Robotic Assisted Gait Training in Individuals with Chronic Stroke

: Functional and Biomechanical Implications

Abstract

Stroke is the leading cause of adult disability and functional impairment with walking ability a top patient goal. The development of robotic-assisted gait training devices may be a potential solution to overcome the limited availability of traditional rehabilitation in the chronic stages of the condition, providing high intensity task specific training. Over-ground robotic assisted gait trainers are portable and have the ability to be used in a home-based setting. Clinical functional outcome measures are commonly reported as the primary outcomes in robotic interventions. However, more detailed biomechanical analysis of gait and balance is needed to examine the mechanisms behind clinically important changes after new rehabilitation programmes. Systems or devices used to measure these outcomes must also be reliable and valid for use in clinical practice. Therefore, the purpose of the first and second studies in this thesis was to assess the reliability and validity of the BTS G-Walk, a portable accelerometer, in those with stroke. The device demonstrated moderate to excellent reliability (ICC=0.70–0.98) when measuring spatio-temporal gait parameters, however validity was not reported in this thesis due to the impact of the COVID-19 pandemic on the study. The purpose of the main experimental studies were to assess the effect of a 10-week home-based rehabilitation programme using a lower limb over-ground robotic-assisted gait training device (AlterG Bionic Leg), in combination with usual care physiotherapy, in ambulatory stroke patients on clinical functional outcomes and biomechanical measures of gait and balance. The intervention elicited a significant change (p<0.05) in several clinical functional outcomes on completion of the intervention, including the 6-minute walk test, with benefits maintained at 3-month follow-up. No changes were seen in the biomechanical measures of gait and balance. An over-ground robotic assisted gait training programme was shown to be feasible in a home-based setting that sustained its benefits in functional outcomes after the intervention. Future research should seek to find which robotic devices are best for different stroke populations and it is recommended that biomechanical outcome measures be reported alongside common clinical functional outcomes.

Date of Award	5 Apr 2024
Original language	English
Awarding Institution	University of Winchester
Supervisor	James Faulkner (Supervisor), Simon Jobson (Supervisor) & Grace Smith (Supervisor)