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Identifying candidates for torque-assisted exoskeleton for gait assistance after stroke: a pre-specified subgroup analysis
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DOI：10.23736/S1973-9087.26.09160-4.png)
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Abstract
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BACKGROUND: Wearable robots show promise for gait assistance in stroke patients, yet the clinical characteristics predicting a positive ambulatory response to exoskeletal assistance remain unclear. AIM: To identify appropriate candidates for torque-assisted exoskeletal wearable robots in stroke patients. DESIGN: A subgroup analysis using data from an international, multicenter, randomised controlled trial. SETTING: Inpatient. POPULATION: Fifty-five early subacute stroke patients who completed four weeks of robot-assisted gait training (RAGT) with the wearable exoskeletal robot (ANGEL LEGS M20, Angel Robotics Co., Ltd.). METHODS: Immediately after RAGT for the four weeks, ambulatory function with the exoskeleton on and off was evaluated using the 10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), and Physiological Cost Index (PCI). At the same time, additional assessments included the Functional Ambulatory Category (FAC), Fugl-Meyer Assessment-Lower Extremity, Motricity Index-Lower Limb, Trunk Control Test, and Berg Balance Score. Participants were classified as good-responder, no-responder, or negative-responder groups based on changes in walking performance with exoskeletal assistance. Univariate and multivariate ordinal logistic regression analyses identified factors associated with responsiveness. RESULTS: In the good-responder group, 10MWT, 6MWT and PCI showed significant improvements in the robot-on state compared with the robot-off state, respectively (P<0.05). Good responders had significantly lower baseline ambulatory, balance, and lower limb motor function compared to negative-responders (P<0.05). Multivariate analysis identified lower FAC as the only independent predictor of positive response to exoskeletal assistance (P<0.05). CONCLUSIONS: Torque-assisted exoskeletal wearable robots may improve ambulatory function in stroke patients with low ambulatory function. CLINICAL REHABILITATION IMPACT: To achieve meaningful effects through exoskeleton robots, patient selection must be adjusted according to clinical needs.
Keywords:
Stroke
Ambulation
Rehabilitation
Robot-assisted gait
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