The Effect of Robot-Assisted Gait Training on Balance, Gait and Kinesiophobia in Individuals With Post-Stroke Hemiparesis: A Randomized Controlled Trial

 Get mental help if you think this will ever reach your hospital, they haven't even gotten music therapy installed! HOW MUCH MORE FUCKING INCOMPETENCE DO YOU NEED DISPLAYED BEFORE YOU REALIZE YOUR STROKE HOSPITAL DOESN'T KNOW ANYTHING ABOUT 100% STROKE RECOVERY?

The Effect of Robot-Assisted Gait Training on Balance, Gait and Kinesiophobia in Individuals With Post-Stroke Hemiparesis: A Randomized Controlled Trial

Ezgi Güçlü, Nuray Girgin

First published: 05 September 2026

https://doi.org/10.1002/pri.70340Digital Object Identifier (DOI)
 

ABSTRACT

Background and Purpose

Robot-assisted gait training (RAGT) is well established for post-stroke gait rehabilitation, but its potential effects on psychological and behavioral outcomes are less clear. This study investigated the effects of adding RAGT to conventional rehabilitation on balance, gait, kinesiophobia, and movement confidence in individuals with post-stroke hemiparesis.

Methods

This single-blind, parallel-group randomized controlled trial included 60 individuals with post-stroke hemiparesis (50–75 years), randomly allocated to an RAGT group (n = 30) or control group (n = 30). Ethical approval was obtained from the Clinical Research Ethics Committee of Istanbul Yeni Yüzyıl University (Approval No. 20.01.2022/05; approval date: 20 January 2022). Both groups received conventional rehabilitation for 8 weeks; the RAGT group additionally received 24 sessions of RAGT. Kinesiophobia was a prespecified study outcome assessed using the Kinesiophobia Causes Scale (KCS); balance, gait, and balance confidence were also assessed. All 60 randomized participants completed follow-up and were analyzed in their assigned groups.

Results

Significant group × time interactions were observed for several outcomes, including BBS, TUG duration, 10MWT walking speed, ABC, and KCS total score (p < 0.05). The between-group difference in change for KCS total score was −0.36 (95% CI: −0.51 to −0.21; partial eta squared = 0.292). In post hoc analyses adjusting each outcome for its baseline value, significant group effects remained for BBS, TUG duration, 10MWT walking speed, ABC, KCS biological domain, and KCS total score (p< = 0.031), whereas 10MWT step count and the KCS psychological domain were no longer statistically significant.

Discussion

Adding RAGT to conventional rehabilitation was associated with greater improvements in several balance, mobility, walking-speed, balance-confidence, and kinesiophobia outcomes compared with conventional rehabilitation alone. These findings suggest potential additional physical and psychological benefits of incorporating RAGT into post-stroke rehabilitation. However, because the RAGT group received greater overall treatment exposure, the observed between-group differences cannot be attributed solely to the robotic component. The principal contribution of this study is the concurrent evaluation of kinesiophobia and movement confidence alongside physical outcomes.

Conflicts of Interest

The authors declare that they have no financial, commercial, personal, or institutional relationships that could have influenced this work. The RoboGait device was already available as part of routine clinical practice and was not provided, loaned, or funded by BAMA Technology or its distributor for this study. Neither the manufacturer nor any distributor had any role in study design, participant recruitment, data collection, analysis, interpretation, manuscript preparation, or the decision to submit the manuscript. The authors have no commercial, financial, or institutional affiliation with the manufacturer or distributor.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request. Due to ethical restrictions related to patient confidentiality, the data are not publicly available.

Post-stroke lower limb rehabilitation: a comparative study between exoskeleton robots and traditional gait training

 If your incompetent? hospital can't even deliver music for music therapy, they'll never purchase robots!

Post-stroke lower limb rehabilitation: a comparative study between exoskeleton robots and traditional gait training

• Wenzhu Xu,
• Nai Yeen Gavin Lai,
• Kok-Hoong Wong,
• Hamza Azam &
• Wei Yang 

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Abstract

Purpose

This study systematically compares the efficacy of robotic-assisted gait training (RAGT) with exoskeletons to traditional gait training (TGT) for lower limb rehabilitation after stroke, focusing on motor recovery, neuroplasticity, and muscle function.

Methods

A comprehensive systematic review was conducted across PubMed, Scopus, Web of Science, IEEE Xplore and Google Scholar for studies published between 2004 and 2024 following the PRISMA guidelines. A total of 86 studies were selected based on strict inclusion criteria, covering moderate to severe stroke patients undergoing RAGT, TGT, or combined interventions. Outcome metrics included gait symmetry, walking speed, neuroplasticity biomarkers (e.g., BDNF, fMRI), and muscle strength indicators. This systematic review was pre-registered with PROSPERO (ID: CRD420261333541).

Results

RAGT demonstrated superior improvements in gait symmetry index (+ 99.8% trajectory accuracy), walking speed (+ 20%), and muscle strength via high-intensity, repeatable training. TGT excelled in promoting active participation, cortical engagement, and functional independence, particularly in activities of daily living. Neuroplasticity analysis revealed RAGT enhanced spinal-brainstem rhythmic-ity, while TGT reinforced cortical-cerebellar motor planning. Muscle recovery was accelerated by RAGT through anti-gravitational support, though TGT better preserved natural movement patterns and coordination.

Conclusion

RAGT and TGT exhibit complementary strengths in stroke rehabilitation. Integrating RAGT’s high-intensity, objective training with TGT’s adaptive, patient-centered approach represents a promising direction for personalized, AI-enhanced neurorehabilitation strategies.

Overground robotic exoskeleton vs conventional therapy in inpatient stroke rehabilitation: results from a pragmatic, multicentre implementation programme

 So, you incompetently didn't create a protocol on this for survivors to find and use? I'd have your mentors and senior researchers fired! Doesn't anyone in stroke realize that the whole point of stroke research is to get survivors recovered? This doesn't do that!

Overground robotic exoskeleton vs conventional therapy in inpatient stroke rehabilitation: results from a pragmatic, multicentre implementation programme

• Pui Kit Tam,
• Ning Tang,
• Nur Shafawati Binte Kamsani,
• Thian Yong Yap,
• Ita Coffey-Aladdin,
• Shi Min Goh,
• Jean Pei Pei Tan,
• Yook Cing Lui,
• Rui Ling Lee,
• Ramaswamy Suresh &
• Effie Chew 

Journal of NeuroEngineering and Rehabilitation volume 22, Article number: 3 (2025) Cite this article

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Abstract

Background

Despite the reported efficacy of overground robotic exoskeleton (ORE) for rehabilitation of mobility post-stroke, its effectiveness in real-world practice is still debated. We analysed prospectively collected data from Improving Mobility Via Exoskeleton (IMOVE), a multicentre clinical implementation programme of ORE enrolling participants with various neurological conditions and were given options to choose between 12 sessions of ORE or conventional therapy (control).

Methods

This is analysis of participants under IMOVE who fulfilled the following criteria (i) primary diagnosis was stroke (ischemic, hemorrhagic; first or recurrent), (ii) onset of stroke was within 9 months and (iii) the intervention was during inpatient stay. They should also fulfill the general IMOVE inclusion and exclusion criteria which were resembling general clinical and manufacturing criteria of ORE. Outcome measures included Functional Ambulatory Category (FAC), Rivermead Mobility Index (RMI), Functional Independence Measure (FIM) and Clinical Outcome Variable Scale (COVS), measured immediately before and after the 12 sessions of therapy, and mean distance walked per session.

Results

Of 149 participants (105 OREs and 44 controls), both groups improved significantly in motor outcomes with no significant between-group differences. Participants with baseline FAC 1 had significantly greater improvement in motor sub-score of FIM (FIM-motor) compared to controls (mean difference 8.4, 95% CI 0.65–16.07, η_p² = 0.136, p = 0.034). The mean distance walked per session for ORE group was almost three times that of control for those with baseline FAC 0 (121.5 [SD 31.1]m vs 35.0 [SD 41.0]m, 95% CI 62.2–110.9, d = 2.54 p < 0.001) and FAC 1 (145.8 [SD 31.6]m vs 52.2 [SD 42.5]m, 95% CI 61.8–125.2, d = 2.71, p < 0.001). The difference was not observed for FAC 2 to 3 (162.9 [SD 29.2]m vs 134.2 [SD 87.5]m, 95% CI −22.2 to 79.7, d = 0.41, p = 0.252).

Conclusion

In a pragmatic setting, use of ORE for gait training enabled patients with lower ambulatory capacity to walk longer distances during therapy sessions. Patients who required continuous assistance during ambulation (FAC 1) had significantly better gains in FIM-motor compared to conventional therapy, suggesting possible benefit of ORE for this group.

Trial Registration

The trial was registered with clinicaltrials.gov (NCT05659121) on April 14, 2022.

Background

Studies from across Europe, America and Asia have found that at least 60% of patients have difficulty in ambulation after a stroke [1,2,3]. Retraining the ability to walk is a priority in post-stroke rehabilitation. Intensity, task-specificity and amount of walking practice is crucial in the rehabilitation of ambulatory function [4] and different types of robotic gait training devices have been developed to augment the intensity and dosage of gait-related training, including exoskeletons and end-effectors [5]. Overground robotic exoskeletons (ORE) have gained popularity in recent years, with advantages of allowing greater interaction with the environment, full weight-bearing, more appropriate sensorimotor integration, more degrees of freedom of movement, greater variability in gait parameters and mobility tasks that can be trained, compared to platform-tethered, body weight-supported robotic devices[6].

Despite multiple studies examining the efficacy of robotic gait training, the role of ORE in real world post-stroke rehabilitation is unclear. A Cochrane review including all electromechanical gait training devices concluded that robotic gait training in combination with physiotherapy increased the odds of independent walking after stroke, with greater benefit in the early phase of stroke [7]. While some studies suggest the benefits of various OREs to improve walking capacity and speed [6], others have reported mixed results[8,9,10,11,12]. Meta-analyses comparing ORE use with conventional therapy post-stroke, which included a heterogenous collection of single- and multi-joint devices, found greater improvement in walking speed, balance, longer-term mobility, with equivocal benefits reported for endurance [13, 14]. However, as data were mostly derived from randomised clinical trials (RCTs), patient selection criteria are typically more stringent, the intensity of therapy, including duration and step count per session and total number of sessions, are typically higher than usual clinical practice, and parameter settings of the device and control interventions are also more strictly controlled. RCTs therefore might provide an inadequate estimate of the actual effectiveness of robotic device in real-world clinical settings [15]. Patients who are typically excluded in RCTs, such as those with recurrent stroke or co-morbidities, may not have the same response rates and magnitude as those reported in RCTs [16].

The aim of this study was to evaluate the effectiveness of ORE in real-world clinical settings by analysing prospectively collected data from a cohort with pragmatic selection criteria and treatment protocol. The “Improving Mobility Via Exoskeleton” (IMOVE) programme, a philanthropy-funded multicentre ORE clinical programme in Singapore which sought to implement the use of EksoGT® ORE at various rehabilitation settings (inpatient and outpatient tertiary, community hospital settings and community day rehabilitation centres) from the acute to chronic phases of rehabilitation. IMOVE patient recruitment, treatment group allocation, treatment dosage, progression and duration of intervention reflected real-world practices, so as to inform clinical practices related to ORE application.