Relationship Between Assistive Functions in Robot-Assisted Gait Training and Walking Independence in Patients Undergoing Conventional Rehabilitation after Subacute Stroke

Purpose: This study aimed to examine the relationship between assistive functions in RAGT-CT and walking independence in patients with subacute stroke.

Methods: This retrospective cohort study included 99 patients with stroke (n=36, ischemic; n=63, hemorrhagic; median post-stroke interval, 36 days [interquartile range, IQR, 25-50]) who underwent RAGT using Welwalk for a median of 3 weeks (IQR, 2–4) followed by conventional training (median, 91 days; IQR, 77–106). The primary outcome was whether the functional independence measure (FIM)walk item score reached 4 within 4 weeks of RAGT. The secondary outcome was whether walking independence was achieved at discharge. Logistic regression analysis was used to investigate the relationship between assistive functions, RAGT dose, and these outcomes related to primary or secondary outcomes. Age, trunk function (Stroke Impairment Assessment Set-trunk), cognitive function (FIM cognitive score), assistive functions (rate of change in knee-extension assist and swing-assist from the beginning to 1 week), and RAGT dose (total gait distance at 1 week) were included as independent variables using the forced entry method.

Results: For the primary outcome of the FIM-walk score reaching 4 within 4 weeks of RAGT (64 patients reached), change in swing-assist (odds ratio, OR: 0.95; 95% confidence interval, 95%CI: 0.92–0.98; p0.01) was identified as a significant variable. For the secondary outcome of walking independence achieved at discharge (33 patients reached), the following significant variables were identified: Age (OR: 0.90; 95%CI: 0.84–0.96; p0.01). FIM cognitive score (OR: 1.17; 95%CI: 1.02–1.34; p0.05)., and change in knee-extension assist (OR: 0.97; 95%CI: 0.95–0.99; p0.01).

Conclusion(s): In RAGT for patients with subacute hemiplegic stroke, reduction in swing-assist was identified as a factor related to improved walking independence before and after RAGT. Additionally, factors such as reduction in knee-extension assist, age, and cognitive function were identified as contributors related to walking independence at discharge.

Implications: These findings suggest that optimizing assistive functions, particularly the reduction of swing and knee-extension assist, is crucial for improving walking independence in patients with subacute stroke. Further, other than assistive functions, cognitive functions should also be considered when aiming for walking independence at discharge. This emphasizes the need to address both assistive strategies and cognitive factors during RAGT to enhance rehabilitation outcomes.