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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

A Journal on Physical Medicine and Rehabilitation after Pathological Events


Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
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European Journal of Physical and Rehabilitation Medicine 2017 October;53(5):676-84

DOI: 10.23736/S1973-9087.17.04591-9

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Wearable robotic exoskeleton for overground gait training in sub-acute and chronic hemiparetic stroke patients: preliminary results

Franco MOLTENI 1, Giulio GASPERINI 1, Marina GAFFURI 1, Maria COLOMBO 1, Chiara GIOVANZANA 1, Chiara LORENZON 1, Nico FARINA 1, Giovanni CANNAVIELLO 2, Stefano SCARANO 3, Davide PROSERPIO 1, Davide LIBERALI 1, Eleonora GUANZIROLI 1

1 Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy; 2 Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy; 3 Department of Biomedical Sciences for Health, University of Milan, Milan, Italy


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BACKGROUND: Recovery of therapeutic or functional ambulatory capacity in post-stroke patients is a primary goal of rehabilitation. Wearable powered exoskeletons allow patients with gait dysfunctions to perform over-ground gait training, even immediately after the acute event.
AIM: To investigate the feasibility and the clinical effects of an over-ground walking training with a wearable powered exoskeleton in sub-acute and chronic stroke patients.
DESIGN: Prospective, pilot pre-post, open label, non-randomized experimental study.
SETTING: A single neurological rehabilitation center for inpatients and outpatients.
POPULATION: Twenty-three post-stroke patients were enrolled: 12 sub-acute (mean age: 43.8±13.3 years, 5 male and 7 female, 7 right hemiparesis and 5 left hemiparesis) and 11 chronic (mean age: 55.5±15.9 years, 7 male and 4 female, 4 right hemiparesis and 7 left hemiparesis) patients.
METHODS: Patients underwent 12 sessions (60 min/session, 3 times/week) of walking rehabilitation training using Ekso™, a wearable bionic suit that enables individuals with lower extremity disabilities and minimal forearm strength to stand up, sit down and walk over a flat hard surface with a full weight-bearing reciprocal gait. Clinical evaluations were performed at the beginning of the training period (t0), after 6 sessions (t1) and after 12 sessions (t2) and were based on the Ashworth scale, Motricity Index, Trunk Control Test, Functional Ambulation Scale, 10-Meter Walking Test, 6-Minute Walking Test, and Walking Handicap Scale. Wilcoxon’s test (P<0.05) was used to detect significant changes.
RESULTS: Statistically significant improvements were observed at the three assessment periods for both groups in Motricity Index, Functional Ambulation Scale, 10-meter walking test, and 6-minute walking test. Sub-acute patients achieved statistically significant improvement in Trunk Control Test and Walking Handicap Scale at t0-t2. Sub-acute and chronic patient did not achieve significant improvement in Ashworth scale at t0-t2.
CONCLUSIONS: Twelve sessions of over-ground gait training using a powered wearable robotic exoskeleton improved ambulatory functions in sub-acute and chronic post-stroke patients. Large, randomized multicenter studies are needed to confirm these preliminary data.
CLINICAL REHABILITATION IMPACT: To plan a completely new individual tailored robotic rehabilitation strategy after stroke, including task-oriented over-ground gait training.


KEY WORDS: Stroke - Rehabilitation - Exoskeleton device - Neurologic gait disorders

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Publication History

Issue published online: October 31, 2017
Article first published online: January 24, 2017
Manuscript accepted: January 23, 2017
Manuscript revised: January 17, 2017
Manuscript received: November 30, 2016

Cite this article as

Molteni F, Gasperini G, Gaffuri M, Colombo M, Giovanzana C, Lorenzon C, et al. Wearable robotic exoskeleton for overground gait training in sub-acute and chronic hemiparetic stroke patients: preliminary results. Eur J Phys Rehabil Med 2017;53:676-84. DOI: 10.23736/S1973-9087.17.04591-9

Corresponding author e-mail

eleonora.guanziroli@gmail.com