Randomized controlled trial of robot-assisted gait training with dorsiflexion assistance on chronic stroke patients wearing ankle-foot-orthosis.
Ling-Fung Yeung, Corinna Ockenfeld, Man-Kit Pang and 4 others
PMID 29914523WHAT IT FOUND
In 19 chronic stroke patients with foot drop, powered ankle assistance during over-ground walking and stair training improved walking independence more than passive AFO training after 20 sessions.
The advantage over passive AFO was not confirmed at 3 months.
Key findings
01The powered group improved walking independence by 0.5 points more than the passive group after training on the 6-level scale.
02More than half of the powered group improved walking independence, and all reached a score of 5 or higher, while only one of ten in the passive group improved.
03The powered group had greater gains in lower-limb motor score and walking speed after training than the passive group, but these between-group gains were not statistically significant at 3 months.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This was a pilot trial with 19 randomized participants. Its sample size was based on a previous single-arm study of 8 people. It is too small to prove the effect. Four participants stopped after at least three sessions, and three were missing the 3-month follow-up. The later results are less secure. All participants were chronic stroke survivors with mild ankle weakness who could already walk without manual assistance. The trial does not show effects in more impaired or sub-acute patients. Walking canes were allowed during training. The paper notes that over-reliance on a cane could affect motor relearning. The powered and sham devices both added 0.5 kg at the affected ankle, and some participants reported poor fit or misalignment. The between-group advantage was significant after training but not at 3 months. Durability is unclear.
Declared interests
The work was supported by the Innovation and Technology Commission.
The easy way to misread this
Do not conclude that the powered ankle AFO alone caused the gains. The powered group also received 20 sessions of over-ground walking, stair ambulation, a skilled trainer walking alongside, verbal cues, and allowed cane use, so the powered ankle assistance cannot be separated from the training package.