Tuesday 01 April 2008, 12:00AM
PEARLS 60, April 2008, written by Brian R
(first published in New Zealand Doctor, 7 May 2008)
Do automated electromechanical-assisted gait training devices
improve walking after stroke?
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.
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.
Electromechanical-assisted gait training uses specialist machines
to assist walking practice, and can reduce dependence on
therapists.The machines consist of either a robot-driven
exoskeleton orthosis1 or an electromechanical solution with 2
driven foot plates simulating the phases of gait.2
Cochrane Systematic Review
Mehrholz J et al. Electromechanical-assisted training for walking
after stroke. Cochrane Reviews 2007, Issue 4. Article No. CD006185.
DOI: 10.1002/14651858. CD006185.pub 2. This review contains 8
trials involving 414 participants in 6 countries
1. Colombo G et al. Journal of Rehabilitation Research and
2. Hesse S et al. Biomedical Engineering 1999;44:194-201.