Regaining their ability to walk is one of the most common goals for stroke survivors. Improved walking can impact their long-term survival after a stroke as well as improve many other areas of a patient’s health, including:  

• Functional movement
• Independence
• Overall health and well-being

A person’s gait is the way they walk. While walking may seem simple, many different functions contribute to the ability to walk, including being upright, balance, posture, shifting weight from one foot to the other, strength and endurance. The brain coordinates these functions, so they may be compromised after a stroke. 

Gait training refers to rehabilitation therapy that helps people regain their walking ability, walking velocity, and walking distance. Or in other words, regain how good, how fast and how far one can walk.

Robotic assisted gait training is used in the rehabilitation of neurological injuries and conditions like stroke, spinal cord injury (SCI), traumatic brain injury (TBI), multiple sclerosis (MS), Parkinson’s disease (PD), or cerebral palsy (CP).

When choosing a stroke rehabilitation program with gait training, it’s important to understand which approach leads to the best outcomes. Combining robot-assisted therapy with conventional therapy has been clinically shown to be more effective than conventional physical therapy alone. In addition, Patients who are non-ambulatory in early rehabilitation benefit most from robot-assisted gait training.

During robot-assisted gait training, a patient uses a therapy device or machine to support their bodyweight. The devices help guide patients through walking movements to reengage muscles and memory to the activity. As the patient improves their functionality, the machines can adjust their resistance and support to match the patient’s needs.

Robot-assisted gait training allows patients to take more steps in a natural walking pattern at a higher speed than they would be able to with conventional therapy alone. Patients who are unable to walk achieve more repetitions with a robotic device than without. This additional support early in their rehabilitation may lead to faster recovery and improved results.

The benefits of robot-assisted gait training may include:

• High intensity: Patients using robot-assisted gait training take more steps per session than those using manually assisted overground walking. Not only can patients sustain robot-assisted therapy for a longer period of time, but they can also take steps at a faster speed. Robot-assisted gait training enables repetitive task training (RTT), which can improve walking ability and distance.
• High dose: Patients using robot-assisted gait therapy double or triple practice time compared to manually assisted overground walking. By spending more time performing therapy exercises, patients may see improvements sooner.
• High motivation: Robot-assisted gait training devices use gamification approaches to motivate patients through each exercise session. Rehabilitation becomes a fun game when combined with achievable milestones and levels to reach. Virtual environments presented on screens let patients complete their exercises on a snowy forest path or in a sunny park.

There are two main types of robotic-assisted devices: Exoskeletons and End-Effector devices.

In Exoskeleton gait training robots, an external skeleton is attached to the legs, and both hip and knee joints are actuated by motors to create stepping movements.

In End-Effector gait training robots, the legs are free while the feet are fixed to motorized foot plates that guide the stepping movements.

Robot-assisted gait training machines were developed to reduce the need of multiple therapists for gait training. Gait training robots consist of either two motor driven foot plates simulating the phases of gait (e.g., LEXO®) or a motor driven exoskeleton orthosis.

All technologies use the principle of Neuroplasticity. This implies that the brain always has the ability to recover and relearn. To induce plasticity, sufficient repetition and training intensity is needed. Electromechanical-assisted gait training increases the number of steps that can be taken during therapy sessions in a safe environment. Therapists are always present during the sessions, supervising the patient and encouraging the patient´s active participation.

Tyromotion uses End-Effector technology to help stroke survivors recover their ability to walk.

OMEGO® Plus is a robot-assisted lower extremity therapy device that helps patients improve their walking and lower limb function. OMEGO® Plus supports patients from early rehabilitation all the way through to the possibility of verticalization. The multifunctional chair adjusts to help patients pursue their therapy goals, including stabilizing blood pressure, strengthening muscles, increasing cardiovascular fitness, and improving range of motion.

LEXO® offers efficient walking practice in a safe environment and works for many different types of patients with different walking abilities. LEXO® helps patients practice shifting their weight from one foot to the other and bearing some of their own bodyweight, even when they’re not yet able to do these on their own to create a more consistent walking pattern.

OMEGO® Plus and LEXO® use gamification and direct feedback to make rehabilitation more fun and engaging.

Sources:

Electromechanical‐assisted training for walking after stroke, 2020

Effects of robotic gait training after stroke: a meta-analysis, 2020

Gait rehabilitation after stroke, 2020

The Improvement of Walking Ability Following Stroke: A Systematic Review and Network Meta-Analysis of Randomized Control Trials, 2018

Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage, 2008

The Effectiveness of Locomotor Therapy Using Robotic-Assisted Gait Training in Subacute Stroke Patients: A Randomized Controlled Trial, 2009

Evidence of end-effector based gait machines in gait rehabilitation after CNS lesion, 2013