A central-peripheral approach to gait rehabilitation in chronic acquired brain injury: robotic training and motor imagery.
Alessandro Arnaudo, Eugenio Scaliti, Francesco Damosso and 5 others
Seven chronic brain-injury patients completed a 4-week robot-assisted walking program with mental rehearsal of steps.
Balance and walking distance improved, and gait timing got faster. But with no control group, we cannot say which part caused the change.
Key findings
1All seven participants completed the full 12-session protocol with no adverse events, confirming the combined robot-plus-imagery protocol is feasible to deliver.
2Balance (Berg Balance Scale) and walking distance (6-Minute Walk Test) both improved from baseline to post-intervention.
3Multiple gait-cycle parameters (stride time, swing velocity, cadence, stride length, stance-swing phase) improved and were largely maintained at 3-month follow-up, under both single-task and dual-task walking.
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What it does not show
No control group: gains cannot be attributed to the robot, the imagery, or their combination; practice and learning effects across 12 sessions cannot be separated from treatment effects. Only seven participants, all from one centre, with heterogeneous aetiologies and varying walking aids, so results may not generalise. Outcome assessors were not blinded to session timing for clinical scales, introducing potential bias; kinematic data were extracted algorithmically, which mitigates this for gait variables. No formal fidelity monitoring of the imagery sessions beyond a standardised prompt script and two trained staff members. Clinical follow-up (BBS, 6MWT) was not collected at 3 months, so long-term clinical durability is unknown; only kinematic data extend to that time point. The dual-task cognitive component was an attentional load manipulation, not a cognitive performance measure; accuracy was not formally quantified.
Declared interests
Funded by the Italian Ministry of University and Research (MUR, PRIN 2020 grant 20207S3NB8) and by Associazione InTo Brain. The REHO exoskeleton was manufactured by Nimble Robotics, which is named in the methods but no financial relationship between Nimble Robotics and the authors is declared in the text provided.
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