Stroke Survivors Walk Better With Human Help
Rehab with therapist had more benefit than those using robotic devices, study finds

HealthDay

By Robert Preidt

Thursday, May 8, 2008
THURSDAY, May 8 (HealthDay News) -- Stroke survivors derive much more benefit from walking therapy when it's conducted by a physical therapist instead of a robotic device, report researchers at the University of Illinois in Chicago.
When stroke patients are too weak to walk on their own, physical therapists fit the patients in a harness, put them on a treadmill and help them move. Because this can be physically demanding, robotic devices have been developed as an alternative.
"We wanted to know whether using a robotic device that guides the limb in a symmetrical walking pattern would facilitate greater improvements in walking speed and symmetry than more traditional walking interventions with a physical therapist," study author T. George Hornby, an assistant professor in the physical therapy department, said in a prepared statement.
The study included 48 people who'd suffered strokes at least six months earlier and still had moderate to severe trouble walking due to weakness on one side of the body. The patients were randomly assigned to receive physical therapist-assisted or robotic-assisted locomotor therapy. All the patients received a dozen 30-minute therapy sessions during the four to five weeks of the study.
"We found that stroke patients improved their walking whether they had the robotic device or the therapist helping them. However, the amount of improvement was greater in the therapist-assisted group," Hornby said.
Patients in the therapist-assisted group showed greater improvements in walking speed and in the amount of time spent on the weak leg during therapy. Among patients who had severe walking deficits, those in the therapist-assisted group -- but not those in the robotic-assisted group -- felt their quality of life improved after therapy because they had fewer physical limitations.
The fact that therapist-assisted training allows for patient error, while the robotic device controls movement and minimizes errors, may explain the differences between the two groups.
"When learning to walk again, if people can make mistakes and realize their errors and change their behavior based on those errors, they may learn better," Hornby said. "We also think that patients work harder and therefore improve more with therapists because the robotic device moved patients' legs for them throughout the therapy. Therapists only help as needed."
The study appears in the current issue of Stroke.
Hornby and colleagues suggested that robotic-assisted therapy may be best for stroke patients who have no ability to walk on their own, while therapist-assisted training is best for those who can walk independently, even at very slow speeds.