Robotic exoskeleton gait training may aid early stroke rehabilitation

A team of researchers from New Jersey have shown that high-dose therapeutic gait training using robotic exoskeletons can aid in early rehabilitation in acute stroke. The article, “Gait training of the robotic exoskeleton during rehabilitation of hospital patients after acute stroke” (doi: 10.339 / fnbot.2020.581815), was published on October 30, 2020 in Frontiers in neurorobotics is available in free access at: https: //www.frontiersin.org /articles/ten.3389 /fnbot.2020.581815 /full

The authors are Karen Nolan, PhD, Kiran Karunakaran, PhD, and Kathleen Chervin, of the Kessler Foundation, Michael Monfett, MD, of the Children’s Specialty Hospital, Radhika Bapineedu, MD, and Neil N. Jasey Jr, MD, of the Kessler Institute for Rehabilitation, and Mooyeon Oh-Park, MD, of Burke Rehabilitation Hospital, formerly with Kessler. Drs. Nolan and Karunakaran are also affiliated with the Specialized Children’s Hospital. Kessler scientists and clinicians are appointed to the faculty of Rutgers New Jersey Medical School.

The need for stroke rehabilitation is enormous, given the large number of stroke survivors with mobility, balance and coordination deficits that limit their activities of daily living. Advances in robotics and biomedical engineering are expanding the options for rehabilitative care.

Researchers are applying new technologies to gait training that may offer advantages over traditional labor-intensive physiotherapy. This hospital-based study of a robotic exoskeleton (Ekso GT, Ekso Bionics, Inc.) demonstrated the potential to improve gait training after acute stroke with the goal of earlier recovery of motor function.

Participants included 44 people (aged 18 to 82) admitted to the Kessler Institute for Rehabilitation for acute stroke. Half received the Conventional Standard of Care (SOC), and half received a SOC with an option of surface walking training in the Ekso GT (RE + SOC). Both groups received the same overall processing time.

The exoskeleton ground walking training was supervised by a licensed physiotherapist who adjusted the variable bilateral assistance of the Ekso GT according to the progress of each individual. Outcome measures were total distance traveled during inpatient rehabilitation and the Functional Independence Measure (FIM) score. The RE-SOC group trained at the Ekso GT at least three times during their stay.

We found that gait training in the exoskeleton allowed us to increase the dose of gait training without increasing the duration of rehabilitation in hospital patients. Because walking on the ground in the exoskeleton requires active effort on the part of the participant, “she added,” early intervention with this type of walking training promotes brain plasticity which can lead to greater functional improvements and longer lasting effects when combined with conventional training.

Dr Karen Nolan, Deputy Director, Mobility and Rehabilitation Engineering Research Center, Kessler Foundation