Vol. 2, Issue 2, Part A (2025)

Background: Restoration of safe, efficient walking is a primary goal of stroke rehabilitation, yet many survivors remain limited household ambulators due to persistent hemiparetic gait, reduced speed, and marked asymmetry. Robotics-assisted gait training (RAGT) has been proposed as a means to deliver high-intensity, task-specific stepping with controlled kinematics, but its added value over well-delivered conventional gait therapy remains incompletely defined.

Objective: To compare the effects of RAGT versus dose-matched conventional therapist-delivered gait rehabilitation on walking speed, functional ambulation, gait endurance, and kinematic parameters in adults with early subacute post-stroke hemiparesis.

Methods: In this controlled clinical study, 60 adults (18-80 years) with first-ever unilateral stroke (2 weeks-6 months post-onset), hemiparetic gait, and Functional Ambulation Category (FAC) 1-3 were randomized (1:1) to RAGT plus standardized multidisciplinary rehabilitation or to conventional gait therapy plus the same rehabilitation dose. Both groups received 45-minute gait-focused sessions, 5 days/week for 4 weeks, in addition to matched usual-care physiotherapy. Primary outcomes were comfortable gait speed (10-Meter Walk Test) and FAC. Secondary outcomes included fast gait speed, 6-Minute Walk Test (6MWT), Berg Balance Scale (BBS), Gait Profile Score (GPS), and spatiotemporal symmetry indices from three-dimensional gait analysis. Assessments were performed at baseline and post-intervention by blinded assessors. Analyses followed the intention-to-treat principle.

Results: Baseline demographic and clinical characteristics were similar between groups. Both groups improved significantly in comfortable gait speed (p<0.001), but gains were greater with RAGT (Δ 0.24±0.11 m/s) than with conventional therapy (Δ 0.12±0.10 m/s), with a between-group difference of 0.12 m/s (95% CI 0.05-0.19, p=0.002). A higher proportion of participants in the RAGT group achieved independent ambulation (FAC ≥4: 60.0% vs 33.3%, p=0.04). RAGT also produced larger improvements in 6MWT distance (Δ 75±35 m vs 47±32 m, p=0.01) and greater reductions in GPS (Δ −3.4±2.1° vs −1.7±2.0°, p=0.03), with significantly greater gains in step-length symmetry ratio. Trends favored RAGT for balance, although between-group differences in BBS change did not reach significance. A responder analysis (clinically meaningful gains in gait speed and FAC) showed more “global gait responders” in the RAGT group (63.3% vs 36.7%, p=0.03).

Conclusions: In early subacute post-stroke hemiparesis, integrating RAGT into a structured multidisciplinary rehabilitation program yields superior improvements in walking speed, functional ambulation, endurance, and gait pattern, including symmetry, compared with dose-matched conventional gait therapy alone. These findings support the use of RAGT as an effective adjunct to conventional physiotherapy to enhance walking recovery and facilitate progression from household to community ambulation after stroke.