Identifying optimal candidates and interventions in physical therapy and exoskeletal and end-effector robot-assisted gait training for balance, gait, and cognition: A longitudinal study of 190 patients with stroke

Background Optimal candidates and interventions for advanced robot-assisted stroke gait rehabilitation remain unknown. Objective We aimed to determine the optimal therapeutic efficacy for balance, sensorimotor and locomotor functions, daily activity, and cognition between the lower-entering functional ambulation category (L-FAC) and higher-entering FAC (H-FAC) groups. Methods 190 stroke patients received conventional physical therapy (CPT), exoskeletal robotic-assisted gait training (RAGT), or end-effector RAGT (eRAGT), each comprising 60-min/session, two times per week for 10–20 weeks. Standardized clinical tests included the Fugl–Meyer assessment of the lower extremities, Berg balance scale, FAC, modified Barthel index, and mini-mental state examination. A two-way analysis of variance was performed, with significance set at P < 0.05. Results Both groups demonstrated significant improvements. Compared with the H-FAC group, L-FAC group achieved the most notable improvements in sensorimotor function, balance, gait, daily activity, and cognition after RAGT, followed by CPT and eRAGT ( P < 0.05). Conclusions RAGT was more effective than CPT and eRAGT on sensorimotor function, balance, and gait function in patients with stroke with L-FAC. We identified the optimal candidates and interventions for balance, gait, and cognition patients with stroke.