training devices are used in rehabilitation and might help to restore walking after stroke. This systematic review examined the effectiveness of automated electromechanical and robotic-assisted gait training devices for improving walking after stroke. We searched the Cochrane Stroke Group Trials Register (last searched September 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 3, 2006), MEDLINE (1966 to September 2006), …

Gait training with the newly developed ‘LokoHelp’-system is feasible for non-ambulatory patients after stroke, spinal cord and brain injury. A feasibility study

Primary objective: To evaluate the feasibility of using a newly developed electromechanical gait device (LokoHelp) for locomotion training in neurological patients with impaired walking ability with respect to training effects and patients’ and therapists’ efforts and discomfort.Methods and procedures: Design: Case series. Setting: A neurological rehabilitation centre for children, adolescents and young adults. Subjects: Six patients with impaired walking function: two after stroke, two after spinal cord injury and two after brain injury. Intervention: Twenty additional training sessions on a treadmill fitted with a newly developed electromechanical gait device and body weight support (BWS), performed over a study-period of 6 weeks.Main outcomes and results: Patients’ progress was assessed with the following instruments: the Functional Ambulation Category FAC (walking ability), the 10-metre walk test (gait velocity), the Motricity Index (lower limb strength), the Berg Balance Scale (postural capacity), the modified Ashworth Scale (spasticity) and the Rivermead Mobility Index (activity). After each therapy session, therapists completed a form, thereby indicating whether manual assistance was necessary and, if so, how much physical effort was expended and how much discomfort was experienced during the therapy session. The therapists also indicated on the form information about the patient's effort and discomfort. No severe adverse events were observed during the locomotion training with the LokoHelp device. Patients improved with regard to Functional Ambulation Category (FAC) (from mean 0.7, SD = 1.6, to mean 2.5, SD = 2.1, p = 0.048), Motricity Index (from mean 94 points, SD = 50, to mean 111, SD = 52, p = 0.086), Berg Balance Scale (BBS) (from mean 20 points, SD = 23 to mean 25, SD = 23, p = 0.168) and Rivermead Mobility Index (RMI) (from mean 5 points, SD = 4, to mean 7, SD = 5, p = 0.033). Therapists required a low level of effort to carry out the training and seldom experienced discomfort. Patients described their effort during training as being low-to-exhausting. They rarely experienced discomfort, which was mostly related to difficulties with the BWS-System. Training intensity had to be adjusted in one patient who complained of knee pain.Conclusions: Locomotion training with the newly developed ‘LokoHelp’-system is feasible in severely affected patients after brain injury, stroke and spinal cord injury. In addition, our results indicate that the described alternative method of gait training may decrease the exertion needed by therapists to carry out the training.

A Pilot Study of Randomized Clinical Controlled Trial of Gait Training in Subacute Stroke Patients With Partial Body-Weight Support Electromechanical Gait Trainer and Functional Electrical Stimulation

This study aimed to assess the effectiveness of gait training using an electromechanical gait trainer with or without functional electrical stimulation for people with subacute stroke. This was a nonblinded randomized controlled trial with a 6-month follow-up. Fifty-four subjects were recruited within 6 weeks after stroke onset and were randomly assigned to 1 of 3 gait intervention groups: conventional overground gait training treatment (CT, n=21), electromechanical gait trainer (GT, n=17) and, electromechanical gait trainer with functional electrical stimulation (GT-FES, n=16). All subjects were to undergo an assigned intervention program comprising a 20-minute session every weekday for 4 weeks. The outcome measures were Functional Independence Measure, Barthel Index, Motricity Index leg subscale, Elderly Mobility Scale (EMS), Berg Balance Scale, Functional Ambulatory Category (FAC), and 5-meter walking speed test. Assessments were made at baseline, at the end of the 4-week intervention program, and 6 months after the program ended. By intention-to-treat and multivariate analysis, statistically significant differences showed up in EMS (Wilks' lambda=0.743, P=0.005), FAC (Wilks' lambda=0.744, P=0.005) and gait speed (Wilks' lambda=0.658, P<0.0001). Post hoc analysis (univariate 2-way ANCOVA) revealed that the GT and GT-FES groups showed significantly better improvement in comparison with the CT group at the end of the 4 weeks of training and in the 6-month follow-up. For the early stage after stroke, this study indicated a higher effectiveness in poststroke gait training that used an electromechanical gait trainer compared with conventional overground gait training. The training effect was sustained through to the 6-month follow-up after the intervention.