Electromechanical-assisted training for walking after stroke

Mehrholz J, Werner C, Kugler J, Pohl M

Published Online:

September 8, 2010

Many patients who have had a stroke have difficulties with walking, and improving walking is one of the main goals of rehabilitation. Electromechanical-assisted gait training uses specialist machines to assist walking practice. This review of 17 trials, which included 837 participants, found some evidence that electromechanical-assisted gait training combined with physiotherapy may improve recovery of independent walking in patients after stroke who could not initially walk independently. However, it is still not clear if such devices should be applied in routine rehabilitation, or when and how often they should be used.

Abstract (click to read)

Background:

Electromechanical and robotic-assisted gait training devices are used in rehabilitation and might help to improve walking after stroke. This is an update of a Cochrane Review first published in 2007.

Objectives:

To investigate the effect of automated electromechanical and robotic-assisted gait training devices for improving walking after stroke.

Search strategy:

We searched the Cochrane Stroke Group Trials Register (last searched February 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2009), MEDLINE (1966 to April 2009), EMBASE (1980 to April 2009), CINAHL (1982 to May 2009), AMED (1985 to April 2009), SPORTDiscus (1949 to April 2009), the Physiotherapy Evidence Database (PEDro, searched June 2009) and the engineering databases COMPENDEX (1972 to April 2009) and INSPEC (1969 to April 2009). We handsearched relevant conference proceedings, searched trials and research registers, checked reference lists and contacted authors in an effort to identify further published, unpublished and ongoing trials.

Selection criteria:

We included studies using random assignment.

Data collection and analysis:

Two review authors independently selected trials for inclusion, assessed trial quality and extracted the data. The primary outcome was the proportion of patients walking independently at follow up.

Main results:

We included 17 trials involving 837 participants in this review. Electromechanical-assisted gait training in combination with physiotherapy increased the odds of becoming independent in walking (odds ratio (OR) 2.21, 95% confidence interval (CI) 1.52 to 3.22; P < 0.001), but did not increase walking velocity (mean difference (MD) = 0.04 m/sec, 95% CI -0.05 to 0.13; P = 0.39) or walking capacity significantly (MD = 7 metres walked in six minutes, 95% CI -32 to 46; P = 0.73). The results must be interpreted with caution because (1) some trials investigated patients who were independent in walking at study onset, (2) we found variations between the trials with respect to duration and frequency of treatment, and (3) some trials included devices with functional electrical stimulation.

Authors' conclusions:

Patients who receive electromechanical-assisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than patients receiving gait training without these devices. However, further research should address specific questions, for example what frequency or duration of electromechanical-assisted gait training might be most effective and at what time after stroke. Follow-up studies are also needed to find out how long the benefit lasts.

This record should be cited as:

Mehrholz J, Werner C, Kugler J, Pohl M. Electromechanical-assisted training for walking after stroke. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006185. DOI: 10.1002/14651858.CD006185.pub2

Assessed as up to date:

October 16, 2009

Find the research

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Primary Review Group:

Stroke Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

Do automated electromechanical-assisted gait training devices improve walking after stroke?

Bottom line:

Patients who receive automated electromechanical-assisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than patients receiving gait training without these devices. The devices plus physiotherapy increased walking capacity (mean difference 34 metres walking in 6 minutes) but did not increase walking velocity significantly. The results could be interpreted as preventing one patient remaining dependent in walking after stroke for every four treated. This apparent benefit is, however, not supported by all secondary variables (such as walking speed and walking capacity). Therefore, it is still not clear if such devices should be applied in routine rehabilitation, or when and how often they should be used.

Caveat:

The results must be interpreted with caution because variations between the trials were found with respect to duration and frequency of treatment, and differences in ambulatory status of patients. Further, some trials (2) tested electromechanical devices in combination with functional stimulation.

Context:

Electromechanical-assisted gait training uses specialist machines to assist walking practice, and can reduce dependence on therapists. The machines consist of either of a robot-driven exoskeleton orthosis¹ or an electromechanical solution with two driven foot plates simulating the phases of gait.² 1. Colombo G et al. Journal of Rehabilitation Research and Development 2000;37:693–700. 2. Hesse S et al. Biomedical Engineering 1999;44:194–201.

Cochrane Systematic Review:

Mehrholz J et al. Electromechanical-assisted training for walking after stroke. Cochrane Reviews 2007, Issue 4. Art No: CD006185. DOI: 10.1002/14651858. CD006185.pub 2. This review contains 8 trials involving 414 participants in 6 countries.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Heart & circulation > Stroke > Prevention & treatment of complications

Neurology > Stroke > Prevention & treatment of complications

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Electromechanical-assisted training for walking after stroke

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