Enhanced Gait-Related Improvements After Therapist- Versus Robotic-Assisted Locomotor Training in Subjects With Chronic Stroke: A Randomized Controlled Study
Abstract
Background and Purpose—Locomotor training (LT) using a treadmill can improve walking ability over conventional rehabilitation in individuals with hemiparesis, although the personnel requirements often necessary to provide LT may limit its application. Robotic devices that provide consistent symmetrical assistance have been developed to facilitate LT, although their effectiveness in improving locomotor ability has not been well established. Methods—Forty-eight ambulatory chronic stroke survivors stratified by severity of locomotor deficits completed a randomized controlled study on the effects of robotic- versus therapist-assisted LT. Both groups received 12 LT sessions for 30 minutes at similar speeds, with guided symmetrical locomotor assistance using a robotic orthosis versus manual facilitation from a single therapist using an assist-as-needed paradigm. Outcome measures included gait speed and symmetry, and clinical measures of activity and participation. Results—Greater improvements in speed and single limb stance time on the impaired leg were observed in subjects who received therapist-assisted LT, with larger speed improvements in those with less severe gait deficits. Perceived rating of the effects of physical limitations on quality of life improved only in subjects with severe gait deficits who received therapist-assisted LT. Conclusions—Therapist-assisted LT facilitates greater improvements in walking ability in ambulatory stroke survivors as compared to a similar dosage of robotic-assisted LT.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Gravity compensation is mostly used in locomotion training for patients in orthotic devices such as the Lokomat.
“This form of haptic support is mostly used in locomotion training for patients in an orthotic device such as the Lokomat (Hidler et al., 2009;Hornby et al., 2008;Husemann et al., 2007;Mayr et al., 2007).”
From Augmented visual, auditory, haptic, and multimodal feedback in motor learning: A review (2013) · cites this paper as Hornby et al., 2008
The Training Protocol describes body-weight support during Lokomat-assisted locomotor training, supporting the Lokomat as an example. It also says the therapist-assisted group received body-weight support, so the paper does not establish that this form of support is mostly used with orthotic devices. Page numbers were not available in our copy. (LLM, conf=0.83)
Experimental — accuracy not yet measuredResults of robot-assisted therapy are controversial: some studies reported patients profit more from conventional therapy than robot-aided therapy, while others reported the opposite.
“However, the results are controversial: Some studies reported that patients profit more from conventional therapy than from robotaided therapy (Hidler et al., 2009;Hornby et al., 2008), whereas others reported the opposite (Husemann, Muller, Krewer, Heller, & Koenig, 2007;Lo et al., 2010;Mayr et al., 2007).”
From Augmented visual, auditory, haptic, and multimodal feedback in motor learning: A review (2013) · cites this paper as Hornby et al., 2008
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Interrater Reliability of a Modified Ashworth Scale of Muscle Spasticity
Bohannon, R. W., & Smith, M. B. (1987) · Physical Therapy · doi:10.1093/ptj/67.2.206 · Cited by 5,461 · see citing works
Motor Control and Learning: A Behavioral Emphasis
Schmidt, R. A. (1982) · Cited by 4,813 · see citing works
Gait Analysis: Normal and Pathological Function
(1992) · JAMA · doi:10.1001/jama.1992.03490220101046 · Cited by 3,875 · see citing works
The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke
Berg, K., Wood-Dauphinée, S., & Williams, J. (1995) · Journal of Rehabilitation Medicine · doi:10.2340/1650197719952736 · Cited by 1,636 · see citing works
Perry, J., Slac, K., & Davids, J. R. (1992) · Journal of Pediatric Orthopaedics · doi:10.1097/01241398-199211000-00023 · Cited by 1,125 · see citing works
Motor learning elicited by voluntary drive
Lotze, M. (2003) · Brain · doi:10.1093/brain/awg079 · Cited by 691 · see citing works
Visintin, M., Barbeau, H., Korner-Bitensky, N. A., & Mayo, N. E. (1998) · Stroke · doi:10.1161/01.str.29.6.1122 · Cited by 687 · see citing works
Locomotor Training After Human Spinal Cord Injury: A Series of Case Studies
Behrman, A. L., & Harkema, S. J. (2000) · Physical Therapy · doi:10.1093/ptj/80.7.688 · Cited by 597 · see citing works
PLASTICITY OF THE SPINAL NEURAL CIRCUITRY AFTER INJURY
Edgerton, V. R., Tillakaratne, N. J. K., Bigbee, A. J., de Leon, R. D., & Roy, R. R. (2004) · Annual Review of Neuroscience · doi:10.1146/annurev.neuro.27.070203.144308 · Cited by 556 · see citing works
Macko, R. F., Ivey, F. M., Forrester, L. W., Hanley, D. F., Sorkin, J. D., Katzel, L. I., Silver, K. H. C., & Goldberg, A. P. (2005) · Stroke · doi:10.1161/01.str.0000181076.91805.89 · Cited by 522 · see citing works
Speed-Dependent Treadmill Training in Ambulatory Hemiparetic Stroke Patients
Pohl, M., Mehrholz, J., Ritschel, C., & Rückriem, S. (2002) · Stroke · doi:10.1161/hs0202.102365 · Cited by 508 · see citing works
Laufband Therapy Based on‘Rules of Spinal Locomotion’is Effective in Spinal Cord Injured Persons
Wernig, A., Müller, S., Nanassy, A., & Cagol, E. (1995) · European Journal of Neuroscience · doi:10.1111/j.1460-9568.1995.tb00686.x · Cited by 494 · see citing works
Wirz, M., Zemon, D. H., Rupp, R., Scheel‐Sailer, A., Colombo, G., Dietz, V., & Hornby, T. G. (2005) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2004.08.004 · Cited by 479 · see citing works
Self-citationPatton, J. L., Stoykov, M. E., Kovic, M., & Mussa-Ivaldi, F. A. (2006) · Experimental Brain Research · doi:10.1007/s00221-005-0097-8 · Cited by 469 · see citing works
Balasubramanian, C. K., Bowden, M. G., Neptune, R. R., & Kautz, S. A. (2007) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2006.10.004 · Cited by 457 · see citing works
Husemann, B., Müller, F., Krewer, C., Heller, S., & Koenig, E. (2007) · Stroke · doi:10.1161/01.str.0000254607.48765.cb · Cited by 418 · see citing works
Sullivan, K. J., Knowlton, B. J., & Dobkin, B. H. (2002) · Archives of Physical Medicine and Rehabilitation · doi:10.1053/apmr.2002.32488 · Cited by 417 · see citing works
Bowden, M. G., Balasubramanian, C. K., Neptune, R. R., & Kautz, S. A. (2006) · Stroke · doi:10.1161/01.str.0000204063.75779.8d · Cited by 388 · see citing works
Mayr, A., Kofler, M., Quirbach, E., Matzak, H., Fröhlich, K., & Saltuari, L. (2007) · Neurorehabilitation and Neural Repair · doi:10.1177/1545968307300697 · Cited by 371 · see citing works
Kendall, F. P., McCreary, E. K., & Provance, P. G. (1994) · Medicine & Science in Sports & Exercise · doi:10.1249/00005768-199408000-00023 · Cited by 366 · see citing works
Cai, L. L., Fong, A. J., Otoshi, C. K., Liang, Y., Burdick, J. W., Roy, R. R., & Edgerton, V. R. (2006) · Journal of Neuroscience · doi:10.1523/jneurosci.2266-06.2006 · Cited by 345 · see citing works
Ada, L., Dean, C. M., Hall, J. M., Bampton, J., & Crompton, S. (2003) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/s0003-9993(03)00349-6 · Cited by 343 · see citing works
Werner, C., von Frankenberg, S., Treig, T., Konrad, M., & Hesse, S. (2002) · Stroke · doi:10.1161/01.str.0000035734.61539.f6 · Cited by 328 · see citing works
Israel, J. F., Campbell, D. D., Kahn, J. H., & Hornby, T. G. (2006) · Physical Therapy · doi:10.2522/ptj.20050266 · Cited by 322 · see citing works
Self-citationBarbeau, H., & Visintin, M. (2003) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/s0003-9993(03)00361-7 · Cited by 313 · see citing works
Hornby, T. G., Zemon, D. H., & Campbell, D. D. (2005) · Physical Therapy · doi:10.1093/ptj/85.1.52 · Cited by 284 · see citing works
Self-citationWinstein, C. J., Pohl, P. S., & Lewthwaite, R. (1994) · Research Quarterly for Exercise and Sport · doi:10.1080/02701367.1994.10607635 · Cited by 264 · see citing works
Arm Training Induced Brain Plasticity in Stroke Studied with Serial Positron Emission Tomography
Nelles, G., Jentzen, W., Jueptner, M., Müller, S., & Diener, H. (2001) · NeuroImage · doi:10.1006/nimg.2001.0757 · Cited by 255 · see citing works
Measurement of Community Ambulation After Stroke
Lord, S. E., & Rochester, L. (2005) · Stroke · doi:10.1161/01.str.0000170698.20376.2e · Cited by 231 · see citing works
Test-retest reliable coefficients and 5-year change scores for the MMSE and 3MS
Tombaugh, T. N. (2005) · Archives of Clinical Neuropsychology · doi:10.1016/j.acn.2004.11.004 · Cited by 224 · see citing works
Lum, P. S., Reinkensmeyer, D. J., Mahoney, R. M., Rymer, W. Z., & Burgar, C. G. (2002) · Topics in Stroke Rehabilitation · doi:10.1310/9kfm-kf81-p9a4-5ww0 · Cited by 218 · see citing works
Roth, E. J., Merbitz, C. T., Mroczek, K. J., Dugan, S. A., & Suh, W. W. (1997) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/00002060-199703000-00008 · Cited by 218 · see citing works
Locomotor Training in Neurorehabilitation: Emerging Rehabilitation Concepts
Barbeau, H. (2003) · Neurorehabilitation and neural repair · doi:10.1177/0888439002250442 · Cited by 208 · see citing works
Hiekkala, S., Tarkka, I. M., Pitkänen, K., & Sivenius, J. (2005) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2005.02.005 · Cited by 205 · see citing works
Kosak, M., & REDING, M. J. (2000) · Neurorehabilitation and neural repair · doi:10.1177/154596830001400102 · Cited by 179 · see citing works
Silver, K. H. C., Macko, R. F., Forrester, L. W., Goldberg, A. P., & Smith, G. V. (2000) · Neurorehabilitation and neural repair · doi:10.1177/154596830001400108 · Cited by 167 · see citing works
Stroke: A Randomized Trial of Exercise or Relaxation
Mead, G. E., Greig, C. A., Cunningham, I., Lewis, S. J., Dinan, S., Saunders, D. H., Fitzsimons, C. F., & Young, A. (2007) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2007.01185.x · Cited by 156 · see citing works
Effects of Stroke Severity and Training Duration on Locomotor Recovery After Stroke: A Pilot Study
Plummer, P., Behrman, A. L., Duncan, P. W., Spigel, P. M., Saracino, D., Martin, J. B., Fox, E. J., Thigpen, M. T., & Kautz, S. A. (2007) · Neurorehabilitation and neural repair · doi:10.1177/1545968306295559 · Cited by 156 · see citing works
Issues in selecting outcome measures to assess functional recovery after stroke
Barak, S., & Duncan, P. W. (2006) · NeuroRx · doi:10.1016/j.nurx.2006.07.009 · Cited by 152 · see citing works
Tools for understanding and optimizing robotic gait training
Reinkensmeyer, D. J., Aoyagi, D., Emken, J. L., Galvez, J. A., Ichinose, W. E., Kerdanyan, G., Maneekobkunwong, S., Minakata, K., Nessler, J. A., Weber, R., et al. (2006) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2005.04.0073 · Cited by 146 · see citing works
Macko, R. F., Ivey, F. M., & Forrester, L. W. (2005) · Topics in Stroke Rehabilitation · doi:10.1310/pjqn-kan9-ttvy-hyqh · Cited by 139 · see citing works
Behrman, A. L., Nair, P. M., Bowden, M. G., Dauser, R. C., Herget, B. R., Martin, J. B., Phadke, C. P., Reier, P. J., Senesac, C., Thompson, F. J., et al. (2008) · Physical Therapy · doi:10.2522/ptj.20070315 · Cited by 101 · see citing works
Modified Emory Functional Ambulation Profile
Baer, H., & Wolf, S. L. (2001) · Stroke · doi:10.1161/01.str.32.4.973 · Cited by 99 · see citing works
Werner, C., Bardeleben, A., Mauritz, K., et al. (2002) · European Journal of Neurology · doi:10.1046/j.1468-1331.2002.00492.x · Cited by 85 · see citing works
Hesse, S., Werner, C., Uhlenbrock, D., von Frankenberg, S., Bardeleben, A., & Brandl-Hesse, B. (2001) · Neurorehabilitation and neural repair · doi:10.1177/154596830101500106 · Cited by 84 · see citing works
Krewer, C., Müller, F., Husemann, B., Heller, S., Quintern, J., & Koenig, E. (2006) · Gait & Posture · doi:10.1016/j.gaitpost.2006.10.003 · Cited by 80 · see citing works
Yagura, H., Hatakenaka, M., & Miyai, I. (2006) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2005.11.035 · Cited by 50 · see citing works
Nash, M. S., Jacobs, P. L., Johnson, B. M., et al. (2004) · Journal of Spinal Cord Medicine · doi:10.1080/10790268.2004.11753734 · Cited by 48 · see citing works
Israel, J., & Hornby, T. G. (2005) · Neurology Report · doi:10.1097/01.npt.0000282389.25807.ae · Cited by 1 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 2
- [6]6. Ada L, Dean CM, Hall JM, Bampton J, Crompton S. A treadmill and overground walking program improves walking in persons residing in the community after stroke: A placebo-controlled, randomized trial. Arch Phys Med Rehabil. 2003;84:1486 -1491.
- [11]11. Barbeau H, Visintin M. Optimal outcomes obtained with body-weight support combined with treadmill training in stroke subjects. Arch Phys Med Rehabil. 2003;84:1458 -1465.
Cited by
Sorted by citations
Winstein, C. J., Stein, J., Arena, R., Bates, B., Cherney, L. R., Cramer, S. C., Deruyter, F., Eng, J. J., Fisher, B., Harvey, R. L., et al. (2016) · Stroke · doi:10.1161/str.0000000000000098 · Cited by 3,293 · see citing works
Augmented visual, auditory, haptic, and multimodal feedback in motor learning: A review
Sigrist, R., Rauter, G., Riener, R., & Wolf, P. (2013) · Psychonomic Bulletin & Review · doi:10.3758/s13423-012-0333-8 · Cited by 1,416 · see citing works
What Is the Evidence for Physical Therapy Poststroke? A Systematic Review and Meta-Analysis
Veerbeek, J. M., van Wegen, E., van Peppen, R., van der Wees, P. J., Hendriks, E., Rietberg, M., & Kwakkel, G. (2014) · PLoS ONE · doi:10.1371/journal.pone.0087987 · Cited by 1,203 · see citing works
Multicenter Randomized Clinical Trial Evaluating the Effectiveness of the Lokomat in Subacute Stroke
Hidler, J., Nichols, D., Pelliccio, M., Brady, K., Campbell, D. D., Kahn, J. H., & Hornby, T. G. (2009) · Neurorehabilitation and Neural Repair · doi:10.1177/1545968308326632 · Cited by 652 · see citing works
Self-citationEfficacy of rehabilitation robotics for walking training in neurological disorders: A review
Tefertiller, C., Pharo, B., Evans, N., & Winchester, P. (2011) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2010.04.0055 · Cited by 167 · see citing works
Cao, J., Xie, S. Q., Das, R., & Zhu, G. L. (2014) · Medical Engineering & Physics · doi:10.1016/j.medengphy.2014.08.005 · Cited by 153 · see citing works
- Authors
- Hornby, T. G., Campbell, D. D., Kahn, J. H., Demott, T., Moore, J. L., & Roth, H. R.
- Affiliations
- Northwestern University (US)
- Venue
- Stroke
- Published
- 2008-06
- Volume
- 39
- Issue
- 6
- Pages
- 1786-1792
- ISSN
- 0039-2499 (ISSN-L)
- 1524-4628
- OpenAlex
- W1998681803
- Cited by
- 541
- References
- 49
- Citations by year
- 2026: 15 · 2025: 17 · 2024: 19 · 2023: 23 · 2022: 31 · 2021: 31 · 2020: 21 · 2019: 22 · 2018: 35 · 2017: 36 · 2016: 34 · 2015: 44 · 2014: 32 · 2013: 30 · 2012: 32
- FWCI
- 42.02
- Type
- journal article
- Language
- en
- Update notices
- correction (2008-08-01)
- Open access
- closed
- Locations
- Stroke (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rehabilitation › Stroke Rehabilitation and Recovery
- Physical Sciences › Engineering › Biomedical Engineering › Prosthetics and Rehabilitation Robotics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spinal Cord Injury Research
- Keywords
- chronic stroke, locomotor training, robot-assisted gait training, treadmill training, hemiparesis, walking speed, gait symmetry, quality of life, stroke rehabilitation
- MeSH terms
- Stroke Rehabilitation, Adult, Aged, Exercise Test, Female, Gait, Humans, Leg, Locomotion, Male, Middle Aged, Orthotic Devices, Paresis, Physical Fitness, Robotics, User-Computer Interface, Treatment Outcome, Muscle, Skeletal, Recovery of Function, Gait Disorders, Neurologic, Stroke, Physical Therapy Modalities, Muscle Strength
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
