Electromechanical Gait Trainers

Evidence Reviewed as of before: 14-02-2020

Author(s)*: Annabel McDermott (BOccThy); Adam Kagan, BSc; Nicol Korner-Bitensky, PhD OT

Content consistency: Gabriel Plumier

Introduction

Electromechanical gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers have been developed as an alternative to conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training methods such as assisted overground walking and treadmill training. Electromechanical gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers differ from traditional treadmill training in that the device guides the lower limbs through the gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
motion. Electromechanical devices can enable intensive repetition of movement with reduced physical assistance from clinicians. The two most common types of electromechanical gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are ‘end-effector’ trainers and exoskeleton trainers.

Patient/Family Information

What is an electromechanical gait trainer and what is it for?

An electromechanical gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer – also called a GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainer – is a piece of equipment that is used to help regain walking skills (gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
) after a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainers are used in strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. rehabilitation centers instead of, or as well as other types of walking training such as walking on a treadmill or walking over obstacles. GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainers help move the leg through the stepping motion. They provide a way for patients to practice walking in a natural pattern.

Two main types of GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainers are:

End-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers look similar to a large treadmill. The patient stands on a treadmill surface or on footplates. The patient wears a harness around his/her upper legs and torso for support. The treadmill or footplates are motor-driven to move the patient’s legs through the correct position and movements of walking.
Exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers use a treadmill or a walking frame on wheels. The exoskeleton is a robotic orthosis that attaches to the patient’s legs. The patient stands on a treadmill surface and is supported by a harness, or stands within a walking frame on wheels. The orthosis guides the legs through the correct walking patterns. These are also called robotic gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers.

Why do we use a Gait Trainer after a stroke?

A strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. can affect aspects of walking such as:

How fast you walk
How long you walk for before tiring
The length of your step
The number of steps you take
The symmetry of your leg movements
Your risk of falling
Your confidence when walking.

If you have difficulty walking after a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., your rehabilitation will probably include gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
(walking) training. GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainers may be a safe way for you to begin walking training if you are not able to walk safely by yourself, because:

The harness supports your body and takes some of the weight off your legs,
The GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainer guides your legs through the walking patterns.

GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainers can be used to help some patients walk sooner after a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., especially if they require help from two people to walk over ground. It also allows some patients to practice walking when they are not ready to walk over ground.

Do electromechanical gait trainers work for stroke?

GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainers enable patients to practice repetitive walking movements. It is believed that this repetition may help rewire the area of the brain affected by the strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. When the patient performs repetitive walking movements, the brain cells form new ‘pathways’ to repair the damage from the strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Research shows that GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainers are as good as usual gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
rehabilitation (e.g. normal walking training, treadmill training) after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainers may be more useful than usual gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training methods for improving:

Leg motor function in the very early stage of recovery (up to one month post-stroke)
ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of daily living, functional walking skills, leg muscle strength and walking endurance in the rehabilitation phase (1-6 months post-stroke)
Functional walking skills, gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
patterns, general mobility and leg muscle strength more than 6 months post-stroke.

Further studies are needed to better understand who can benefit most from this type of training. GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainers are best used in conjunction with standard physical therapy.

What can I expect?

There are many different types of GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainers. Here is what you can expect when using most types of GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainer:

You will wear a harness over your clothes
The harness is fastened to an overhead suspension system. This harness supports your upper body and reduces the amount of weight you carry through your legs while you walk. Your therapist will decide how much of your body weight is supported by the harness and how much is carried through your legs
Your therapist will start the GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainer at a very low speed. As your walking skills improve, your therapist can (a) increase your walking speed slowly, and (b) increase the amount of weight you are taking through your legs
The device will guide your legs through walking movements.

Are there any side effects or risks?

There are no specific side effects from using GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainers. In fact, research has shown that it is easier on your heart if you walk with your body weight supported. As such, it may be easier for some patients who have had a strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to use the gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer than walking on the ground.

Who provides the treatment?

GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainers are usually used by a physical therapistIn charge of the “assessment and treatment of motor functioning, including motor control, strength and physical conditioning; balance, gait and mobility retraining; home and community visits; patient and family education regarding mobility and safety issues.” (Suggested by Philips et al, 2002)
at a rehabilitation center. An assistant may be present to help you get ready by putting on your harness and staying with you during rest periods.

GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainers are a fairly new treatment device and are labor-intensive. It requires specific equipment that is quite costly. As such, GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainers may not be available in all rehabilitation centers.

How much does it cost?

GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainers are very expensive pieces of equipment and are only suitable for use in rehabilitation centers under supervision of a trained rehabilitation professional. They are not suitable for private use.

Is a Gait Trainer suitable for me?

GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainers have been shown to be as good as other walking rehabilitation approaches for most outcomes after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Factors such as time since strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., the severity of your strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., and your rehabilitation center’s access to a GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainer may affect your ability to use this form of rehabilitation. Ask your rehabilitation specialist if this is a suitable intervention for you.

Clinician Information

Note: When reviewing the findings, it is important to note that they are always made according to randomized clinical trial (RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness.) criteria – specifically as compared to a control group. To clarify, if a treatment is “effective” it implies that it is more effective than the control treatment to which it was compared. Non-randomized studies are no longer included when there is sufficient research to indicate strong evidence (Level 1a) for an outcome.

Electromechanical gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers have been developed as an alternative to conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training methods such as assisted overground walking and treadmill training. Electromechanical gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers differ from traditional treadmill training in that the device guides the lower limbs through the gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
motion, which enables intensive repetition of movement with reduced physical assistance from clinicians. GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers use automated mechanical forces to drive movements of the lower extremity (Morone et al., 2017). This motor-driven stepping may improve the symmetry of walking patterns as it forces timing between the lower limbs, promotes hip extension and discourages compensatory movement patterns (Regneaux et al., 2008; Polese et al., 2013).

The two common types of electromechanical gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are end-effector devices and exoskeleton devices. Both devices move the lower limbs through kinematically repetitive stepping patterns in the sagittal plane. Both systems adopt a ‘forced use’ motor learning approach to promote task-oriented training of walking. This enables intensive, repetitive practice of typical walking patterns that simulate stance and swing phases of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training (Bruni et al., 2018; Kim & You, 2017; Polese et al., 2013; Regneaux et al., 2008).

End-effector devices use footplates to facilitate stance and swing phases during locomotor training (Bruni et al., 2018). The most common electromechanical gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are the Reha-Stim GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainers (GT1, GT2), G-EO system, Lokohelp and the Haptik walker. This StrokEngine review of end-effector devices includes ten high quality RCTs, three fair quality RCTs and two non-randomized studies; most studies were conducted with patients in the subacute or chronic phases of recovery. In this review, end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are compared with interventions including conventional physiotherapy, conventional rehabilitation, conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training, overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training and body-weight supported treadmill training. While end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers were no more effective than comparison interventions for most outcomes, findings from this review provide at least moderate evidence (Level 1b) end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers were more effective than comparison interventions for improving:

ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of daily living, functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
, lower extremity muscle strength and walking endurance in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery;
Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
, gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters, mobility and lower extremity muscle strength in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery; and
Disability in a sample of patients across the strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery continuum.

Exoskeleton devices facilitate movement of the hips and knees during the phases of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
(Bruni et al., 2018). Examples of exoskeleton devices include the Lokomat and the LOPES. The Lokomat uses a harness-supported body weight system in conjunction with a treadmill. This StrokEngine review of exoskeleton devices includes eight high quality RCTs, nine fair quality RCTs and two non-randomized studies; most studies were conducted with patients in the subacute or chronic phases of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. In this review, exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are compared with interventions including conventional physical therapy, treadmill training, therapist-assisted gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training, or no additional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. While exoskeleton devices were no more effective than comparison interventions for most functional outcomes, findings from this review provide at least moderate evidence (Level 1b) that exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers were more effective than comparison interventions for improving:

Lower extremity motor function in the acute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery; and
Functional independence, functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
, neurological recovery, and stair climbing in a sample of patients across the strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery continuum.

Results Table

View results table

Outcomes

Acute Phase - End-effector gait trainers

Functional ambulation

Not Effective

One fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Peurala et al., 2009) examined the effect of an end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer on functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
in the acute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. This fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive (1) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device, (2) time-matched overground walking training, or (3) conventional rehabilitation alone. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured using the Functional AmbulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
Category at post-treatment (3 weeks) and follow-up (6 months). No significant between-group differences were found at either time point.
Note: The end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training group showed significantly lower perceived exertion during training (measured by the Borg scale) compared to the other groups, and achieved the required 20 minutes of walking per 1-hour session in less time than the overground walking training group, which often required the full 1 hour before achieving 20 minutes of walking.

Conclusion: There is limited evidence (Level 2a) from 1 fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than comparison interventions (overground walking training, conventional rehabilitation alone) in improving functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
in the acute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Mobility

Not Effective

One fair quality RCT (Peurala et al., 2009) examined the effect of an end-effector gait trainer on mobility in the acute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. This fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive (1) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device, (2) time-matched overground walking training, or (3) conventional rehabilitation alone. Mobility was measured using the Rivermead Mobility Index and the Rivermead Motor Assessment Scale (RMA – Gross motor function, Lower extremity function and trunk control) at post-treatment (3 weeks) and follow-up (6 months). No significant between-group differences were found on either measure at either time point.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than comparison interventions (overground walking training, conventional rehabilitation alone) in improving mobility in the acute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Motor function

Effective

One fair quality RCT (Peurala et al., 2009) examined the effect of an end-effector gait trainer on motor function in the acute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. This fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive (1) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device, (2) time-matched overground walking training, or (3) conventional rehabilitation alone. Motor function was measured using the Modified Motor Assessment Scale (MMAS) at post-treatment (3 weeks) and follow-up (6 months). A significant between-group difference was seen at post-treatment, in favour of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. conventional rehabilitation alone. Differences did not remain significant at follow-up. There were no significant differences between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. overground walking training.
Note: A significant between-group difference was found at post-treatment in favour of overground walking vs. conventional rehabilitation; differences did not remain significant at follow-up.

Conclusion: There is limited evidence (Level 2a) from 1 fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are more effective, in short-term, than a comparison intervention (conventional rehabilitation) in improving motor function in the acute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.
Note: End-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers were not more effective than overground walking training.

Walking endurance

Not Effective

One fair quality RCT (Peurala et al., 2009) examined the effect of an end-effector gait trainer on walking endurance in the acute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. This fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive (1) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device, (2) time-matched overground walking training, or (3) conventional rehabilitation alone. Walking endurance was measured using the 6 Minute Walk Test at post-treatment (3 weeks) and follow-up (6 months). A significant difference was found at follow-up, in favour of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. overground walking.
Note: Insufficient data was gathered from the conventional rehabilitation group at either time point and no between-group comparisons were made.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than a comparison intervention (overground walking training) in improving walking endurance in the acute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.
Note: End-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers were more effective than overground walking in the long term.

Walking speed

Not Effective

One fair quality RCT (Peurala et al., 2009) examined the effect of an end-effector gait trainer on walking speed in the acute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. This fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive (1) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device, (2) time-matched overground walking training, or (3) conventional rehabilitation alone. Walking speed was measured using the 10-meter walking test at post-treatment (3 weeks) and follow-up (6 months). No significant between-group differences were found at either time point.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than comparison interventions (overground walking training, conventional rehabilitation alone) in improving walking speed in the acute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Acute Phase - Exoskeleton gait trainers

Cardiopulmonary fitness

Not Effective

One high quality RCT (Chang et al., 2012) investigated the effect of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on cardiopulmonary fitness in the acute phase of stroke recovery. The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or time-matched conventional physical therapy; both groups received additional physical therapy. Cardiopulmonary fitness was measured according to aerobic capacity (peak VO2Blood oxygen level.
, respiratory exchange ratio), cardiovascular response (oxygen pulse, peak heart rate, systolic/diastolic blood pressure, rate of perceived exertion) and ventilatory response (minute ventilation, ventilatory efficiency) at post-treatment (2 weeks). There was a significant between-group difference in aerobic capacity only (peak VO2Blood oxygen level.
), in favour of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. conventional physical therapy.

Functional ambulation

Not Effective

One high quality RCT (Chang et al., 2012) investigated the effect of exoskeleton gait trainers on functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
in the acute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. The high quality RCT randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or time-matched conventional physical therapy; both groups received additional physical therapy. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured using the Functional AmbulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
Categories at post-treatment (2 weeks). No significant between-group difference was found.

Motor function – lower extremity

Effective

One high quality RCT (Chang et al., 2012) investigated the effect of exoskeleton gait trainers on lower extremity motor function in the acute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or time-matched conventional physical therapy; both groups received additional physical therapy. Lower extremity motor function was measured using the Fugl-Meyer Assessment – Lower Extremity score (FMA-LE) at post-treatment (2 weeks). There was a significant between-group difference, in favour of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. conventional physical therapy.

Motor power – lower extremity

Not Effective

One high quality RCT (Chang et al., 2012) investigated the effect of exoskeleton gait trainers on lower extremity motor power in the acute phase of stroke recovery. The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or time-matched conventional physical therapy; both groups received additional physical therapy. Lower extremity motor power was measured using the Motricity Index – Leg score at post-treatment (2 weeks). No significant between-group difference was found.

Subacute Phase - End-effector gait trainers

Activities of daily living

Effective

One high quality RCT (Pohl et al., 2007) investigated the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on activities of daily living (ADLs) in the subacute phase of stroke recovery. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device or time-matched physical therapy. ADLs were measured using the Barthel Index (BI) at post-treatment (4 weeks) and follow-up (6 months). A significant between-group difference in the number of patients who achieved BI scores > 75 was seen at post-treatment, in favour of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. physical therapy. This difference did not remain significant at follow-up.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are more effective, in short-term, than a comparison intervention (time-matched physical therapy) in improving ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of daily living in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Balance

Not Effective

One non-randomized study (Iacovelli et al., 2018) examined the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on balance in the subacute phase of stroke recovery. This non-randomized controlled trial assigned patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the G-EO device or conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Balance was measured using the Tinetti Scale at post-treatment (20 sessions). No significant between-group difference was found.

Conclusion: There is limited evidence (Level 2b) from one non-randomized study that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than a comparison intervention (conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training) in improving balance in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Functional ambulation

Effective

Two high quality RCTs (Werner et al., 2002; Pohl et al., 2007) and two non-randomized studies (Hesse et al., 2012; Iacovelli et al., 2018) investigated the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The first high quality cross-over design RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Werner et al., 2002) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device or body-weight supported treadmill training (BWS-TT). Interventions were provided using an A-B-A or B-A-B design, with each block lasting 2 weeks (6 weeks total). Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured by the Functional AmbulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
Category (FAC) at post-treatment (6 weeks) and follow-up (6 months). A significant between-group difference was found at post-treatment, in favour of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. BWS-TT; the difference did not remain significant at follow-up.

The first non-randomized controlled trial (Hesse et al., 2012) assigned non-ambulatory patients to receive gait training using the G-EO device or time-matched physical therapy. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured using the FAC at post-treatment (4 weeks) and follow-up (3 months). A significant between-group difference was found at both time points, in favour of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. physical therapy.

The second non-randomized controlled trial (Iacovelli et al., 2018) assigned patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the G-EO device or conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured using the FAC and the Walking Handicap Scale at post-treatment (20 sessions). No significant between-group differences were found.

Conclusion: There is strong evidence (Level 1a) from 2 high quality RCTs and one non-randomized study that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are more effective than comparison interventions (body-weight supported treadmill training or physical therapy) for improving functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Gait parameters

Not Effective

One non-randomized study (Iacovelli et al., 2018) examined the effect of end-effector gait trainers on gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. This non-randomized controlled trial assigned patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the G-EO device or conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters were measured using the SMART0D500 optoelectronic system (stride time, stride length, step length, cadence, velocity, swing velocity, mean velocity) and five measures (step length, swing time, stance time, double support time, intra-limb ratio of swing: stance time) were used to calculate the symmetry index (symmetry ratio, symmetry index, gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
asymmetry, symmetry angle) at post-treatment (20 sessions). Significant between-group differences were found in only two gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters (symmetry ratio – step length, symmetry angle – step length), in favour of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.

Conclusion: There is limited evidence (Level 2b) from one non-randomized study that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than a comparison intervention (conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training) for improving gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Mobility

Conflicting

Two high quality RCTs (Werner et al., 2002; Pohl et al., 2007) and two non-randomized studies (Hesse et al., 2012; Iacovelli et al., 2018) investigated the effect of end-effector gait trainers on mobility in patients with subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first non-randomized controlled trial (Hesse et al., 2012) assigned non-ambulatory patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the G-EO device or time-matched physical therapy. Mobility was measured using the RMI at post-treatment (4 weeks) and follow-up (3 months). A significant between-group difference was found at post-treatment in favour of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. physical therapy. Differences did not remain significant at follow-up.

The second non-randomized controlled trial (Iacovelli et al., 2018) assigned patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the G-EO device or conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Mobility was measured using the Timed Up and Go (TUG) test and the Trunk Control Test at post-treatment (20 sessions). A significant between-group difference was found in one measure of mobility (TUG) in favour of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.

Conclusion: There is conflicting evidence (Level 4) regarding the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on mobility in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and two non-randomized studies found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are more effective than comparison interventions (physical therapy, conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training); a second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found no significant difference compared with body-weight supported treadmill training.
Note: Differences in results may relate to the variation in outcome measures used.

Motor function - lower extremity

Not Effective

One non-randomized study (Iacovelli et al., 2018) examined the effect of end-effector gait trainers on lower extremity motor function in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. This non-randomized controlled trial assigned patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the G-EO device or conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Lower extremity motor function was measured using the Fugl-Meyer Assessment – Lower Extremity at post-treatment (20 sessions). No significant between-group difference was found.

Conclusion: There is limited evidence (Level 2b) from one non-randomized study that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than a comparison intervention (conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training) for improving lower extremity motor function in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Muscle strength - lower extremity

Effective

One high quality RCT (Pohl et al., 2007) and two non-randomized studies (Hesse et al., 2012; Iacovelli et al., 2018) examined the effect of end-effector gait trainers on lower extremity muscle strength in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The high quality RCT (Pohl et al., 2007) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device or time-matched physical therapy. Lower extremity muscle strength was measured using the Motricity Index (MI) and post-treatment (4 weeks) and follow-up (6 months). A significant between-group difference was seen at post-treatment in favour of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. physical therapy. Differences did not remain significant at follow-up.

The first non-randomized controlled trial (Hesse et al., 2012) assigned non-ambulatory patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the G-EO device or time-matched physical therapy. Lower extremity muscle strength was measured using the MI at post-treatment (4 weeks) and follow-up (3 months). A significant between-group difference was found at both time points in favour of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. physical therapy.

The second non-randomized controlled trial (Iacovelli et al., 2018) assigned patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the G-EO device or conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Lower extremity muscle strength was measured using the MI and the Medical Research Council Scale (MRC Scale – Hip extension, Knee flexion, Ankle flexion) at post-treatment (20 sessions). Significant between-group differences were found on two measures of muscle strength (MRC scale – Hip extension, Ankle flexion), in favour of end-effector gait training vs. conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.

Muscle tone/Spasticity - lower extremity

Not Effective

One high quality RCT (Werner et al., 2002) and two non-randomized studies (Hesse et al., 2012; Iacovelli et al., 2018) examined the effect of end-effector gait trainers on lower extremity muscle tone/spasticity in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The high quality cross-over design RCT (Werner et al., 2002) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device or body-weight supported treadmill training (BWS-TT). Interventions were provided using an A-B-A or B-A-B design, with each block lasting 2 weeks (6 weeks total). SpasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
was measured by the Modified Ashworth Scale at post-treatment (6 weeks). No significant between-group difference was found.

The first non-randomized controlled trial (Hesse et al., 2012) assigned non-ambulatory patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the G-EO device or time-matched physical therapy. Lower extremity muscle tone was measured using the Resistance to Passive Movement Scale at post-treatment (4 weeks) and follow-up (3 months). No significant between-group difference was found at either time point.

The second non-randomized controlled trial (Iacovelli et al., 2018) assigned patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the G-EO device or conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Lower extremity spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
was measured using the Ashworth Scale (Total score, Hip, Knee) at post-treatment (20 sessions). Significant between-group differences were found on all measures of Ahsworth Scale, in favour of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.

Range of motion - lower extremity

Not Effective

One non-randomized study (Iacovelli et al., 2018) examined the effect of end-effector gait trainers on lower extremity range of motion in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. This non-randomized controlled trial assigned patients to receive gait training using the G-EO device or conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Lower extremity range of motion (Hip, Knee, Ankle) was measured in the sagittal plane at post-treatment (20 sessions). No significant between-group differences were found.

Conclusion: There is limited evidence (Level 2b) from one non-randomized study that end-effector gait trainers are not more effective than a comparison intervention (conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training) for improving lower extremity range of motion in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Walking endurance

Effective

One high quality RCT (Pohl et al., 2007) and one non-randomized study (Iacovelli et al., 2018) examined the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on walking endurance in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The non-randomized controlled trial (Iacovelli et al., 2018) assigned patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the G-EO device or conventional gait training. Walking endurance was measured using the 6MWT at post-treatment (20 sessions). A significant between-group difference was found in favour of end-effector gait training vs. conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.

Walking speed

Conflicting

Two high quality RCTs (Werner et al., 2002; Pohl et al., 2007) and two non-randomized studies (Hesse et al., 2012; Iacovelli et al., 2018) investigated the effect of end-effector gait trainers on walking speed in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The first non-randomized controlled trial (Hesse et al., 2012) assigned non-ambulatory patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the G-EO device or time-matched physical therapy. Walking speed was measured using the 10-meter walking test at post-treatment (4 weeks) and follow-up (3 months). A significant between-group difference was found at post-treatment in favour of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. physical therapy. Differences did not remain significant at follow-up.

The second non-randomized controlled trial (Iacovelli et al., 2018) assigned patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the G-EO device or conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Walking speed was measured using the 10-meter walking test at post-treatment (20 sessions). A significant between-group difference was found in favour of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.

Conclusion: There is conflicting evidence (Level 4) regarding the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on walking speed in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and two non-randomized studies found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are more effective than comparison interventions (physical therapy, conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training), whereas a second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found no significant difference between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers and Body-Weight Supported Treadmill Training.

Subacute Phase - Exoskeleton gait trainers

Activities of daily living (ADLs)/Instrumental ADLs

Not Effective

One high quality RCT (Husemann et al., 2007), two fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Hidler et al., 2009; Han et al., 2016) and one non-randomized study (Chung, 2017) investigated the effect of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on ADLs or IADLs in the subacute phase of stroke recovery.

The first fair quality RCT (Hidler et al., 2009) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or time-matched conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. IADLs were measured using the Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Index at mid-treatment (12 sessions), post-treatment (24 sessions) and follow-up (3 months). No significant between-group difference was found at any timepoint.

Balance

Not Effective

One high quality RCT (Taveggia et al., 2016), three fair quality RCTs (Hidler et al., 2009; van Nunen et al., 2015; Han et al., 2016) and one non-randomized study (Chung, 2017) investigated the effect of exoskeleton gait trainers on balance in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The high quality RCT (Taveggia et al., 2016) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or time-matched conventional physical therapy for gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
retraining; both groups received additional physical therapy. Balance was measured by the Tinetti Balance Scale at post-treatment (5 weeks) and follow-up (3 months). No significant between-group difference was found at either timepoint.

Functional ambulation

Not Effective

One high quality RCT (Husemann et al., 2007), three fair quality RCTs (Hidler et al., 2009; van Nunen et al., 2015; Han et al., 2016) and one non-randomized study (Chung, 2017) investigated the effect of exoskeleton gait trainers on functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The high quality RCT (Husemann et al., 2007) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or conventional physical therapy. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured by the Functional AmbulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
Category (FAC) at post-treatment (4 weeks). No significant between-group difference was found.

The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Hidler et al., 2009) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or time-matched conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured using the FAC at mid-treatment (12 sessions), post-treatment (24 sessions) and follow-up (3 months). No significant between-group difference was found at any timepoint.

The second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (van Nunen et al., 2015) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or dose-matched overground gait training; both groups received additional physical therapy. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured by the FAC at post-treatment (10 weeks) and follow-up (week 24, week 36). No significant between-group difference was found at any timepoint.

The third fair quality RCT (Han et al., 2016) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or conventional physical therapy; both groups received additional physical therapy and occupational therapy. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured by the FAC at post-treatment (4 weeks). No significant between-group difference was found.

The non-randomized case-controlled study (Chung, 2017) provided patients with gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device and physical therapy or time-matched physical therapy. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured by the modified FAC at baseline and at discharge (approximately 5 weeks). A significant between-group difference in change scores from baseline to discharge was found, in favour of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training + physical therapy vs. physical therapy alone.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and three fair quality RCTs that exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than comparison interventions (conventional physical therapy, conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training, overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training) for improving functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.
Note: The non-randomized study found that the exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer was more effective than time-matched physical therapy.

Functional independance

Not Effective

One high quality RCT (Taveggia et al., 2016) investigated the effect of an exoskeleton gait trainer on functional independence in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or time-matched conventional physical therapy for gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
retraining; both groups received additional physical therapy. Functional independence was measured by the Functional Independence Measure at post-treatment (5 weeks) and follow-up (3 months). No significant between-group difference was found at either timepoint.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that an exoskeleton gait trainer is not more effective than a comparison intervention (conventional physical therapy) for improving functional independence in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Gait parameters

Not Effective

One high quality RCT (Husemann et al., 2007) and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Hidler et al., 2009) investigated the effect of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The fair quality RCT (Hidler et al., 2009) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or time-matched conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. One gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameter was measured using the GAITRite system (Cadence) at mid-treatment (12 sessions), post-treatment (24 sessions) and follow-up (3 months). No significant between-group difference was found at any timepoint.

Health related quality of life

Not Effective

One high quality RCT (Taveggia et al., 2016) and two fair quality RCTs (Hidler et al., 2009; van Nunen et al., 2015) investigated the effect of exoskeleton gait trainers on health related quality of life (HRQoL) in the subacute phase of stroke recovery.

The first fair quality RCT (Hidler et al., 2009) randomized patients to receive gait training using the Lokomat device or time-matched conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. HRQoL was measured using the SF-36 at mid-treatment (12 sessions), post-treatment (24 sessions) and follow-up (3 months). No significant between-group difference was found at any timepoint.

The second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (van Nunen et al., 2015) randomized patients to receive gait training using the Lokomat device or dose-matched overground gait training; both groups received additional physical therapy. HRQoL was measured by the SF-36 (General health, Social functioning scores) and the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Impact Scale (SIS 3.0 – ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of Daily Living, Mobility scores) at post-treatment (10 weeks) and follow-up (week 24, week 36). No significant between-group differences were found on either measure at any timepoint.

Mobility

Not Effective

Two fair quality RCTs (Hidler et al., 2009; van Nunen et al., 2015) and one non-randomized study (Chung, 2017) investigated the effect of exoskeleton gait trainers on mobility in the subacute phase of stroke recovery.

The second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (van Nunen et al., 2015) randomized patients to receive gait training using the Lokomat device or dose-matched overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training; both groups received additional physical therapy. Mobility was measured by the RMI at post-treatment (10 weeks) and follow-up (week 24, week 36); the Timed Up and Go test was also used with patients with a Functional AmbulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
Category of or greater than 3. No significant between-group differences were found on either measure at any timepoint.

The non-randomized case-controlled study (Chung, 2017) provided patients with gait training using the Lokomat device and physical therapy or time-matched physical therapy. Mobility was measured by the modified RMI at baseline and at discharge (approximately 5 weeks). A significant between-group difference in change scores from baseline to discharge was found, in favour of exoskeleton gait training + physical therapy vs. physical therapy alone.

Conclusion: There is limited evidence (Level 2a) from two fair quality RCTs that exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than comparison interventions (conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training, overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training) for improving mobility in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.
Note: A non-randomized study found that the exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer was more effective than physical therapy alone.

Motor function - lower extremity

Not Effective

Three fair quality RCTs (Hidler et al., 2009; van Nunen et al., 2015; Han et al., 2016) investigated the effect of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on lower extremity motor function in the subacute phase of stroke recovery.

The first fair quality RCT (Hidler et al., 2009) randomized patients to receive gait training using the Lokomat device or time-matched conventional gait training. Lower extremity motor function was measured using the Motor Assessment Scale at mid-treatment (12 sessions), post-treatment (24 sessions) and follow-up (3 months). No significant between-group difference was found at any timepoint.

Conclusion: There is limited evidence (Level 2a) from three fair quality RCTs that exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than comparison interventions (conventional gait training, overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training, conventional physical therapy) for improving lower extremity motor function in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Muscle strength - lower extremity

Not Effective

One high quality RCT (Husemann et al., 2007) and one fair quality RCT (van Nunen et al., 2015) investigated the effect of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on lower extremity muscle strength in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The fair quality RCT (van Nunen et al., 2015) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or dose-matched overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training; both groups received additional physical therapy. Muscle strength was measured according to maximal voluntary isometric torque of bilateral knee extensors and flexors at post-treatment (10 weeks) and follow-up (week 24, week 36). No significant between-group difference was found at any timepoint.

Spasticity

Not Effective

One high quality RCT (Husemann et al., 2007) investigated the effect of an exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer on spasticity in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. The high quality RCT randomized patients to receive gait training using the Lokomat device or conventional physical therapy. SpasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
was measured by the Modified Ashworth Scale at post-treatment (4 weeks). No significant between-group difference was found.

Stroke impact

Not Effective

One fair quality RCT (van Nunen et al., 2015) investigated the effect of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on stroke impact the subacute phase of stroke recovery. The fair quality RCT randomized patients to receive gait training using the Lokomat device or dose-matched overground gait training; both groups received additional physical therapy. StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. impact was measured by the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Impact Scale (SIS 3.0 – ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of Daily Living, Mobility scores) at post-treatment (10 weeks) and follow-up (week 24, week 36). No significant between-group difference was found at any time point.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that exoskeleton gait trainers are not more effective than a comparison intervention (overground gait training) for reducing the impact of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Stroke severity

Not Effective

One fair quality RCT (Hidler et al., 2009) investigated the effect of an exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer on stroke severity in the subacute phase of stroke recovery. The fair quality RCT randomized patients to receive gait training using the Lokomat device or time-matched conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Stroke severity was measured using the National Institute of Health Stroke Scale (NIHSS) at mid-treatment (12 sessions), post-treatment (24 sessions) and follow-up (3 months). No significant between-group difference was found at any timepoint.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that an exoskeleton gait trainer is not more effective than a comparison intervention (conventional gait training) for reducing stroke severity in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Walking endurance

Not Effective

One high quality RCT (Taveggia et al., 2016) and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Hidler et al., 2009) investigated the effect of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on walking endurance in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The fair quality RCT (Hidler et al., 2009) randomized patients to receive gait training using the Lokomat device or time-matched conventional gait training. Walking endurance was measured using the 6MWT at mid-treatment (12 sessions), post-treatment (24 sessions) and follow-up (3 months). A significant between-group difference was found at mid-treatment and post-treatment, in favour of conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. exoskeleton gait training. Differences did not remain significant at follow-up.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than comparison interventions (conventional physical therapy, conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training) for improving walking endurance in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.
Note: The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training was more effective than exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.

Walking speed

Not Effective

Two high quality RCTs (Husemann et al., 2007; Taveggia et al., 2016) and two fair quality RCTs (Hidler et al., 2009; van Nunen et al., 2015) investigated the effect of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on walking speed in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The first high quality RCT (Husemann et al., 2007) randomized patients to receive gait training using the Lokomat device or conventional physical therapy. Walking speed was measured by the 10-meter walking test at post-treatment (4 weeks). No significant between-group difference was found.

The second high quality RCT (Taveggia et al., 2016) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or time-matched conventional physical therapy for gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
retraining; both groups received additional physical therapy. Walking speed was measured by the 10-meter walking test at post-treatment (5 weeks) and follow-up (3 months). No significant between-group difference was found at either timepoint.

The first fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Hidler et al., 2009) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or time-matched conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Walking speed was measured using the 5 meter walking test at mid-treatment (12 sessions), post-treatment (24 sessions) and follow-up (3 months). A significant between-group difference was found at all timepoints, in favour of conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. exoskeleton gait training.

Conclusion: There is strong evidence (Level 1a) from two high quality RCTs and two fair quality RCTs that exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than comparison interventions (conventional physical therapy, conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training, overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training) for improving walking speed in the subacute phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.
Note: One fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training was more effective than exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.

Chronic Phase - End-effector gait trainers

Activities of daily living

Not Effective

One fair quality RCT (Dias et al., 2007) investigated the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on Activities of daily living (ADLs) in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device or time-matched conventional rehabilitation. ADLs were measured using the Barthel Index (BI) at post-treatment (5 weeks) and follow-up (3 months). No significant between-group difference was found at either time point.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than a comparison intervention (conventional rehabilitation) for improving ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of daily living in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Balance

Not Effective

One high quality RCT (Peurala et al., 2005) and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Dias et al., 2007) investigated the effect of end-effector gait trainers on balance in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The high quality RCT (Peurala et al., 2005) randomized patients to receive (1) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device, (2) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training + Functional Electrical Stimulation (GT1+FES), or (3) overground walking training. Postural sway was measured using a force plate at mid-treatment (2 weeks), post-treatment (3 weeks) and follow-up (6 months). No significant between-group differences were found at any time point.

The fair quality RCT (Dias et al., 2007) randomized patients to receive gait training using the GT1 device or time-matched conventional rehabilitation. Balance was measured using the Toulouse Motor Scale (Balance: items 1-10; items 11-20; total), Berg Balance Scale (BBS) and the Step Test at post-treatment (5 weeks) and follow-up (3 months). No significant between-group differences were found on either measure at either time point.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one fair quality RCT that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than comparison interventions (overground walking training, conventional rehabilitation) for improving balance in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.
Note: The high quality RCT also found that GT1+FES is not more effective than overground walking training for improving balance in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. There was no significant difference between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with/without FES.

Functional ambulation

Effective

One high quality RCT (Geroin et al., 2011), one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Dias et al., 2007) and one fair non-randomized study (Park et al., 2015) examined the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
in the chronic phase of stroke recovery.

The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Geroin et al., 2011) randomized patients to receive (1) gait training using the GT1 device + sham stimulation (GT1 + sham stimulation), (2) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training + transcranial direct current stimulation (GT1+tDCS), or (3) conventional overground walking exercises. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured using the Functional AmbulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
Category (FAC) at post-treatment (2 weeks) and follow-up (4 weeks). A significant between-group difference was found at both time points in favour of GT1 + sham stimulation vs. conventional walking exercises.
Note: A significant between-group difference was found in favour of GT1+tDCS vs. conventional walking exercises at both time points. No significant difference was found between GT1 + sham stimulation vs. GT1+tDCS.

The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Dias et al., 2007) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device or time-matched conventional rehabilitation. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured using the FAC at post-treatment (5 weeks) and follow-up (3 months). No significant between-group difference was found at either time point.

The fair non-randomized controlled trial (Park et al., 2015) assigned patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT2 device or conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured using the FAC at post-treatment (4 weeks). No significant between-group difference was found.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are more effective than a comparison intervention (conventional overground walking exercises) in improving functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. However, one fair quality RCT and fair one non-randomized study found that end-effector gait trainers are not more effective than comparison interventions (conventional rehabilitation, overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training).
Note: The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. also found that GT1+tDCS was more effective than conventional overground walking exercises. There was no significant difference between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with/without tDCS.

Functional independance

Not Effective

One high quality RCT (Peurala et al., 2005) investigated the effect of end-effector gait trainers on functional independence in patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive (1) gait training using the GT1 device, (2) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training + Functional Electrical Stimulation (GT1+FES), or (3) overground walking training. Functional independence was measured using the Functional Independence Measure at mid-treatment (2 weeks), post-treatment (3 weeks) and follow-up (6 months). No significant between-group differences were found at any time point.

Gait parameters

Effective

One high quality RCT (Geroin et al., 2011) and one fair non-randomized study (Park et al., 2015) examined the effect of end-effector gait trainers on gait parameters in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The high quality RCT (Geroin et al., 2011) randomized patients to receive (1) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device + sham stimulation (GT1 + sham stimulation), (2) gait training + transcranial direct current stimulation (GT1+tDCS), or (3) conventional overground walking exercises. GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters were measured using the GAITRite system (Cadence, Temporal symmetry ratio of swing time to stance phase, Single to double support duration ratio) at post-treatment (2 weeks) and follow-up (4 weeks). Significant between-group differences were found on all gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters at both time points, in favour of GT1 + sham stimulation vs. conventional walking exercises.
Note: Significant between-group differences were found on all gait parameters at both time points in favour of GT1+tDCS vs. conventional walking exercises. No significant differences were found between GT1 + sham stimulation vs. GT1+tDCS.

The fair non-randomized controlled trial (Park et al., 2015) assigned patients to receive gait training using the GT2 device or conventional overground gait training. Spatiotemporal gait parameters were measured using the GAITRite system (Walking speed, Walking cycle, Stance phase and stride length of affected side, Symmetry index of stance phase and stride length) at post-treatment (4 weeks). No significant between-group differences were found on either measure.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers (+ sham stimulation) are more effective than a comparison intervention (conventional overground walking exercises) for improving gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.
Note: The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. also found that GT1+tDCS was more effective than conventional overground walking exercises for improving gait parameters. There was no significant difference between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with/without tDCS.
Note: A fair non-randomized study found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training was not more effective than conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.

Mobility

Effective

One high quality RCT (Geroin et al., 2011) and one fair quality RCT (Dias et al., 2007) investigated the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on mobility in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers (+ sham stimulation) are more effective than a comparison intervention (conventional overground walking exercises) for improving mobility in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.
Note: However, one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that end-effector gait trainers are not more effective than conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.
Note: The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that GT1+tDCS is more effective than conventional walking exercises. There is no significant difference between end-effector gait training with/without tDCS.

Motor function

Not Effective

One high quality RCT (Peurala et al., 2005) and one fair quality RCT (Dias et al., 2007) investigated the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on motor function in the chronic phase of stroke recovery.

The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Dias et al., 2007) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device or time-matched conventional rehabilitation. Motor function was measured using the Fugl-Meyer StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Scale at post-treatment (5 weeks) and follow-up (3 months). No significant between-group difference was found at either time point.

Muscle strength - lower extremity

Effective

One high quality RCT (Geroin et al., 2011) and one fair quality RCT (Dias et al., 2007) investigated the effect of end-effector gait trainers on lower extremity muscle strength in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The high quality RCT (Geroin et al., 2011) randomized patients to receive (1) gait training using the GT1 device + sham stimulation (GT1 + sham stimulation), (2) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training + transcranial direct current stimulation (GT1+tDCS), or (3) conventional overground walking exercises. Muscle strength was measured using the Motricity Index (MI – Leg score) at post-treatment (2 weeks) and follow-up (4 weeks). A significant between-group difference was found at both time points in favour of GT1 + sham stimulation vs. conventional walking exercises.
Note: A significant between-group difference was found at both time points in favour of GT1+tDCS vs. conventional walking exercises. No significant difference was found between GT1 + sham stimulation vs. GT1+tDCS.

Conclusion: There is moderate evidence (level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers (+ sham stimulation) are more effective than a comparison intervention (conventional overground walking exercises) for improving lower extremity muscle strength in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.
Note: One fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than conventional rehabilitation.
Note: The high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that GT1+tDCS is more effective than conventional walking exercises. There is no significant difference between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with/without tDCS.

Spasticity

Conflicting

Two high quality RCTs (Peurala et al., 2005; Geroin et al., 2011) and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Dias et al., 2007) investigated the effect of end-effector gait trainers on spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
in the chronic phase of stroke recovery.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Geroin et al., 2011) randomized patients to receive (1) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device + sham stimulation (GT1 + sham stimulation), (2) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training + transcranial direct current stimulation (GT1+tDCS), or (3) conventional overground walking exercises. SpasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
was measured using the MAS (hip adductors, quadriceps femoris, ankle plantiflexors) at post-treatment (2 weeks) and follow-up (4 weeks). A significant between-group difference was found at both time points in favour of GT1 + sham stimulation vs. conventional walking exercises.
Note: A significant between-group difference was found at both time points in favour of GT1+tDCS vs. conventional walking exercises. No significant difference was found between GT1 + sham stimulation vs. GT1+tDCS.

The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Dias et al., 2007) randomized patients to receive gait training using the GT1 device or time-matched conventional rehabilitation. SpasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
was measured using the MAS at post-treatment (5 weeks) and follow-up (3 months). No significant between-group difference was found at either time point.

Conclusion: There is conflicting evidence (Level 4) regarding the effect of end-effector gait trainers on spasticity in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that end-effector gait trainers were more effective than conventional walking exercises, whereas a second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and a fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers were not more effective than comparison interventions (overground walking training, conventional rehabilitation).
Note: A high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that GT1+tDCS was more effective than conventional overground walking training. There was no significant difference between end-effector gait training with/without tDCS.

Walking endurance

Conflicting

Two high quality RCTs (Peurala et al., 2005; Geroin et al., 2011) and one fair quality RCT (Dias et al., 2007) investigated the effect of end-effector gait trainers on walking endurance in the chronic phase of stroke recovery.

The second high quality RCT (Geroin et al., 2011) randomized patients to receive (1) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device + sham stimulation (GT1 + sham stimulation), (2) gait training + transcranial direct current stimulation (GT1+tDCS), or (3) conventional overground walking exercises. Walking endurance was measured using the 6MWT at post-treatment (2 weeks) and follow-up (4 weeks). A significant between-group difference was found at both time points in favour of GT1 + sham stimulation vs. conventional walking exercises.
Note: A significant between-group difference was found at both time points in favour of GT1+tDCS vs. conventional walking exercises. No significant difference was found between GT1 + sham stimulation vs. GT1+tDCS at either time point.

Conclusion: There is conflicting evidence (Level 4) regarding the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on walking endurance in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers were not more effective than comparison interventions (overground walking training, conventional rehabilitation), whereas a second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers were more effective than conventional walking exercises.
Note: One high quality RCT found that GT1+FES is not more effective than overground walking training, whereas a second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that GT1+tDCS is more effective than conventional overground walking exercises. There is no significant difference between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with/without FES, nor between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with/without tDCS.

Walking speed

Conflicting

Two high quality RCTs (Peurala et al., 2005; Geroin et al., 2011), two fair quality RCTs (Dias et al., 2007) and a fair non-randomized study (Park et al., 2015) investigated the effect of end-effector gait trainers on walking speed in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The first high quality RCT (Peurala et al., 2005) randomized patients to receive (1) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device, (2) gait training + Functional Electrical Stimulation (GT1+FES), or (3) overground walking training. Walking speed was measured using a 10-meter walking test at mid-treatment (2 weeks), post-treatment (3 weeks) and follow-up (6 months). No significant between-group differences were seen at any time point.

The second high quality RCT (Geroin et al., 2011) randomized patients to receive (1) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device + sham stimulation (GT1 + sham stimulation), (2) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training + transcranial direct current stimulation (GT1+tDCS), or (3) conventional overground walking exercises. Walking speed was measured using a 10-meter walking test at post-treatment (2 weeks) and follow-up (4 weeks). A significant between-group difference was found at both time points in favour of GT1 + sham stimulation vs. conventional walking exercises.
Note: A significant between-group difference was found at both time points in favour of GT1+tDCS vs. conventional walking exercises. No significant difference was found between GT1 + sham stimulation vs. GT1+tDCS.

The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Dias et al., 2007) randomized patients to receive gait training using the GT1 device or time-matched conventional rehabilitation. Walking speed was measured using a 10-meter walking test (Velocity, Step length, Step cadence with and without gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
aid) at post-treatment (5 weeks) and follow-up (3 months). No significant between-group differences were found at either time point.

The fair non-randomized controlled trial (Park et al., 2015) assigned patients to receive gait training using the GT2 device or conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Walking speed was measured using a 10-meter walking test at post-treatment (4 weeks). No significant between-group difference was found.

Conclusion: There is conflicting evidence (Level 4) regarding the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on walking speed in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness., one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one fairnon-randomized study found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers were not more effective than comparison interventions (overground walking training, conventional rehabilitation, overground gait training), whereas a second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers were more effective than conventional overground walking exercises.
Note: One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that GT1+FES is not more effective than overground walking training; a second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that GT1+tDCS is more effective than conventional overground walking exercises. There is no significant difference between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with/without FES, nor between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with/without tDCS.

Chronic Phase - Exoskeleton gait trainers

Activities of daily living (ADLs)/Instrumental ADLs

Not Effective

One high quality RCT (Kelley et al., 2013) and two fair quality RCTs (Hornby et al., 2008; Cho et al., 2015) investigated the effect of exoskeleton gait trainers on ADLs or IADLs in patients with chronic stroke.

The high quality RCT (Kelley et al., 2013) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or overground gait training. ADLs were measured by the Barthel Index (BI) at post-treatment (8 weeks) and follow-up (3 months). No significant between-group difference was found at either timepoint.

The first fair quality RCT (Hornby et al., 2008) randomized patients to receive locomotor training using the Lokomat device or therapist-assisted locomotor treadmill training. IADLs were measured using the Frenchay ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
Index at post-treatment (12 sessions) and follow-up (6 months). No significant between-group difference was found at either timepoint.

The second fair quality (crossover) RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Cho et al., 2015) randomized patients to receive gait training using the Lokomat device or no additional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training; both groups received conventional physical therapy. ADLs were measured using the modified BI (mBI – Total, Transfers, Ambulation scores) at post-treatment (4 weeks, 8 weeks). A significant between-group difference was found in one measure (mBI – Transfers), in favour of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. no gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.

Ataxia

Not Effective

One fair quality RCT (dos Santos et al., 2018) investigated the effect of an exoskeleton gait trainer on ataxia in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. The fair quality RCT randomized patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and ataxia to receive gait training using the Lokomat 5.0 or therapist-assisted gait training. Ataxia was measured using the Scale for the Assessment and Rating of Ataxia at post-treatment (5 months). No significant between-group difference was found.

Balance

Conflicting

Two high quality RCTs (Westlake & Patten, 2009; Bang & Shin, 2016) and three fair quality RCTs (Hornby et al., 2008; Cho et al., 2015; dos Santos et al., 2018) investigated the effect of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on balance in the chronic phase or strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The third fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (dos Santos et al., 2018) randomized patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and ataxia to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat 5.0 or therapist-assisted gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Balance was measured using the BBS at post-treatment (5 months). No significant between-group difference was found.

Conclusion: There is conflicting evidence (Level 4) regarding the effect of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on balance in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and three fair quality RCTs found that the Lokomat device was not more effective than comparison interventions (manually-assisted body-weight supported treadmill training, therapist-assisted locomotor treadmill training, no gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training, therapist-assisted gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training), whereas one high quality RCT found that the Lokomat device was more effective than treadmill gait training.

Balance confidence

Effective

One high quality RCT (Bang & Shin, 2016) investigated the effect of an exoskeleton gait trainer on balance confidence in the chronic phase or stroke recovery. This high quality RCT randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or treadmill gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Balance confidence was measured using the Activities-Specific Balance Confidence scale at post-treatment (4 weeks). Significant between-group difference was found, in favour of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. treadmill gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.

Functional ambulation

Not Effective

Two fair quality RCTs (Hornby et al., 2008; Cho et al., 2015) investigated the effect of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The first fair quality RCT (Hornby et al., 2008) randomized patients to receive locomotor training using the Lokomat device or therapist-assisted locomotor treadmill training. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured using the modified Emory Functional AmbulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
Profile at post-treatment (12 sessions) and follow-up (6 months). No significant between-group difference was found at either timepoint.

The second fair quality (crossover) RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Cho et al., 2015) randomized patients to receive gait training using the Lokomat device or no additional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training; both groups received conventional physical therapy. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured using the Functional AmbulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
Category at post-treatment (4 weeks, 8 weeks). No significant between-group difference was found.

Conclusion: There is limited evidence (Level 2a) from two fair quality RCTs that exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than no gait training or a comparison intervention (therapist-assisted treadmill training) for improving functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Functional independence

Not Effective

One high quality RCT (Kelley et al., 2013) and one fair quality RCT (dos Santos et al., 2018) investigated the effect of exoskeleton gait trainers on functional independence in the chronic phase of stroke recovery.

The fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (dos Santos et al., 2018) randomized patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and ataxia to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat 5.0 or therapist-assisted gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Functional independence was measured using the FIM at post-treatment (5 months). No significant between-group difference was found.

Gait parameters

Conflicting

Two high quality RCTs (Westlake & Patten 2009,; Bang & Shin, 2016) and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Hornby et al., 2008) investigated the effect of exoskeleton gait trainers on gait parameters in the chronic phase of stroke recovery.

The first high quality RCT (Westlake & Patten, 2009) randomized patients to receive gait training using the Lokomat device or time-matched manually-assisted body-weight supported treadmill training. GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters were measured using the GAITRite system (Self-selected walking speed, Fast walking speed, Step length ratio of paretic limb) at post-treatment (4 weeks). No significant between-group differences were found.

The second high quality RCT (Bang & Shin, 2016) randomized patients to receive gait training using the Lokomat device or treadmill gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters was measured using the GAITRite system (GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
speed, Cadence, Step length, Double limb support period) at post-treatment (4 weeks). Significant between-group differences were found on all measures, in favour of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. treadmill gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.

The fair quality RCT (Hornby et al., 2008) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or therapist-assisted locomotor treadmill training. Gait parameters (% Single limb stance, Step asymmetry: self-selected velocity/fast velocity) were measured at post-treatment (12 sessions) and follow-up (6 months). A significant between-group difference in one measure (% Single limb stance – Fast velocity) was found at post-treatment, in favour of therapist-assisted locomotor treadmill training vs. exoskeleton gait training. Results did not remain significant at follow-up.

Conclusion: There is conflicting evidence (Level 4) regarding the effect of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one fair quality RCT found that the Lokomat gait trainer was not more effective than comparison interventions (body-weight supported treadmill training, therapist-assisted treadmill training), whereas a second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that the Lokomat gait trainer was more effective than treadmill training.

Kinematics - lower extremity

Not Effective

One high quality RCT (Lewek et al., 2009) investigated the effect of an exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer on lower extremity kinematics in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. The high quality RCT randomized patients to receive gait training using the Lokomat device or therapist-assisted treadmill training. Kinematic coordination was measured according to the consistency of intralimb hip and knee angular trajectories over gait cycles (average coefficient of correspondence (ACC): Hip – involved/uninvolved; Knee – involved/uninvolved) at post-treatment (4 weeks). No between-group differences were found.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that an exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer is not more effective than a comparison intervention (treadmill training) for improving lower extremity kinematics in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Mobility

Conflicting

Two fair quality RCTs (Ukar, Paker, & Bugdayci, 2014; dos Santos et al., 2018) investigated the effect of exoskeleton gait trainers on mobility in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The first fair quality RCT (Ukar, Paker, & Bugdayci, 2014) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or time-matched conventional physical therapy home exercises. Mobility was measured using the Timed Up and Go test (TUG) at post-treatment (2 weeks) and follow-up (8 weeks). A significant between-group difference was found at both time points, in favour of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. conventional home exercises.

The second fair quality RCT (dos Santos et al., 2018) randomized patients with chronic stroke and ataxia to receive gait training using the Lokomat 5.0 or therapist-assisted gait training. Mobility was measured using the TUG at post-treatment (5 months). No significant between-group difference was found.

Conclusion: There is conflicting evidence (Level 4) regarding the effect of exoskeleton gait trainers on mobility in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. One fair quality RCT found that the Lokomat gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer was more effective than home exercises, whereas a second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that the Lokomat device was not more effective than therapist-assisted gait training.

Motor function - lower extremity

Not Effective

Two high quality RCTs (Westlake & Patten, 2009; Kelley et al., 2013) and one fair quality RCT (Cho et al., 2015) investigated the effect of exoskeleton gait trainers on lower extremity motor function in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The first high quality RCT (Westlake & Patten, 2009) randomized patients to receive gait training using the Lokomat device or time-matched manually-assisted body-weight supported treadmill training. Lower extremity motor function was measured using the Fugl-Meyer Assessment – Lower Extremity (FMA-LE) and the short physical performance battery at post-treatment (4 weeks). No significant between-group differences were found.

The second high quality RCT (Kelley et al., 2013) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Lower extremity motor function was measured by the FMA-LE at post-treatment (8 weeks) and follow-up (3 months). No significant between-group difference was found at either timepoint.

The fair quality (crossover) RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Cho et al., 2015) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or no additional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training; both groups received conventional physical therapy. Lower extremity motor function was measured using the FMA-LE at post-treatment (4 weeks, 8 weeks). No significant between-group difference was found.

Conclusion: There is strong evidence (Level 1a) from two high quality RCTs and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than comparison interventions (body-weight supported treadmill training, overground gait training, no additional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training) for improving lower extremity motor function in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Muscle strength - lower extremity

Not Effective

One fair quality RCT (Cho et al., 2015) investigated the effect of an exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer on lower extremity muscle strength in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. This fair quality (crossover) RCT randomized patients to receive gait training using the Lokomat device or no additional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training; both groups received conventional physical therapy. Lower extremity muscle strength was measured using the Motricity Index at post-treatment (4 weeks, 8 weeks). No significant between-group difference was found.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than no additional training for improving lower extremity strength in the chronic phase of stroke recovery.

Participation in life events

Not Effective

One high quality RCT (Westlake & Patten, 2009) investigated the effect of an exoskeleton gait trainer on participation in life events in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. This high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive gait training using the Lokomat device or time-matched manually-assisted body-weight supported treadmill training. ParticipationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. in life events was measured using the Late Life Function and Disability Instrument (LLFDI: Disability Frequency, Disability Limitation, Function) at post-treatment (4 weeks). No significant between-group differences were found.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that an exoskeleton gait trainer is not more effective than a comparison intervention (body-weight supported treadmill training) for improving participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. in life events in the chronic phase of stroke recovery.

Quality of life

Not Effective

One fair quality RCT (Hornby et al., 2008) investigated the effect of an exoskeleton gait trainer on quality of life in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. This fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. randomized patients to receive gait training using the Lokomat device or therapist-assisted locomotor treadmill training. Quality of life was measured using the Medical Outcomes Questionnaire Short Form – 36 (SF-36 – Physical component summary score) at post-treatment (12 sessions) and follow-up (6 months). A significant between-group difference was found at post-treatment in a subgroup of participants with severe gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
deficits (walking velocity ≤ 0.5m/s), in favour of therapist-assisted locomotor treadmill training vs. exoskeleton gait training. Results did not remain significant at follow-up.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that exoskeleton gait trainers are not more effective than a comparison intervention (therapist-assisted treadmill training) for improving quality of life in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.
Note: In fact, the fair quality RCT found that therapist-assisted treadmill training was more effective than the Lokomat gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer.

Spasticity

Not Effective

One fair quality RCT (Cho et al., 2015) investigated the effect of an exoskeleton gait trainer on muscle tone in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. The fair quality (crossover) RCT randomized patients to receive gait training using the Lokomat device or no additional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training; both groups received conventional physical therapy. SpasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
was measured using the Modified Ashworth Scale at post-treatment (4 weeks, 8 weeks). No significant between-group difference was found.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that an exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer is not more effective no additional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training for reducing spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Stroke impact

Not Effective

One high quality RCT (Kelley et al., 2013) investigated the effect of an exoskeleton gait trainer on stroke outcomes in the chronic phase of stroke recovery. This high quality RCT randomized patients to receive gait training using the Lokomat device or overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Stroke impact was measured by the Stroke Impact Scale (SIS – Strength, Mobility, ADL/IADL, Social participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations., Total recovery scores) at post-treatment (8 weeks) and follow-up (3 months). No significant between-group differences were found at either timepoint.

Walking endurance

Not Effective

Two high quality RCTs (Westlake & Patten, 2009; Kelley et al., 2013) and one fair quality RCT (Hornby et al., 2008) investigated the effect of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on walking endurance in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

The first high quality RCT (Westlake & Patten, 2009) randomized patients to receive gait training using the Lokomat device or time-matched manually-assisted body-weight supported treadmill training. Walking endurance was measured by the 6 Minute Walk Test (6MWT) at post-treatment (4 weeks). No significant between-group difference was found.

The second high quality RCT (Kelley et al., 2013) randomized patients to receive gait training using the Lokomat device or overground gait training. Walking endurance was measured by the 6MWT at post-treatment (8 weeks) and follow-up (3 months). No significant between-group difference was found at either timepoint.

Conclusion: There is strong evidence (Level 1a) from two high quality RCTs and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that exoskeleton gait trainers are not more effective than comparison interventions (body-weight supported treadmill training, overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training, treadmill training) for improving walking endurance in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery.

Walking speed

Not Effective

One high quality RCT (Kelley et al., 2013) and two fair quality RCTs (Hornby et al., 2008; Ukar, Paker, & Bugdayci, 2014) investigated the effect of exoskeleton gait trainers on walking speed in the chronic phase of stroke recovery.

The high quality RCT (Kelley et al., 2013) randomized patients to receive gait training using the Lokomat device or overground gait training. Walking speed was measured by the 10-meter walking test at post-treatment (8 weeks) and follow-up (3 months). No significant between-group difference was found at either timepoint.

The first fair quality RCT (Hornby et al., 2008) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device, or therapist-assisted treadmill training. Walking speed was measured by the 10-meter walking test using the GaitMat device (Self-selected velocity, Fast velocity) at post-treatment (12 sessions) and follow-up (6 months). Significant between-group differences on all measures were found at post-treatment, in favour of therapist-assisted treadmill training vs. exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Results did not remain significant at follow-up.

The second fair quality RCT (Ukar, Paker, & Bugdayci, 2014) randomized patients to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device or time-matched conventional physical therapy home exercises. Walking speed was measured using the 10-meter walking test at post-treatment (2 weeks) and follow-up (8 weeks). A significant between-group difference was found at both time points, in favour of exoskeleton gait training vs. home exercises.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. and one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. that exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than comparison interventions (overground gait training, treadmill training) for improving walking speed in the chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. recovery. In fact, the fair quality RCT found that therapist-assisted treadmill training was more effective than gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device.
Note: However, a second fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with the Lokomat device was more effective than home exercises.

Phase not specific to one period - End-effector gait trainers

Activities of daily living

Not Effective

Four high quality RCTs (Tong et al., 2006; Ng et al., 2008; Morone et al., 2011; Chua, Culpan & Menon, 2016) examined the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of daily living (ADLs) following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCT (Tong et al., 2006) randomized patients with acute/subacute stroke to receive (1) gait training using the GT1 device, (2) gait training and Functional Electrical Stimulation (GT1+FES), or (3) conventional overground gait training. ADLs were measured using the Barthel Index (BI) at post-treatment (4 weeks). No significant between-group differences were found.

The second high quality RCT (Ng et al., 2008) randomized patients with acute/subacute stroke to receive (1) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT2 device, (2) gait training + Functional Electrical Stimulation (GT2+FES), or (3) conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. ADLs were measured using the BI at post-treatment (4 weeks) and follow-up (6 months). No significant between-group differences were found at either timepoint.

The third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Morone et al., 2011) randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device or conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Patients were stratified by level of motor impairmentLoss of strength and coordination, decrease in arm or leg movement
(Motricity Index score ≤29: low motricity, > 29: high motricity). ADLs were measured using the BI at post-treatment (4 weeks) and at discharge (average 86-102 days post-stroke according to level of impairment); discharge results were reported. A significant difference was found between low motricity groups only, in favour of end-effector gait training vs. conventional gait training.

The fourth high quality RCT (Chua, Culpan & Menon, 2016) randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device or time-matched conventional physical therapy. ADLs was measured by the BI at mid-treatment (4 weeks), post-treatment (8 weeks) and follow-up (12 weeks, 24 weeks, 48 weeks). No significant between-group difference was found at any time point.

Conclusion: There is strong evidence (Level 1a) from four high quality RCTs that end-effector gait trainers are not more effective than comparison interventions (conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training, physical therapy) for improving ADLs following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Note: One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training is more effective than conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training for improving ADLs in patients with low motricity (MI score ≤29).
Note: Two high quality RCTs found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training + Functional Electrical Stimulation is not more effective than conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. There is no significant difference between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with/without FES.

Balance

Not Effective

Four high quality RCTs (Tong et al., 2006; Ng et al., 2008; Freivogel, Schmalohr & Mehrholz, 2009; Morone et al., 2011) investigated the effect of end-effector gait trainers on balance following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCT (Tong et al., 2006) randomized patients with acute/subacute stroke to receive (1) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device, (2) gait training and Functional Electrical Stimulation (GT1+FES), or (3) conventional overground gait training. Balance was measured using the Berg Balance Scale (BBS) at mid-treatment (2 weeks) and post-treatment (4 weeks). No significant between-group differences were found at either time point.

The second high quality RCT (Ng et al., 2008) randomized patients with acute/subacute stroke to receive (1) gait training using the GT2 device, (2) gait training + Functional Electrical Stimulation (GT2+FES), or (3) conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Balance was measured by the BBS at post-treatment (4 weeks) and follow-up (6 months). No significant between-group differences were found at either timepoint.

The fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Morone et al., 2011) randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device or conventional gait training. Patients were stratified by level of motor impairmentLoss of strength and coordination, decrease in arm or leg movement
(Motricity Index score ≤29: low motricity, > 29: high motricity). Balance was measured using the Trunk Control Test at post-treatment (4 weeks) and at discharge (average 86-102 days post-stroke according to level of impairment); discharge results were reported. A significant difference was found between low motricity groups only, in favour of end-effector gait training vs. conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.

Conclusion: There is strong evidence (Level 1a) from four high quality RCTs that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than comparison interventions (conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training, conventional treadmill training) following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Note: One high quality RCT found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training is more effective than conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training for improving balance in patients with low motricity (MI score ≤ 29).
Note: Two high quality RCTs found that end-effector gait training with Functional Electrical Stimulation (FES) is not more effective than conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. There is no difference between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with/without FES.

Disability

Effective

One high quality RCT (Morone et al., 2011) investigated the effect of an end-effector gait trainer on disability following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The high quality RCT randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gait training using the GT1 device or conventional gait training. Patients were stratified by level of motor impairmentLoss of strength and coordination, decrease in arm or leg movement
(Motricity Index score ≤ 29: low motricity, > 29: high motricity). Disability was measured using the Rankin Scale at post-treatment (4 weeks) and at discharge (average 86-102 days post-stroke according to level of impairment); discharge results were reported. A significant difference was found between low motricity groups only, in favour of end-effector gait training vs. conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that end-effector gait training is more effective than a comparison intervention (conventional gait training) for reducing disability among patients with low motricity following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Note: End-effector gait training is not more effective than conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training for improving disability among patients with high motricity.

Functional ambulation

Conflicting

Five high quality RCTs (Tong et al., 2006; Ng et al., 2008; Freivogel, Schmalohr & Mehrholz, 2009; Morone et al., 2011; Chua, Culpan & Menon, 2016) and one non-randomized study (Hesse et al., 2001) investigated the effect of end-effector gait trainers on functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
following stroke.

The first high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Tong et al., 2006) randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive (1) gait Training using the GT1 device, (2) gait training and Functional Electrical Stimulation (GT1+FES), or (3) conventional overground gait training. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured using the Functional AmbulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
Categories (FAC) at mid-treatment (2 weeks) and post-treatment (4 weeks). Significant between-group differences were found at both time points, in favour of end-effector gait training vs. conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.
Note: Significant between-group differences in functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
were found at both time points, in favour of GT1+FES vs. conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. There were no significant differences between end-effector gait training vs. GT1+FES.

The second high quality RCT (Ng et al., 2008) randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive (1) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT2 device, (2) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training + Functional Electrical Stimulation (GT2+FES), or (3) conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured by the FAC at post-treatment (4 weeks) and follow-up (6 months). A significant difference was found at follow-up only, in favour of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. conventional gait training.
Note: A significant difference was found at both timepoints, in favour of GT2+FES vs. conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. No significant difference was found between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. GT2+FES at either timepoint.

The third high quality cross-over RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Freivogel, Schmalohr & Mehrholz, 2009) randomized patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the LokoHelp electromechanical device or conventional treadmill/overground gait training. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured using the FAC at post-treatment (6 weeks). No significant between-group difference was found.

The fourth high quality RCT (Morone et al., 2011) randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device or conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Patients were stratified by level of motor impairmentLoss of strength and coordination, decrease in arm or leg movement
(Motricity Index score ≤ 29: low motricity, > 29: high motricity). Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured using the FAC at post-treatment (4 weeks) and at discharge (average 86-102 days post-stroke according to level of impairment); discharge results were reported. A significant difference was found between low motricity groups only, in favour of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.

The fifth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Chua, Culpan & Menon, 2016) randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gait training using the GT1 device or time-matched conventional physical therapy. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured using the FAC at mid-treatment (4 weeks), at post-treatment (8 weeks), and follow-up (12 weeks, 24 weeks, 48 weeks). No significant between-group difference was found at any time point.

The non-randomized controlled trial (Hesse et al., 2001) assigned patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. who were wheelchair-dependent to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device in addition to conventional physical therapy. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured using the FAC at post-treatment (4 weeks). No significant improvement was seen.

Conclusion: There is conflicting evidence (Level 4) regarding the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are more effective than conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training at mid-treatment and post-treatment; another high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are more effective than conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training in the long term; and a third high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are more effective than conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training in patients with low motricity but not those with high motricity. However, two high quality RCTs and one non-randomized study found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than comparison interventions (conventional treadmill/overground gait training, conventional physical therapy).
Note: Two high quality RCTs found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training + Functional Electrical Stimulation (FES) is more effective than overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. There is no difference between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with/without FES.

Functional independence

Not Effective

Two high quality RCTs (Tong et al., 2006; Ng et al., 2008) investigated the effect of end-effector gait trainers on functional independence following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCT (Tong et al., 2006) randomized patients with acute/subacute stroke to receive (1) gait training using the GT1 device, (2) gait training and Functional Electrical Stimulation (GT1+FES), or (3) conventional overground gait training. Functional independence was measured using the Functional Independence Measure (FIM) at post-treatment (4 weeks). No significant between-group differences were found.

The second high quality RCT (Ng et al., 2008) randomized patients with acute/subacute stroke to receive (1) gait training using the GT2 device, (2) gait training + Functional Electrical Stimulation (GT2+FES), or (3) conventional gait training. Functional independence was measured by the Functional Independence Measure (FIM) at post-treatment (4 weeks) and follow-up (6 months). No significant differences were found at either timepoint.

Conclusion: There is strong evidence (Level 1a) from two high quality RCTs that end-effector gait trainers are not more effective than comparison interventions (conventional overground gait training) for improving functional independence following stroke.
Note: Two high quality RCTs found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with Functional Electrical Stimulation (FES) is not more effective than conventional overground gait training. There is no difference between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with/without FES.

Gait parameters

Effective

One non-randomized study (Hesse et al., 2001) investigated the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on gait parameters following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The non-randomized controlled trial assigned patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. who were wheelchair-dependent to receive gait training using the GT1 device in addition to conventional physical therapy. Gait parameters (velocity, cadence, stride length) and limb-dependent cycle parameters (single-stance period, double-stance phase, stance duration, swing duration, swing symmetry, stance symmetry) were measured at post-treatment (4 weeks). Significant improvements were seen (velocity, cadence, stride length, single-stance period, terminal double-stance phase, swing symmetry).

Conclusion: There is limited evidence (Level 2b) from one non-randomized study that end-effector gait trainers are effective for improving gait parameters following stroke.

Mobility

Conflicting

Four high quality RCTs (Tong et al., 2006; Ng et al., 2008; Freivogel, Schmalohr & Mehrholz, 2009; Morone et al., 2011) and one non-randomized study (Hesse et al., 2001) investigated the effect of end-effector gait trainers on mobility following stroke.

The first high quality RCT (Tong et al., 2006) randomized patients with acute/subacute stroke to receive (1) gait training using the GT1 device, (2) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training and Functional Electrical Stimulation (GT1+FES), or (3) conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Mobility was measured using the Elderly Mobility Scale at mid-treatment (2 weeks) and post-treatment (4 weeks). A significant between-group difference was found at post-treatment, in favour of end-effector gait training vs. conventional overground gait training.
Note: A significant between-group differences was found at post-treatment in favour of GT1+FES vs. conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. No significant difference between end-effector gait training vs. GT1+FES was found at either timepoint.

The third high quality cross-over RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Freivogel, Schmalohr & Mehrholz, 2009) randomized patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gait training using the LokoHelp electromechanical device or conventional treadmill/overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Mobility was measured using the Rivermead Mobility Index (RMI) at post-treatment (6 weeks). No significant between-group difference was found.

The fourth high quality RCT (Morone et al., 2011) randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device or conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Patients were stratified by level of motor impairmentLoss of strength and coordination, decrease in arm or leg movement
(Motricity Index score ≤29: low motricity, > 29: high motricity). Mobility was measured using the RMI at post-treatment (4 weeks) and at discharge (average 86-102 days post-stroke according to level of impairment); discharge results were reported. A significant difference was found between low motricity groups only, in favour of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.

The The non-randomized controlled trial (Hesse et al., 2001) assigned patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. who were wheelchair-dependent to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device in addition to conventional physical therapy. Functional mobility was measured using the Rivermead Motor Assessment (Gross function, Legs and trunk scores) at post-treatment (4 weeks). No significant improvement was seen.

Conclusion: There is conflicting evidence (Level 4) regarding the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on mobility following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Two high quality RCTs found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are more effective than conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training, whereas another high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than conventional treadmill/overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training; these studies used different devices and outcome measures. A fourth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that an end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer was more effective than conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training among patients with low motricity but not those with high motricity.
Note: Two high quality RCTs found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with Functional Electrical Stimulation (FES) is more effective than conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. There is no difference between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with/without FES.

Muscle strength - lower extremity

Not Effective

Four high quality RCTs (Tong et al., 2006; Ng et al., 2008; Freivogel, Schmalohr & Mehrholz, 2009; Morone et al., 2011) investigated the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on lower extremity muscle strength following stroke.

Four high quality RCTs (Tong et al., 2006; Ng et al., 2008; Freivogel, Schmalohr & Mehrholz, 2009; Morone et al., 2011) investigated the effect of end-effector gait trainers on lower extremity muscle strength following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

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Note: A significant between-group difference was found at post-treatment in favour of GT1+FES vs. conventional overground gait training. There was no significant difference between end-effector gait training vs. GT1+FES.

The third high quality cross-over RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Freivogel, Schmalohr & Mehrholz, 2009) randomized patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the LokoHelp electromechanical device or conventional treadmill/overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Muscle strength was measured using the MI (Leg score) at post-treatment (6 weeks). No significant between-group difference was found.

The fourth high quality RCT (Morone et al., 2011) randomized patients with acute/subacute stroke to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device or conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Patients were stratified by level of motor impairmentLoss of strength and coordination, decrease in arm or leg movement
(MI score ≤29: low motricity, > 29: high motricity). Muscle strength was measured using the Motricity Index at post-treatment (4 weeks) and at discharge (average 86-102 days post-stroke according to level of impairment); discharge results were reported. No significant between-group differences were found at either timepoint.

Conclusion: There is strong evidence (Level 1a) from three high quality RCTs that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than comparison interventions (conventional overground/treadmill gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training) for improving lower extremity muscle strength following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Note: However, one high quality RCT found that end-effector gait training is more effective than conventional overground gait training.
Note: One high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with Functional Electrical Stimulation (FES) is more effective than conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Two high quality RCTs found no significant difference between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with/without FES.

Neurological status

Not Effective

One high quality RCT (Morone et al., 2011) investigated the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training on neurological status following stroke. The high quality RCT randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gait training using the GT1 device or conventional gait training. Patients were stratified by level of motor impairmentLoss of strength and coordination, decrease in arm or leg movement
(Motricity Index score ≤29: low motricity, > 29: high motricity). Neurological status was measured using the Canadian Neurological Scale at post-treatment (4 weeks) and at discharge (average 86-102 days post-stroke according to level of impairment); discharge results were reported. No significant between-group differences were found at either time point.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that end-effector gait trainers are not more effective than a comparison intervention (conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training) for improving neurological status following stroke.

Spasticity

Not Effective

Two high quality RCTs (Freivogel, Schmalohr & Mehrholz, 2009; Morone et al., 2011) and one non-randomized study (Hesse et al., 2001) investigated the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training on spasticity following stroke.

The first high quality cross-over RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Freivogel, Schmalohr & Mehrholz, 2009) randomized patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the LokoHelp electromechanical device or conventional treadmill/overground gait training. SpasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
was measured using the Modified Ashworth Scale at post-treatment (6 weeks). No significant between-group difference was found.

The second high quality RCT (Morone et al., 2011) randomized patients with acute/subacute stroke to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device or conventional gait training. Patients were stratified by level of motor impairmentLoss of strength and coordination, decrease in arm or leg movement
(Motricity Index score ≤ 29: low motricity, > 29: high motricity). SpasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
was measured using the Ashworth Scale at post-treatment (4 weeks) and at discharge (average 86-102 days post-stroke according to level of impairment); discharge results were reported. No significant between-group differences were found at either time point.

The non-randomized controlled trial (Hesse et al., 2001) assigned patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. who were wheelchair-dependent to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device in addition to conventional physical therapy. SpasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
was measured using the Modified Ashworth Scale at post-treatment (4 weeks). No significant improvement was seen.

Conclusion: There is strong evidence (Level 1a) from two high quality RCTs that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than comparison interventions (conventional overground/treadmill gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training,conventional gait training) for reducing spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. A non-randomized study also reported no significant improvement in spasticity following end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.

Stroke impact

Not Effective

One high quality RCT (Chua, Culpan & Menon, 2016) investigated the effect of end-effector gait training on stroke. The high quality RCT randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gait training using the GT1 device or time-matched conventional physical therapy. StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. impact was measured by the StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Impact Scale (SIS – Physical, Memory and thinking, Mood and emotion, Communication, ParticipationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations., Recovery domains) at mid-treatment (4 weeks), post-treatment (8 weeks) and follow-up (12 weeks, 24 weeks, 48 weeks). No significant between-group difference was found at any time point.

Walking endurance

Not Effective

Two high quality RCTs (Morone et al., 2011; Chua, Culpan & Menon, 2016) investigated the effect of end-effector gait training on walking endurance following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The first high quality RCT (Morone et al., 2011) randomized patients with acute/subacute stroke to receive gait training using the GT1 device or conventional gait training. Patients were stratified by level of motor impairmentLoss of strength and coordination, decrease in arm or leg movement
(Motricity Index score ≤29: low motricity, > 29: high motricity). Walking endurance was measured using the 6 Minute Walk Test (6MWT) at post-treatment (4 weeks) and at discharge (average 86-102 days post-stroke according to level of impairment); discharge results were reported. A significant difference was found between low motricity groups only, in favour of end-effector gait training vs. conventional gait training.

The second high quality RCT (Chua, Culpan & Menon, 2016) randomized patients with acute/subacute stroke to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device or time-matched conventional physical therapy. Walking endurance was measured by the 6MWT at mid-treatment (4 weeks), post-treatment (8 weeks) and follow-up (12 weeks, 24 weeks, 48 weeks). No significant between-group difference was found at any time point.

Conclusion: There is strong evidence (Level 1a) from two high quality RCTs that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than comparison interventions (conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training, conventional physical therapy) in improving walking endurance following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Note: However, one of these studies found that end-effector gait trainers are more effective than conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training among patients with low motricity (but not those with high motricity).

Walking speed

Conflicting

Five high quality RCTs (Tong et al., 2006; Ng et al., 2008; Freivogel, Schmalohr & Mehrholz, 2009; Morone et al., 2011; Chua, Culpan & Menon, 2016) investigated the effect of end-effector gait training on walking speed following stroke.

The first high quality RCT (Tong et al., 2006) randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive (1) gait training using the GT1 device, (2) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training and Functional Electrical Stimulation (GT1+FES), or (3) conventional overground gait training. Walking speed was measured using the 5-meter walking test at mid-treatment (2 weeks) and post-treatment (4 weeks). A significant between-group difference was found at post-treatment, in favour of end-effector gait training vs. conventional overground gait training.
Note: Significant between-group differences in walking speed were found at both timepoints, in favour of GT1+FES vs. conventional overground gait training. There were no significant differences between end-effector gait training vs. GT1+FES.

The second high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Ng et al., 2008) randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive (1) gait training using the GT2 device, (2) gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training + Functional Electrical Stimulation (GT2+FES), or (3) conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. Walking speed was measured using the 5 meter walking test at post-treatment (4 weeks) and follow-up (6 months). A significant between-group difference was found at both timepoints, in favour of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training.
Note: A significant between-group difference was found at both timepoints, in favour of GT2+FES vs. conventional gait training. No significant difference was found between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. GT2+FES at either timepoint.

The third high quality cross-over RCT (Freivogel, Schmalohr & Mehrholz, 2009) randomized patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the LokoHelp electromechanical device or conventional treadmill/overground gait training. Walking speed was measured using the 10-meter walking test at post-treatment (6 weeks). No significant between-group difference was found.

The fifth high quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Chua, Culpan & Menon, 2016) randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the GT1 device or time-matched conventional physical therapy. Walking speed was measured by the 10-meter walking test at mid-treatment (4 weeks), post-treatment (8 weeks) and follow-up (12 weeks, 24 weeks, 48 weeks). No significant between-group difference was found at any time point.

Conclusion: There is conflicting evidence (Level 4) regarding the effect of end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on walking speed following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Two high quality RCTs found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are more effective than a comparison intervention (conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training), whereas three high quality RCTs found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are not more effective than comparison interventions (conventional treadmill/overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training, conventional physical therapy).
Note: Two high quality RCTs found that end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training + FES is more effective than conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training. There is no difference between end-effector gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training with/without FES.

Phase not specific to one period - Exoskeleton gait trainers

Activities of daily living

Not Effective

One fair quality RCT (Kim et al., 2015) investigated the effect of an exoskeleton gait trainer on ADLs following stroke. The fair quality RCT randomized patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gait training using the WALKBOT device or time-matched conventional locomotor training; both groups received additional conventional locomotor training. ADLs were measured using the Korean modified Barthel Index (Grooming, Bathing, Feeding, Toilet use, Stairs, Dressing, Bowels, Bladder, Ambulation, Transfers, Total scores) at post-treatment (4 weeks) and follow-up (8 weeks). Significant between-group differences were found on only three ADL scores at both timepoints (Dressing, Ambulation, Total score), in favour of exoskeleton gait training vs. conventional locomotor training.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that an exoskeleton gait trainer is not more effective than a comparison intervention (conventional locomotor training) for improving ActivitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of daily living following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Balance

Effective

One fair quality RCT (Kim et al., 2015) and one non-randomized study (Dundar et al., 2014) investigated the effect of exoskeleton gait trainers on balance following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The fair quality RCT (Kim et al., 2015) randomized patients with subacute/chronic stroke to receive gait training using the WALKBOT device or time-matched conventional locomotor training; both groups received additional conventional locomotor training. Balance was measured using the Berg Balance Scale (BBS) at post-treatment (4 weeks) and follow-up (8 weeks). A significant between-group difference was found at both timepoints, in favour of exoskeleton gait training vs. conventional locomotor training.

Cognition

Effective

One non-randomized study (Dundar et al., 2014) investigated the effect of exoskeleton gait trainers on cognition following stroke. The non-randomized retrospective study compared patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. who had received gait training using the Lokomat device with those who had received physical therapy. Cognition was measured using the Mini Mental Status Examination at post-treatment (minimum 30 sessions). A significant between-group difference was found, in favour of exoskeleton gait training vs. physical therapy.

Conclusion: There is limited evidence (Level 2b) from one non-randomized study that an exoskeleton gait trainer is more effective than a comparison intervention (physical therapy) for improving cognition following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Functional ambulation

Effective

One high quality RCT (Schwartz et al., 2009), one fair quality RCTA randomized controlled trial (RCT) is an experimental design in which subjects are randomly assigned to a treatment group, or to a control (no treatment or alternative treatment) group. Effects of the experimental treatment are then compared statistically to results of the control treatment to determine effectiveness. (Kim et al., 2015) and one non-randomized study (Dundar et al., 2014) investigated the effect of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers on functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The high quality RCT (Schwartz et al., 2009) randomized patients with acute/subacute stroke to receive gait training using the Lokomat device or time-matched conventional physical therapy for gait retraining; both groups received additional physical therapy. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured by the Functional AmbulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
Category (FAC) at post-treatment (6 weeks). A significant between-group difference was found, in favour of Lokomat training vs. conventional physical therapy.

The fair quality RCT (Kim et al., 2015) randomized patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gait training using the WALKBOT device or time-matched conventional locomotor training; both groups received additional conventional locomotor training. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured using the FAC at post-treatment (4 weeks) and follow-up (8 weeks). A significant between-group difference was found at both timepoints, in favour of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. conventional locomotor training.

The non-randomized retrospective study (Dundar et al., 2014) compared patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. who had received gait training using the Lokomat device with those who had received physical therapy. Functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
was measured using the FAC at post-treatment (minimum 30 sessions). No significant between-group difference was found.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT and one fair quality RCT that exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are more effective than comparison interventions (physical therapy, conventional locomotor training) for improving functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Functional independence

Effective

One high quality RCT (Schwartz et al., 2009) and one non-randomized study (Dundar et al., 2014) investigated the effect of exoskeleton gait trainers on functional independence following stroke.

The non-randomized retrospective study (Dundar et al., 2014) compared patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. who had received gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using the Lokomat device with those who had received physical therapy. Functional independence was measured using the FIM at post-treatment (minimum 30 sessions). A significant between-group difference was found, in favour of exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training vs. physical therapy.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT and one non-randomized study that exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are more effective than comparison interventions (physical therapy) for improving functional independence following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Health related quality of life

Not Effective

One fair quality RCT (Kim et al., 2015) and one non-randomized study (Dundar et al., 2014) investigated the effect of exoskeleton gait trainers on Health related quality of life (HRQoL) following stroke.

The fair quality RCT (Kim et al., 2015) randomized patients with subacute/chronic stroke to receive gait training using the WALKBOT device, or time-matched conventional locomotor training; both groups received additional conventional locomotor training. HRQoL was measured using the EuroQoL 5-dimension (EQ-5D) at post-treatment (4 weeks) and follow-up (8 weeks). No significant between-group difference was found at either timepoint.

The non-randomized retrospective study (Dundar et al., 2014) compared patients with subacute/chronic stroke who had received gait training using the Lokomat device with those who had received physical therapy. HRQoL was measured using the Medical Outcomes Study Short Form 36 (SF-36 – Physical functioning, Physical role limitations, Pain, General health, Social functioning, General mental health, Emotional role limitations, Vitality, Physical component, Mental component) at post-treatment (minimum 30 sessions). Significant between-group differences were found on all SF-36 scores, in favour of exoskeleton gait training vs. physical therapy.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT that exoskeleton gait trainers are not more effective than a comparison intervention (conventional locomotor training) for improving quality of life following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Note: However, a non-randomized study found that the Lokomat device was more effective than physical therapy.

Mobility

Not Effective

One high quality RCT (Schwartz et al., 2009) investigated the effect of an exoskeleton gait trainer on mobility following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The high quality RCT randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gait training using the Lokomat device or time-matched conventional physical therapy for gait retraining; both groups received additional physical therapy. Mobility was measured by the Timed Up and Go test and the Stroke Activity Scale (Walking, Standing scores) at post-treatment (6 weeks). No significant between-group differences were found on either measure.

Motor recovery

Effective

One non-randomized study (Dundar et al., 2014) investigated the effect of an exoskeleton gait trainer on motor recovery following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The non-randomized retrospective study compared patients with subacute/chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. who had received gait training using the Lokomat device with those who had received physical therapy. Motor recovery was measured using the Brunnstrom Recovery Scale (Lower extremity categories) at post-treatment (minimum 30 sessions). Significant between-group differences were found on all lower extremity categories, in favour of exoskeleton gait training vs. physical therapy.

Conclusion: There is limited evidence (Level 2b) from one non-randomized study that exoskeleton gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainers are more effective than a comparison intervention (physical therapy) for improving motor recovery following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Spasticity

Not Effective

One fair quality RCT (Kim et al., 2015) and one non-randomized study (Dundar et al., 2014) investigated the effect of exoskeleton gait trainers on spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

The fair quality RCT (Kim et al., 2015) randomized patients with subacute/chronic stroke to receive gait training using the WALKBOT device or time-matched conventional locomotor training; both groups received additional conventional locomotor training. SpasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
was measured using the Modified Ashworth Scale at post-treatment (4 weeks) and follow-up (8 weeks). No significant between-group difference was found at either timepoint.

The non-randomized retrospective study (Dundar et al., 2014) compared patients with subacute/chronic stroke who had received gait training using the Lokomat device with those who had received physical therapy. SpasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
was measured using the Modified Ashworth Scale at post-treatment (minimum 30 sessions). No significant between-group difference was found.

Conclusion: There is limited evidence (Level 2a) from one fair quality RCT and one non-randomized study that exoskeleton gait trainers are not more effective than comparison interventions (conventional locomotor training, physical therapy) for reducing spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Stair climbing

Effective

One high quality RCT (Schwartz et al., 2009) investigated the effect of an exoskeleton gait trainer on stair climbing following stroke. The high quality RCT randomized patients with acute/subacute stroke to receive gait training using the Lokomat device or time-matched conventional physical therapy for gait retraining; both groups received additional physical therapy. Stair climbing was measured according to number of stairs climbed at post-treatment (6 weeks). A significant between-group difference was found in a subgroup of patients with high functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
(Functional AmbulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
Category score ≥ 3), in favour of Lokomat training vs. conventional physical therapy.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that an exoskeleton gait trainer is more effective than a comparison intervention (physical therapy) for improving stair climbing following stroke, among patients with high functional ambulationThe ability to walk, with or without the aid of appropriate assistive devices (such as canes or walkers), safely and sufficiently to carry out mobility-related activities of daily living (ADLs). From Perry et al (1995), functional ambulation is referred to as walking in parallell bars for exercise at a speed of about 10/cm per second.
.

Stroke severity

Effective

One high quality RCT (Schwartz et al., 2009) investigated the effect of exoskeleton gait trainers on stroke severity following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The high quality RCT randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gait training using the Lokomat device, or time-matched conventional physical therapy for gait retraining; both groups received additional physical therapy. Stroke severity was measured by the National Institute of Health Stroke Scale at post-treatment (6 weeks). A significant between-group difference was found, in favour of exoskeleton gait training vs. conventional physical therapy.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that an exoskeleton gait trainer is more effective than a comparison intervention (physical therapy) for reducing stroke severity following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Walking endurance

Not Effective

One high quality RCT (Schwartz et al., 2009) investigated the effect of exoskeleton gait trainers on walking endurance following strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The high quality RCT randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gait training using the Lokomat device or time-matched conventional physical therapy for gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
retraining; both groups received additional physical therapy. Walking endurance was measured by the 2 Minute Walk Test at post-treatment (6 weeks). No significant between-group difference was found.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that an exoskeleton gait trainer is not more effective than a comparison intervention (physical therapy) for improving walking endurance following stroke.

Walking speed

Not Effective

One high quality RCT (Schwartz et al., 2009) investigated the effect of exoskeleton gait trainers on walking speed following stroke. The high quality RCT randomized patients with acute/subacute strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. to receive gait training using the Lokomat device or time-matched conventional physical therapy for gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
retraining; both groups received additional physical therapy. Walking speed was measured by the 10-meter walking test at post-treatment (6 weeks). No significant between-group difference was found.

Conclusion: There is moderate evidence (Level 1b) from one high quality RCT that exoskeleton gait trainers are not more effective than a comparison intervention (physical therapy) for improving walking speed following stroke.

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Kelley, C.P., Childress, J., Boake, C., & Noser, E.A. (2013). Over-ground and robotic-assisted locomotor training in adults with chronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.: a blinded randomized clinical trial. Disability and Rehabilitation: Assistive Technology, 8(2), 161-8.
DOI: 10.3109/17483107.2012.714053

Kim, H.Y. & You, J.S.H. (2017). A review of robot-assisted gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training in strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients. Brain & Neurorehabilitation, 10(2), e9.
DOI: 10.12786/bn.2017.10.e9

Kim, S.-Y., Yang, L., Park, I.J., Kim, E.J., JoshuaPark, M.S., You, S.H., Kim, Y.-H., Ko, H.-Y., & Shin, Y.-I. (2015). Effects of innovative WALKBOT robotic-assisted locomotor training on balance and gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
recovery in hemiparetic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.: a prospective, randomized, experimenter blinded case control study with a four-week follow-up. IEEE Transactions on Neural Systems and Rehabilitation Engineering, 23(4), 636-42.
DOI: 10.1109/TNSRE.2015.2404936

Lewek, M.D., Cruz, T.H., Moore, J.L., Roth, H.R., Dhaher, Y.Y., & Hornby, G. (2009). Allowing intralimb kinematic variability during locomotor training poststroke improves kinematic consistency: a subgroup analysis from a randomized clinical trial. Physical Therapy, 89(8), 829-39.
DOI: 10.2522/ptj.20080180

Morone, G., Bragoni, M., Iosa, M., De Angelis, D., Venturiero, V., Coiro, P., Pratesi, L., & Paolucci, S. (2011). Who may benefit from robotic-assisted gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training? A randomized clinical trial in patients with subacute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Neurorehabilitation and Neural Repair, 25(7), 636-644.
DOI: 10.1177/1545968311401034

Morone, G., Paolucci, S., Cherubini, A., DeAngelis, D., Venturiero, V., Coiro, P., & Iosa, M. (2017). Robot-assisted gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training for strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients: current state of the art and perspectives of robotics. Neuropsychiatric Disease and Treatment, 13, 1303-11.
DOI: 10.2147/NDT.S114102.

Ng, M.F.W., Tong, R.K.Y., & Li, L.S.W. (2008). A pilot study of randomized clinical controlled trial of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training in subacute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients with partial body-weight support electromechanical gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer and functional electrical stimulation: six-month follow-up. StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. 39(1), 154-60.
https://www.ncbi.nlm.nih.gov/pubmed/18006861

Park, B.-S., Kim, M.-Y., Lee, L.-K., Yang, S.-M., Lee, W.-D., Noh, J.-W., Shin, Y.-S., Kim, J.-H., Lee, J.-U., Kwak, T.-Y., Lee, T.-H., Kim, J.-Y., & Kim, J. (2015). Effects of conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training and a gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer with partial body weight support on spatiotemporal gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters of patients after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. The Journal of Physical Therapy Science, 27, 1603-7.
DOI: 10.1589/jpts.27.1603

Peurala, S., Airaksinen, O, Huuskonen, P. et al. (2009). Effects of Intensive Therapy Using GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainer or Floor Walking Exercises Early After StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Journal of Rehabilitative Medicine, 41, 166-73.
http://www.ncbi.nlm.nih.gov/pubmed/19229450

Peurala, S.H., Tarkka, I.M., Pitkänen, K. (2005). The effectiveness of body weight–supported gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training and ï¬‚oor walking in patients with chronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Archives of Physical Medicine and Rehabilitation, 86, 1557-64.
http://www.ncbi.nlm.nih.gov/pubmed/16084808

Pohl, M., Werner, C., Holzgraefe, M., et al. (2007). Repetitive locomotor training and physiotherapy improve walking and basic activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
of daily living after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.: a single-blind, randomized multicentre trial. Clinical Rehabilitation, 21, 17-27.
http://www.ncbi.nlm.nih.gov/pubmed/17213237

Polese, J.C., Ada, L., Dean, C.M., Nascimento, L.R., Teixeira-Salmela, L. (2013). Treadmill training is effective for ambulatory adults with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.: a systematic reviewA systematic review is a summary of available research on a given topic that compares studies based on design and methods. It summarizes the findings of each, and points out flaws or potentially confounding variables that may have been overlooked. A critical analysis of each study is done in an effort to rate the value of its stated conclusions. The research findings are then summarized, and a conclusion is provided.
. Journal of Physiotherapy, 59, 73-80.
DOI:10.1016/S1836-9553(13)70159-0

Regneaux, J.-P., Saremi, K., Marehbian, J., Bussel, B., & Dobkin, B.H. (2008). An accelerometry-based comparison of 2 robotic assistive devicesAssistive devices are any piece of equipment that you use to make your daily activities easier to perform.
for treadmill training of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
. Neurorehabilitation and Neural Repair, 22, 348-54.
DOI: 10.1177/1545968307310050

Schwartz, I., Sajin, A., Fisher, I., Neeb, M., Shochina, M., Katz-Leurer, M., & Meiner, Z. (2009). The effectiveness of locomotor therapy using robotic-assisted gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training in subacute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients: a randomized controlled trial. Physical Medicine & Rehabilitation, 1(6), 516-23.
DOI: 10.1016/j.pmrj.2009.03.009

Taveggia, G., Borboni, A., Mule, C., Villafane, J.H., & Negrini, S. (2016). Conficting results of robot-assisted versus usual gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training during postacute rehabilitation of strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients: a randomized clinical trial. International Journal of Rehabilitation Research, 39, 29-35.
DOI: 10.1097/MRR.0000000000000137

Tong, R.K., Ng, M.F., & Li, L.S. (2006). Effectiveness of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using an electromechanical gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer, with and without Functional Electric Stimulation, in subacute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 87, 1298-1304.
DOI:10.1016/j.apmr.2006.06.016

Ukar, D.E., Paker, N., & Bugdayci, D. (2014). Lokomat: a therapeutic chance for patients with chronic hemiplegiaComplete paralysis of the arm, leg, and trunk on one side of the body that results from damage to the parts of the brain that control muscle movements. Hemiplegia is not a progressive condition, nor is it a disease.. NeuroRehabilitation, 34, 447-53.
DOI: 10.3233/NRE-141054

van Nunen, M.P.M., Gerrits, K.H.L., Konijnenbelt, M., Janssen, T.W.J., & de Haan, A. (2015). Recovery of walking ability using a robotic device in subacute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients: a randomized controlled study. Disability and Rehabilitation: Assistive Technology, 10(2), 141-8.
DOI: 10.3109/17483107.2013.873489

Werner, C., Von Frankenberg, S., Treig, T., Konrad, M., & Hesse, S. (2002). Treadmill training with partial body weight support and an electromechanical gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
trainer for restoration of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
in subacute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients: a randomized crossover study. StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., 33(12), 2895-2901.
http://www.ncbi.nlm.nih.gov/pubmed/12468788

Westlake, K.P. & Patten, C. (2009). Pilot study of Lokomat versus manual-assisted treadmill training for locomotor recovery post-stroke. Journal of NeuroEngineering and Rehabilitation, 6(18), 1-11.
DOI: 10.1186/1743-0003-6-18

Excluded Studies

Bae, Y.-H., Kim, Y.-H., & Fong, S.S.M. (2016). Comparison of heart rate reserve-guided and ratings of perceived exertion-guided methods for high-intensity robot-assisted gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training in patients with chronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Topics in Geriatric Rehabilitation, 32(2), 119-26.

Reason for exclusion: Both groups received gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using an exoskeleton device (Lokomat).

Bonnyaud, C., Zory, R., Boudarham, J., Pradon, D., Bensmail, D., & Roche, N. (2014). Effect of a robotic restraint gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training versus robotic conventional gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training on gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
parameters in strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients. Experimental Brain Research, 232, 31-42.

Reason for exclusion: Single session; all groups received gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training using an exoskeleton device (Lokomat).

Calabro, R.S., Reitano, S., Leo, A., De Luca, R., Melegari, C., & Bramanti, P. (2014). Can robot-assisted movement training (Lokomat) improve functional recovery and psychological well-being in chronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.? Promising findings from a case study. Functional Neurology, 29(2), 139-141.

Reason for exclusion: Case study.

Calabro, R.S., De Cola, M.C., Leo, A., Reitano, S., Balletta, T., Trombetta, G., Naro, A., Russo, M., Berte, F., De Luca, R., & Bramanti, P. (2015). Robotic neurorehabilitation in patietns with cnronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.: psychological well-being beyond motor improvement. International Journal of Rehabilitation Research, 38, 219-225.

Reason for exclusion: Non-randomized study, between-group differences not reported.

Conesa, L., Costa, U., Morales, E., Edwards, D.J., Cortes, M., Leon, D., Bernabeu, M., & Medina, J. (2012). An observational report of intensive robotic and manual gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training in sub-acute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. Journal of NeuroEngineering and Rehabilitation, 9(1), 13. DOI: 10.1186/1743-0003-9-13.

Reason for exclusion: All participants received GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Training using the Reha-Stim GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainer followed by conventional overground gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training; between-group comparisons were not conducted.

Delussu, A.S., Morone, G., Iosa, M., Bargoni, M., Traballesi, M., & Paolucci, S. (2014). Physiological responses and energy cost of walking on the GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainer with and without body weight support in subacute strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients. Journal of Neuroengineering and Rehabilitation, 11, 54-63.

Reason for exclusion: The intervention group was compared with healthy subjects.

Krewer, C., Muller, F., Husemann, B., Heller, S., Quintern, J., & Koenig, E. (2007). The influence of different Lokomat walking conditions on the energy expenditure of hemiparetic patients and healthy subjects. GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
& Posture, 26, 372-7.

Reason for exclusion: Comparison of patients with healthy subjects using Lokomat under different walking conditions over a single session.

Krewer, C., Rie, K., Bergmann, J., Muller, F., Jahn, K., & Koenig, E. (2013). Immediate effectiveness of single-session therapeutic interventions in pusher behaviour. GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
& Posture, 37(2), 246-50.

Reason for exclusion: Single session; study was specifically examining pusher behaviour.

Mayr, A., Kofler, M., Quirbach, E., Matzak, H., Frohlich, K., & Saltuari, L. (2007). Prospective, blinded, randomized crossover study of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
rehabilitation in strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients using the Lokomat gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
orthosis. Neurorehabilitation and Neural Repair, 21(4), 307-14.

Reason for exclusion: Between-group differences not reported.

Ochi, M., Wada, F., Saeki, S., & Hachisuka, K. (2015). GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training in subacute non-ambulatory strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. patients using a full weight-bearing gait-assistance robot: a prospective, randomized, open, blinded-endpoint trial. Journal of the Neurological Sciences, 353, 130-6.

Reason for exclusion: The device used was a robot arm control system.

Picelli, A., Bacciga, M., Melotti, C., La Marchina, E., Verzini, E., Ferrari, F., Pontillo, A., Corradi, J., Tamburin, S., Saltuari, L., Corradini, C., Waldner, A., & Smania, N. (2016). Combined effects of robot-assisted gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
training and botulinum toxin type A on spastic equinus foot in patients with chronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.: a pilot, single blind, randomized controlled trial. European Journal of Physical and Rehabilitation Medicine, 52(6), 759-66.

Reason for exclusion: Study incorporated use of botulinum toxin type A.

Regnaux, J.P., Saremi, K., Marehbian, J., Bussel, B., & Dobkin, B.H. (2008). An accelerometry-based comparison of 2 robotic assistive devicesAssistive devices are any piece of equipment that you use to make your daily activities easier to perform.
for treadmill training of gaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
. Neurorehabilitation and Neural Repair, 22(4), 348-54.

Reason for exclusion: Single case study; comparison of GaitThe pattern of walking, which is often characterized by elements of progression, efficiency, stability and safety.
Trainer and Lokomat over single session.

Stoller, O., de Bruin, E.D., Schindelholz, M., Schuster-Amft, C., de Bie, R.A., & Hunt, K.J. (2015). Efficacy of feedback-controlled robotics-assisted treadmill exercise to improve cardiovascular fitness early after strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.: a randomized controlled pilot trial. Journal of Neurologic Physical Therapy, 39, 156-65.