What is the best way to re-learn to walk after suffering a stroke, also known as a cerebral vascular accident (CVA)? A recently published study of treadmill training using robotic gait assistance/control shows that this newly developed therapy may be the most beneficial for stroke patients. Authors of the study, however, point out that there are pros and cons to both methods of treatment.

Stroke Recovery
Traditionally, physical therapy has consisted of two or more physical therapists physically supporting a patient and manually moving the patient's affected leg while walking them up and down hospital hallways. The desired outcome is to make the brain create new connections to the spinal cord, nerves, and muscles.

Body Weight Supported Physical Therapy
This is an effective method. However, it is strenuous for the stroke patient and the physical therapists. Consequently, it limits how often and how long each stroke recovery session can be. With the introduction of body weight-supported treadmill training, the physical burden on the patient and on the therapist has been reduced. With body weight supported treadmill training, the patient is suspended in a harness over a treadmill.

The physical therapist determines how much or how little body weight the patient can bear and then adjusts the device accordingly. The therapist "walks" the patient by manually guiding and/or moving the affected limb. A LiteGait is an example of this type of device. It can be used with a treadmill or over ground. It does still require a lot of assistance by one or more therapists. But it is much safer for both the patient and the physical therapist because it prevents the patient from falling. The patient can also start stroke recovery sooner, since weight bearing is not as much of an issue.  

Some rehabilitation facilities are currently using body weight supported treadmill training with the addition of robotic control. These newer devices, such as GTI, Lokomat, and AutoAmbulator, are similar to the older treadmill exercise practice. With the GTI, the patient's feet are placed on movable plates that sense the amount of assistance needed. The physical therapist can still help foot movement when necessary.

With Lokomat and AutoAmbulator, a robotic frame is attached by straps to the outside of the patient's legs. The physical therapist operates a computer that controls movements of the patient's affected limb. Body responses are measured. The degree of weight-bearing and the walking pace can be controlled.

Robotic Control Studies
Ongoing studies are trying to determine what role these robotic control devices should play in CVA recovery. Two researchers at the University of Missouri reviewed some of these studies and published their results in Missouri Medicine (March/April 2008). Dr. Sayers and Jeffrey Krug, the physical therapist who co-authored the report, state that there are advantages and disadvantages when using robotic control body weight supported treadmill training to help with CVA recovery.

Pros of Robotic Control Physical Therapy
Advantages include safety, ability to start physical therapy sooner, decreased physical burden on therapist(s), increased session time and frequency, and decreased stress on affected limb due to less weight placed on the limb. Many studies have demonstrated significant improvement in mobility and functional outcomes with robotic body weight supported treadmill training.

Cons of Robotic Control Physical Therapy
Disadvantages include rigidity of robotic control movement, causing the gait to be less normal; ability of using the device for only one patient at a time; amount of time it takes to get the patient into and out of the device; possibility of pressure sores caused by the harness; up-front purchase prices; and decreased interaction between the patient and the therapist.

The AutoAmbulator is being used in ongoing studies at the University of Missouri and has shown favorable results. The authors recommend a more systematic approach to gait parameters and to evidence-based results for anyone designing future studies.  

For further information, refer to: "Robotic Gait-Assisted Therapy in Patients with Neurological Injury," Sayers, S PhD; Krug, J PT; Missouri Medicine, Volume105, Number 2.    

See Related Articles
For more information on therapy for stroke recovery, see Stroke Recovery Through Music Therapy.

Some stroke patients experience problems with their wrists and fingers, and find relief with Neuromove. For more information,  see Many Stroke Patients Benefit from Electrical Stimulation Therapy.