Top Stroke Rehabil 2011;18(3):269–276
© 2011 Thomas Land Publishers, Inc.
Robot-Assisted Gait Training for Patients
with Hemiparesis Due to Stroke
Stanley Fisher, MD,1,2 Leah Lucas,2 and T. Adam Thrasher, PhD3
1Methodist Neurological Institute, Houston, Texas; 2HealthSouth Rehabilitation Hospital, Humble, Texas;
3University of Houston, Center for Neuromotor and Biomechanics Research, Houston, Texas
Robot-assisted devices are becoming a popular alternative to manual facilitation in stroke rehabilitation. These devices have
the potential to reduce therapist burden and treatment costs; however, their effectiveness in terms of functional recovery
remains in question. This pilot study compared the outcomes of a stroke rehabilitation program that incorporates robot-
assisted gait training (RAGT) with a more traditional therapy program that does not. Twenty hemiparetic stroke patients
were recruited at a rehabilitation hospital in Houston, Texas, and were randomly assigned to 2 groups. The control group
(n = 10) received 24 1-hour sessions of conventional physical therapy, whereas the RAGT group (n = 10) received 24
1-hour sessions of conventional physical therapy combined with RAGT on a treadmill. Gait function was assessed before
and after treatment by an 8-m walk test, a 3-minute walk test, and the Tinetti balance assessment. Both groups showed
signifi cant improvement in all 3 outcome measures following treatment (P < .05), but there was no difference between
groups. It is concluded that RAGT may provide improvements in balance and gait comparable with conventional physical
therapy. A larger multicenter trial is required to investigate the effectiveness of RAGT in hemiparetic stroke. Key words:
gait, hemiparesis, robot-assisted training, stroke, treadmill training
goals for many stroke patients, and signifi cant
improvements are possible through rehabilitation.
The current evidence indicates that intensive,
task-specifi c therapy produces the highest level of
recovery of motor function, even in cases of severe
impairment.1 Locomotor training is the process
of retraining gait through the repetitive execution
of assisted walking movements. The traditional
approach to locomotor training involves manual
assistance from therapists as patients walk on a
treadmill or overground.2 When applied at a high
enough intensity and for a suffi cient duration,
locomotor training has the potential to produce
significant, long-lasting improvements in gait
function.3 In recent years, there has been a lot of
attention focused on the development of advanced
therapeutic interventions involving technologies
such as functional electrical stimulation4 (FES)
and robotics.5 These interventions are designed
to facilitate walking and enable patients to engage
in gait retraining at the earliest point in their
Currently, there are many treatment options
available for gait rehabilitation after stroke.6 Many
large proportion of strokes result in
hemiparesis and gait impairments. Recovery
of balance and walking function are key
of these have proved to be effective in clinical
studies; however, it is not clear that any particular
approach is superior for improving gait speed or
quality.3 The use of partial body weight support
to facilitate locomotor training became popular
in the mid-1990s. Many severely impaired stroke
patients have diffi culty bearing their total body
weight on the affected leg during the swing phase
of gait. This problem can be addressed by partially
relieving the patient’s body weight using an
overhead harness, thus compensating for weakness
of the weight-bearing muscles and allowing the
patient to focus on motor control during walking.
In stroke rehabilitation, body weight–supported
treadmill training (BWSTT) typically involves 1
or 2 therapists who provide manual assistance
to facilitate correct movement. Compared with
traditional locomotor training approaches, BWSTT
enables patients to walk longer and to take more
steps, thus signifi cantly increasing the number of
repetitions and functional gains.7 BWSTT has been
shown to be effective in improving gait function in
Elliot J. Roth, MD, Editor
276 TOPICS IN STROKE REHABILITATION/MAY-JUNE 2011
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