Effects of high-intensity gait training with and without soft robotic exosuits in people post-stroke: a development-of-concept pilot crossover trial.
Franchino Porciuncula, Dheepak Arumukhom Revi, Teresa C Baker and 4 others
PMID 37936135WHAT IT FOUND
In four people with chronic stroke, high-intensity walking training with a soft exosuit improved walking speed and distance more than the same training without the device.
The study is a small pilot, so treat this as early feasibility, not proof.
Key findings
01Exosuit-augmented high-intensity gait training increased mean maximum walking speed by 0.08 ± 0.03 m/s, a significant and clinically meaningful change; the same training without the exosuit increased mean maximum walking speed by 0.01 ± 0.06 m/s, a non-significant change.
02Exosuit-augmented high-intensity gait training increased mean 6-minute walk distance by 68 ± 27 m, a large clinically meaningful change; the same training without the exosuit increased mean 6-minute walk distance by 30 ± 16 m, a small clinically meaningful change.
03After exosuit-augmented high-intensity gait training, three of four participants showed significant improvements in peak paretic propulsion; after the same training without the exosuit, one participant improved, one worsened, and two had non-significant changes.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study included only four participants, so it is a development-of-concept pilot and cannot establish that the exosuit works in broader stroke populations. Between-arm comparisons for the primary outcomes were descriptive, and the authors did not perform formal between-group statistical tests because of the small sample. Participants were chronic stroke survivors who could walk independently for 6 minutes and had comfortable walking speeds no faster than 1.0 m/s, so results may not apply to people who cannot walk independently or who have much slower walking. The propulsion outcomes were measured at speed-matched treadmill speeds, which may have masked larger training-related propulsion changes; overground data were available for only two participants. The crossover design cannot completely rule out carryover, although washout and order counterbalancing were used and baseline outcomes were similar. Exosuit force settings were fixed after initial tuning, and two participants could not test all four profiles because of technical issues.
Declared interests
Funding is listed as American Heart Association, National Institutes of Health, and National Science Foundation. The supplied text does not report author conflicts of interest.
The easy way to misread this
Do not conclude that the soft exosuit alone caused the walking improvements. Both arms received the same high-intensity gait training delivered by a physical therapist, one with a soft exosuit and one without, and the between-arm comparison was descriptive in a four-participant pilot.