Stride management assist exoskeleton vs functional gait training in stroke

摘要

<h3>Objective</h3> To test the hypothesis that gait training with a hip-assistive robotic exoskeleton improves clinical outcomes and strengthens the descending corticospinal drive to the lower limb muscles in persons with chronic stroke. <h3>Methods</h3> Fifty participants completed the randomized, single-blind, parallel study. Participants received over-ground gait training with the Honda Stride Management Assist (SMA) exoskeleton or intensity-matched functional gait training, delivered in 18 sessions over 6–8 weeks. Performance-based and self-reported clinical outcomes were measured at baseline, midpoint, and completion, and at a 3-month follow-up. Corticomotor excitability (CME) of 3 bilateral leg muscles was measured using transcranial magnetic stimulation. <h3>Results</h3> The primary outcome, walking speed, improved for the SMA group by completion of the program (0.24 ± 0.14 m/s difference, <i>p</i> &lt; 0.001). Compared to the functional group, SMA users had greater improvement in walking endurance (46.0% ± 27.4% vs 35.7% ± 20.8%, <i>p</i> = 0.033), took more steps during therapy days (4,366 ± 2,426 vs 3,028 ± 1,510; <i>p</i> = 0.013), and demonstrated larger changes in CME of the paretic rectus femoris (178% ± 75% vs 33% ± 32%, <i>p</i> = 0.010). Participants with hemorrhagic stroke demonstrated greater improvement in balance when using the SMA (24.7% ± 20% vs 6.8% ± 6.7%, <i>p</i> = 0.029). <h3>Conclusions</h3> Gait training with the SMA improved walking speed in persons with chronic stroke, and may promote greater walking endurance, balance, and CME than functional gait training. <h3>Clinicaltrials.gov identifier</h3> NCT01994395. <h3>Classification of evidence</h3> This study provides Class I evidence that gait training with a hip-assistive exoskeleton increases clinical outcomes and CME in persons with chronic stroke, but does not significantly improve walking speeds compared to intensity-matched functional gait training.