Robotic Therapy Aids Immobilized Stroke Survivors

Adding robotic assistance to standard rehabilitation was more effective than traditional methods in helping severely impaired stroke survivors regain the ability to walk, according to a new study.

Researchers at Fondazione Santa Lucia (Rome, Italy) conducted a study involving 48 nonambulant participants after subacute stroke, who were stratified by motricity index into high and low motor impairment groups, with each group randomized to a robotic or control group 20 days after stroke. The robotic group subjects underwent 20 sessions of robotic-assisted gait training in the first 4 weeks of inpatient therapy and abbreviated conventional therapy, whereas control group patients received only conventional gait training; all patients underwent subsequent therapy sessions twice a day, five days a week, for three months.

The primary outcome was functional ambulation category, and secondary measures were the Rivermead Mobility Index and Barthel Index scores, as measured before and after the inpatient stay and two years after discharge. The results showed that only patients with the greatest degree of motor impairment who underwent robotic training showed improvement in walking without assistance two years after their discharge. The study was published ahead of print on December 15, 2011, in Stroke.

“After two years, five times more patients who underwent robotic assistance training were able to walk without assistance, but only the most severely impaired. In others it seemed to make little difference, so the patient selection for this type of treatment is most important,” said lead author Giovanni Morone, MD, and colleagues of the Institute for Research Hospitalization and Health Care. “It could be time to change the research question from whether or not robotic-assisted walking training is effective, to who will benefit the most. Doctors need to select the right patients and remember that this is an adjunct to traditional gait training.”

The robotic devices used were electromechanical platforms attached to a patient's feet that were controlled by a physical therapist. The therapist uses a controller to measure carefully a patient's status and progressively to set bearing weight and their walking pace.

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