Ambulation Outcomes After Robotic Gait Rehabilitation in a  Regional Hospital: A 2-Year Retrospective Observational Study

Napatt Phusiripinyo; Rachawan Suksathien; Paveenrath  Charussuriyong

Authors

Napatt Phusiripinyo Maha Sarakham Hospital, Maha sarakham
Rachawan Suksathien Department of rehabilitation, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima
Paveenrath Charussuriyong Department of rehabilitation, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima

Keywords:

Gait disorders, neurologic, robotics, rehabilitation, stroke, spinal cord injuries

Abstract

Objectives: To evaluate changes in the level of walking ability as measured by the Functional Ambulation Category (FAC) following 10 sessions of robotic gait rehabilitation

Study design: A retrospective observational study

Settings: Department of Rehabilitation Medicine, Maharat Nakhon Ratchasima Hospital, a public regional hospital in Thailand

Participants: A total of 162 patients diagnosed with stroke, traumatic brain injury (TBI), or incomplete spinal cord injury (SCI), who presented with ambulation impairments and who received robotic gait rehabilitation at a regional hospital between November 2022 and November 2024.

Methods: Medical records of patients with ambulation impairments who received robotic gait rehabilitation at a regional hospital between November 2022 and November 2024, completed 10 training sessions, and had available pre- and post-training ambulation outcome data were included in the analysis. General demographic characteristics, diagnoses and ambulation outcomes, including the FAC, were collected. FAC scores before training and after 10 training sessions were compared. Associations between clinical variables and improvements in FAC were analyzed.

Result: Among the 162 patients who received robotic gait rehabilitation at a regional hospital, 48 were excluded due to incomplete training or missing data, leaving 114 patients for analysis. More than half of the patients (54%) demonstrated improvement in FAC scores after 10 training sessions. No patients experienced a reduction in FAC following training. Factors significantly associated with FAC improvement included the interval from the neurological event and the patients’ baseline FAC. Minor complications were reported, including muscle strain in eight patients and dizziness in one patient.

Conclusion: This retrospective analysis of 2 years of robotic gait rehabilitation services at a regional hospital demonstrated that more than half of the patients achieved at least a one level improvement in the FAC following training. Factors associated with FAC improvement included the interval from the neurological event and the patients’ baseline FAC.

References

Pohl M, Werner C, Holzgraefe M, Kroczek G, Mohrholz J, Wingendorf I, et al. Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: a single-blind, randomized multicentre trial (DEutsche GAngtrainerStudie, DEGAS). Clin Rehabil [internet]. 2007 Jan [cited 2024 Sep 8];21(1):17–27. Available from: https://pubmed.ncbi.nlm.nih.gov/17213237/. doi: 10.2519/jospt.2009.2930

Moucheboeuf G, Griffier R, Gasq D, Glize B, Bouyer L, Dehail P, et al. Effect of robotic gait training after stroke: a meta-analysis. Ann Phys Rehabil Med [internet]. 2020 Nov [cited 2024 Sep 8];63(6):518–34. Available from: https://pubmed.ncbi.nlm.nih.gov/32229177/. doi: 10.1016/j.rehab.2020.02.008.

Diaz I, Gil JJ, Sanchez E. Lower-limb robotic rehabilitation: literature review and challenges. J Robot [internet]. 2011 Nov [cited 2024 Sep 8];2011:1–11. Available from: https://onlinelibrary.wiley.com/doi/10.1155/2011/759764/. doi: 10.1155/2011/759764

Pennycott A, Wyss D, Vallery H, Klamroth-Marganska V, Riener R. Towards more effective robotic gait training for stroke rehabilitation: a review. J Neuroeng Rehabil [internet]. 2012 Sep 7 [cited 2024 Sep 8];9:65. Available from: https://pubmed.ncbi.nlm.nih.gov/22953989/. doi: 10.1186/1743-0003-9-65

Lee J, Kim DY, Lee SH, Kim JH, Kim DY, Lim KB, Yoo J. End-effector lower limb robot-assisted gait training effects in subacute stroke patients: a randomized controlled pilot trial. Medicine (Baltimore) [internet]. 2023 Oct 20 [cited 2024 Sep 8];102(42):e35568. Available from: https://pubmed.ncbi.nlm.nih.gov/37861512/. doi:10.1097/MD.0000000000035568.

Morone G, Paolucci S, Cherubini A, De Angelis D, Venturiero V, Coiro P, et al. Robot-assisted gait training for stroke patients: current state of the art and perspectives of robotics. Neuropsychiatr Dis Treat [internet]. 2017 May 15 [cited 2024 Sep 8];13:1303–11. Available from: https://pubmed.ncbi.nlm.nih.gov/28553117/. doi:10.2147/NDT.S114102.

Gassert R, Dietz V. Rehabilitation robots for the treatment of sensorimotor deficits: a neurophysiological perspective. J Neuroeng Rehabil [internet]. 2018 Jun 5 [cited 2024 Sep 8];15:46. Available from: https://pubmed.ncbi.nlm.nih.gov/29866106/. doi: 10.1186/s12984-018-0383-x.

Cho JE, Yoo JS, Kim KE, Cho ST, Jang WS, Cho KH, Lee WH. Systematic review of appropriate robotic intervention for gait function in subacute stroke patients. Biomed Res Int [internet]. 2018 Feb 6 [cited 2024 Sep 8];2018:4085298. Available from: https://pubmed.ncbi.nlm.nih.gov/29546057/. doi:10.1155/2018/4085298.

Iosa M, Morone G, Fusco A, Bragoni M, Coiro P, Multari M, et al.et al. Seven capital devices for the future of stroke rehabilitation. Stroke Res Treat [internet]. 2012 Dec [cited 2024 Sep 8];2012:187965. Available from: https://onlinelibrary.wiley.com/doi/10.1155/2012/187965.doi: 10.1155/2012/187965.

Chen S, Zhang W, Wang D, Chen Z. How robot-assisted gait training affects gait ability, balance, and kinematic parameters after stroke: a systematic review and meta-analysis. Eur J Phys Rehabil Med [internet]. 2024 Jun [cited 2024 Sep 8];60(3):400–11. Available from: https://pubmed.ncbi.nlm.nih.gov/29546057/. doi: 10.23736/S1973-9087.24.08354-0.

Li Y, Fan T, Qi Q, Wang J, Qiu H, Zhang L, et al. Efficacy of a novel exoskeletal robot for locomotor rehabilitation in stroke patients: a multicenter, noninferiority, randomized controlled trial. Front Aging Neurosci [internet]. 2021 Aug 23 [cited 2024 Sep 8];13:1–8. Available from: https://pubmed.ncbi.nlm.nih.gov/34497506/. doi: 10.3389/fnagi.2021.706569.

Jezernik S, Scharer R, Colombo G, Morari M. Adaptive robotic rehabilitation of locomotion: a clinical study in spinally injured individuals. Spinal Cord [internet]. 2003 Dec [cited 2024 Sep 8];41(12):657–66. Available from: https://pubmed.ncbi.nlm.nih.gov/14639444/. doi: 10.1038/sj.sc.3101518

Reinkensmeyer DJ, Aoyagi D, Emken JL, Galvez JA, Ichinose W, Kerdanyan G, et al. Tools for understanding and optimizing robotic gait training. J Rehabil Res Dev [internet]. 2006 Aug-Sep [cited 2024 Sep 8];43(5):657–70. Available from: https://pubmed.ncbi.nlm.nih.gov/17123206/. doi: 10.1682/jrrd.2005.04.0073