I can't find any protocol that came out of this research, so useless for survivors! I'd have you all fired!
Efficacy of robot-assisted gait training on lower extremity function in subacute stroke patients: a systematic review and meta-analysis
Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 165 (2024)
Abstract
Background
Robot-Assisted Gait Training (RAGT) is a novel technology widely employed in the field of neurological rehabilitation for patients with subacute stroke. However, the effectiveness of RAGT compared to conventional gait training (CGT) in improving lower extremity function remains a topic of debate. This study aimed to investigate and compare the effects of RAGT and CGT on lower extremity movement in patients with subacute stroke.
Methods
Comprehensive search was conducted across multiple databases, including PubMed, Web of Science, Cochrane Library, EBSCO, Embase, Scopus, China National Knowledge Infrastructure, Wan Fang, SinoMed and Vip Journal Integration Platform. The database retrieval was performed up until July 9, 2024. Meta-analysis was conducted using RevMan 5.4 software.
Results
A total of 24 RCTs were included in the analysis. The results indicate that, compared with CGT, RAGT led to significant improvements in the Fugl-Meyer Assessment for Lower Extremity [MD = 2.10, 95%CI (0.62, 3.59), P = 0.005], Functional Ambulation Category[MD = 0.44, 95%CI (0.23, 0.65), P < 0.001], Berg Balance Scale [MD = 4.55, 95%CI (3.00, 6.11), P < 0.001], Timed Up and Go test [MD = −4.05, 95%CI (−5.12, −2.98), P < 0.001], and 6-Minute Walk Test [MD = 30.66, 95%CI (22.36, 38.97), P < 0.001] for patients with subacute stroke. However, it did not show a significant effect on the 10-Meter Walk Test [MD = 0.06, 95%CI (−0.01, 0.14), P = 0.08].
Conclusions
This study provides evidence that RAGT can enhance lower extremity function, balance function, walking ability, and endurance levels compared to CGT. However, the quality of evidence for improvements in gait speed remains low.
Background
Stroke is a neurological disorder caused by either a rupture or blockage of cerebral blood vessels, resulting in high morbidity, disability, and a substantial social burden [1]. Globally, there were approximately 12.2 million incident cases of stroke, 101 million prevalent cases of stroke, and 6.55 million deaths attributed to stroke [2]. Stroke survivors usually experience physical dysfunction, notably affecting walking, which increases their risk of falling due to compromised gait and balance. This not only directly jeopardizes mobility and daily life, but also significantly diminishes their quality of life [3, 4]. Regaining the ability to walk is a critical milestone in the recovery of stroke survivors [5]. Physical rehabilitation plays a crucial role in improving motor function, mobility, and performance in daily life for stroke patients, particularly those with lingering movement disorders, and aiming to enhance their function, independence, and participation [6].
Conventional gait training (CGT) methods encompassing conventional floor gait training, stair gait training, and treadmill training, have been widely utilized in the rehabilitation of stroke survivors. CGT methods provided by therapists can improve gait speed and endurance, and other functional aspects for stroke survivors. Despite its benefits, CGT has several limitations, for example, the therapist ‘s physical limitations, vulnerable to interference from the outside environment, etc [5, 7]. Confronted with the huge rehabilitation needs of stroke patients, more effective treatment methods should be taken [8]. Robot-assisted gait training (RAGT) is widely used as a novel neurorehabilitation training technique. The robot equipment can include end-effector and exoskeleton systems [9], which are more effective in improving mobility than traditional therapy because they can provide a higher volume and more intensive treatment options [10]. These technologies are particularly effective in minimizing environmental disturbances during the rehabilitation process [11]. However, the efficacy of RAGT in the comprehensive rehabilitation of stroke survivors has yet to reach full satisfaction, indicating the need for further refinement and research in this area.
Existing studies point out that RAGT surpasses CGT in enhancing gait ability, balance function, and overall quality of life [12,13,14]. However, some studies challenge this view, suggesting that RAGT is not superior to traditional gait training in some respects [15, 16]. Amidst this backdrop, there are currently ongoing systematic evaluations or Meta-analyses with mixed results. For instance, Calafiore et al [17]. showed that robotic exoskeletons may have a potential role in walking ability recovery among subacute stroke patients. Conversely, Wang et al [18]. indicated that RAGT is an effective intervention to improve balance function in stroke survivors. Nedergård et al [19]. found no significant differences on step speed, treadmill frequency, stride length, and spatial asymmetries between the RAGT and the control group, leading to meta-analyses that also report no significant advantage of RAGT over CGT. The discrepancy in findings underscores the complexity of stroke rehabilitation and the variable effectiveness of RAGT. Therefore, this study aimed to delve into the effect of RAGT on the lower extremity function of subacute stroke patients through a Meta-analysis. By focusing on the subacute stage of stroke recovery, which is critical for rehabilitation, this study seeks to clarify the role of RAGT in enhancing the lower extremity function of stroke survivors, thereby offering valuable insights for clinical rehabilitation practices.
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