Electromechanical exoskeleton-assisted gait training with Exowalk, composed of a fitted ambulatory exoskeleton that works in accordance with the movements of the patient, is just as effective as a conventional, physical therapist-directed gait training program in improving walking in patients with stroke, according to a study published in the Archives of Physical Medicine Rehabilitation.
Patients with stroke were randomly assigned to either intervention (n=18) or control (n=16). In the intervention group, participants received electromechanical gait training assisted with an exoskeleton ambulatory device, whereas those randomized to control received conventional gait training by a physical therapist. Training in both groups was performed for 30 minutes per day, 5 days a week, for a total of 4 weeks.
Investigators compared groups with regard to changes in functional ambulatory category (FAC) scores. In addition, the researchers evaluated changes in mobility (Rivermead mobility index), walking speed (10-meter walk test), walking capacity (6-minute walk test), leg muscle strength (motricity index), daily activity (modified Barthel index), and balance (Berg balance scale).
At baseline, the FAC scores in the control and intervention groups were 2.44±1.55 and 3.22±1.31, respectively. Comparatively, FAC scores in the control and intervention groups were 2.75±1.53 and 3.78±1.44, respectively, after the study period. Patients in the intervention group experienced a significantly greater improvement in FAC scores from pre- to posttreatment (P =.032). Secondary outcome measures, including scores on the Rivermead mobility index, 10-meter walk test, 6-minute walk test, motricity index, modified Barthel index, and Berg balance scale, improved after therapy in both groups. In the intervention group, the investigators observed a negative correlation between changes in FAC scores and stroke duration (FAC, r=-0.507; P <.05).
A limitation of the analysis was the differences in baseline characteristics, including age and stroke duration, between groups.
The use of an over-ground walking exoskeleton device without harness “may replace physical therapist-assisted gait training in patients who are able to stand alone,” the investigators concluded.
Nam YG, Lee JW, Park JW, et al. Effects of electromechanical exoskeleton-assisted gait training on walking ability of stroke patients: a randomized controlled trial [published online July 25, 2018]. Arch Phys Med Rehabil. doi: 10.1016/j.apmr.2018.06.020