Repetitive gait training early after stroke
Table II. Characteristics of included studies regarding the methodological quality, recruited population and applied intervention
Experimental/control group
Baseline motor impairment
Additional time
spent walking in the
experimental group
ID MQ n Stroke interval, days
(SD) MI (SD) [0–99] Type
Frequency, duration
intervention of training Peurala et al.
(48) 2009
Tong et al.
(39) 2006
Ng et al. (42)
2008
Morone et al.
(43) 2011
Morone et al.
(44) 2012
Chua et al.
(40) 2016
Pohl et al. (35)
2007
Chang et al.
(38) 2012
Han et al. (49)
2016
Schwartz et al.
(45) 2009
Ochi et al. (46)
2015
Franceschini
et al. (47)
2009
Ada et al. (36)
2010
Dean et al.
(37) 2010
Nilsson et al.
(41) 2001 5 17/20 8.6 (2.3)/7.8 (3.0) n/r RAGT EE 5×/w, 3w 20 min × 15 = 300 min
15/20 16 (7.0)/18.9 (8.7) 52.3 (21.2)/51.6 (13.1) RAGT EE 5×/w, 4w 20 min × 20 = 400 min
6 12*/12* 16.3 (11.3)*/20 (12.8)* 16.1 (11.4)*/16.3 (9.5)* 7 12/12 21.9 (10.7)/20 (15.7) 52.0 (10.3)/51.3 (12.7) RAGT EE 5×/w, 4w 20 min × 20 = 400 min
7 53/53 27.2 (11.3)/29.8 (14.1) n/r RAGT EE 6×/w, 8w 20 min × 48 = 960 min
8 77/78 29.4 (12.6)/31.5 (13.3) 32.3 (22.6)/33.4 (24.0) RAGT EE 5×/w, 4w 20 min × 20 = 400 min
7 20/17 16.1 (4.9)/18.2 (5.0) 46.8 (9.1)/47.3 (12.1) RAGT Exo 5×/w, 2 w 40 min × 10 = 400 min
5 30/26 21.6 (8)/18.1 (9.8) n/r RAGT Exo 5×/w, 4w 30 min × 20 = 600 min
6 37/30 21.6 (8.7)/23.6 (10.1) n/r RAGT Exo 3×/w, 6w 30 min × 18 = 540 min
7 13/13 26.1 (8.0)/22.9 (7.4) n/r RAGT Exo 5×/w, 4w 20 min × 20 = 400 min
6 52/45 16.7 (9.8)/14.4 (7.3) 44.0 (31.3)/51.0 (26.8) BWSTT 5×/w, 4w 20 min × 20 = 400 min
64/62 18 (8)/18 (7) n/r BWSTT 5×/w until discharge 30 min each session
36/37 22 (range 10–56)/18
(range 8–53) n/r BWSTT 5×/w until discharge 30 min each session
7
6
8
8
7
*Indicates the low motricity group, i.e. the group with more motor impairments at baseline. Studies Tong et al. 2006 and Ng et al. 2008, Morone et al. 2011 and
Morone et al. 2012, and Ada et al. 2010 and Dean 2010 et al. are dependent as they investigated the same dataset.
MQ: methodological quality as assessed with the PEDro scale (…/10); SD: standard deviation; MI: Motricity Index subscale for the lower limb; RAGT: robot-assisted
gait training; BWSTT: body-weight supported treadmill training; EE: end-effector device; Exo: exoskeleton device; n/r, not reported.
Descriptive analysis of the intervention
81
All participants were provided with repetitive gait
training or conventional therapy as an add-on to usual
care, depending on the group to which they were al-
located. Usual care included 25–60 min of physioth-
erapy daily.
To allow non-ambulant patients in the experimental
group to repetitively practice gait, various forms of
manual and (electro-) mechanical assistance were pro-
vided. In all but 1 (46) included studies, participants’
body weight and trunk was (partly) supported by an
overhead harness system, while stationary practicing
walking on a moving treadmill or footplates. In a
single study, the trunk is not suspended in a harness,
but a robot device supports the legs and trunk for
stance stability to allow full weight-bearing by the
patient (46). Body weight supported training can be
divided into BWSTT and RAGT depending on the
kind of assistance in locomotion provided. During
BWSTT, patients train on a treadmill while therapists
manually assist stance stability, swing initiation and
forward progression of the paretic leg in a cyclical
motion (36, 37, 41, 47). RAGT involves a similar
stationary set-up while patients are not manually
assisted by the therapist(s), but with an electromecha-
nical device, i.e. a robot. Two different kinds of robots
can be classified based on the motion they apply to the
patient (see Fig. 2):
• The Gait Trainer (35, 39, 40, 42–44, 48) is an end-
effector device, meaning that motion is applied to
the feet of the patient only by 2 footplates whose
driven movement simulates stance- and swing-phase
of a symmetrical gait pattern. This kind of assistance
differs from treadmill-based training, as during the
whole gait-cycle the feet are in contact with the
Repetitive Gait Training
Manual
assistance
Electromechanical
assistance
Robot-assisted
Gait Training
Body-Weight Supported
Treadmill Training
Body-weight
support
Body-weight
support Body-weight
support
Exoskeleton End-effector
Hip drive
Knee drive
Footplate
Treadmill
Drive
Treadmill
Fig. 2. Graphic illustration of identified interventions.
J Rehabil Med 51, 2019