Is robot-assisted gait training intensity a determinant of functional recovery early after stroke? A pragmatic observational study of clinical care

Gait rehabilitation is a critical factor in functional recovery after a stroke. The aim of this pragmatic observational study was to identify the optimal dose and timing of robot-assisted gait training (RAGT) that can lead to a favourable outcome in a sample of subacute stroke survivors. Subacute patients with stroke who underwent a RAGT within a multidisciplinary rehabilitation program were enrolled. A set of clinical (i.e. age, type of stroke and time since stroke) and rehabilitation stay outcomes (length of stay and RAGT number of sessions) were recorded to evaluate their impact on functional outcome measures by functional independence measure (FIM) or functional ambulation category (FAC). We included 236 patients (62.73 ± 11.82 year old); 38.44% were females, and 59.32% were ischaemic stroke patients. Patients that received at least 14 RAGT sessions, had 15.83% more chance to be responders compared to those that receive less sessions (P = 0.006). Similarly, younger patients (≤60 years) were more prone to be responders (+15.1%). Lastly, an early rehabilitation (<6 weeks) was found to be more efficient (+21.09%) in determining responsiveness (P < 0.001). Becoming newly independent for gait, that refers to a FAC score ≥4, was related with age and RAGT sessions (P = 0.001). In conclusion, a younger age (≤60 years), an early rehabilitation (<6 weeks since stroke) and a higher RAGT dose (at least 14 sessions) were related to a favourable outcome in patients with subacute stroke

The cognitive level does not interfere with recovery after robot-assisted gait training in traumatic brain injury: A 10-year cohort study

BACKGROUND: There is still no clear evidence available on the role of robot-assisted gait training (RAGT) in severe traumatic brain injury (TBI) and on the relationship between this intervention and cognitive impairment. OBJECTIVE: This study investigates the impact of the cognitive level at admission on functional recovery in a cohort of patients with severe TBI who received RAGT training within a multidisciplinary rehabilitation setting. METHODS: We included patients with gait disturbance due to a severe TBI. Patients were grouped into three classes according to their level of cognitive functioning (LCF) at admission (LCF 2-3; LCF 4-5-6; LCF 7-8). We collected demographics (sex, age), clinical data, and a set of outcome measures at admission and discharge. RESULTS: We registered 80 patients, 19 females and 61 males, 35.3 ± 14.85 years. Patients with a low cognitive level at admission were mostly subacute (p= 0.001). Cognitive impairment despite longer length stay in the hospital (LOS) (p= 0.001) did not preclude recovery after RAGT in terms of cognition (R2= 0.68; p< 0.0001), functional independence (R2= 0.30; p< 0.0001) and overall disability (R2= 0.32; p< 0.0001). CONCLUSION: Irrespective of their level of cognition, patients with severe TBI might benefit from RAGT during a multidisciplinary program