Effects of Knee-Powered Exoskeleton-Assisted Gait Training on Walking Function and Symmetry in Subacute Stroke: A Randomized Pilot Trial

Background: Our objective was to evaluate the clinical effects on walking function and symmetry of combined knee-powered exoskeleton-assisted gait training (EAGT) and conventional physiotherapy versus conventional therapy alone in patients with subacute stroke. Methods: This randomized pilot trial enrolled patients 1–3 months post-stroke with Functional Ambulation Classification scores of 3 or 4. Participants were randomly assigned in a 1:1 ratio to receive EAGT plus conventional therapy or conventional therapy alone for 4 weeks. Outcomes included gait speed (10MWT), endurance (6MWT), and motor function (FMA-LE), assessed at baseline, 4 weeks, and 16 weeks. Accelerometer-based spatiotemporal gait parameters were analyzed in the EAGT group. Results: Twenty-four participants (EAGT: 17, control: 7) completed the study. No significant group × time interaction was observed for gait speed, walking endurance, or lower-extremity motor function, indicating that changes over time did not differ significantly between the EAGT and control groups. In the EAGT group, increased gait speed was accompanied by augmented cadence (p < 0.001) without significant changes in stride length or gait symmetry. Conclusions: From this preliminary pilot study, knee-powered EAGT improved walking performance in subacute stroke but did not demonstrate superiority over conventional rehabilitation. Gains were accompanied by cadence augmentation without restoration of gait symmetry. Larger randomized trials are needed to validate these preliminary findings.