Stride management assist exoskeleton vs functional gait training in stroke: A randomized trial

Arun Jayaraman*, Megan K. O'brien, Sangeetha Madhavan, Chaithanya K. Mummidisetty, Heidi Rebecca Roth, Kristen Hohl, Annie Tapp, Kimberly Brennan, Masha Kocherginsky, Kenton J. Williams, Hideaki Takahashi, William Z Rymer

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

ObjectiveTo test the hypothesis that gait training with a hip-assistive robotic exoskeleton improves clinical outcomes and strengthens the descending corticospinal drive to the lower limb muscles in persons with chronic stroke.MethodsFifty participants completed the randomized, single-blind, parallel study. Participants received over-ground gait training with the Honda Stride Management Assist (SMA) exoskeleton or intensity-matched functional gait training, delivered in 18 sessions over 6-8 weeks. Performance-based and self-reported clinical outcomes were measured at baseline, midpoint, and completion, and at a 3-month follow-up. Corticomotor excitability (CME) of 3 bilateral leg muscles was measured using transcranial magnetic stimulation.ResultsThe primary outcome, walking speed, improved for the SMA group by completion of the program (0.24 ± 0.14 m/s difference, p < 0.001). Compared to the functional group, SMA users had greater improvement in walking endurance (46.0% ± 27.4% vs 35.7% ± 20.8%, p = 0.033), took more steps during therapy days (4,366 ± 2,426 vs 3,028 ± 1,510; p = 0.013), and demonstrated larger changes in CME of the paretic rectus femoris (178% ± 75% vs 33% ± 32%, p = 0.010). Participants with hemorrhagic stroke demonstrated greater improvement in balance when using the SMA (24.7% ± 20% vs 6.8% ± 6.7%, p = 0.029).ConclusionsGait training with the SMA improved walking speed in persons with chronic stroke, and may promote greater walking endurance, balance, and CME than functional gait training.Clinicaltrials.gov identifierNCT01994395.Classification of evidenceThis study provides Class I evidence that gait training with a hip-assistive exoskeleton increases clinical outcomes and CME in persons with chronic stroke, but does not significantly improve walking speeds compared to intensity-matched functional gait training.

Original languageEnglish (US)
Pages (from-to)E263-E273
JournalNeurology
Volume92
Issue number3
DOIs
StatePublished - Jan 15 2019

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Gait
Stroke
Walking
Hip
Single-Blind Method
Muscles
Transcranial Magnetic Stimulation
Quadriceps Muscle
Lower Extremity
Leg
Walking Speed

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Jayaraman, Arun ; O'brien, Megan K. ; Madhavan, Sangeetha ; Mummidisetty, Chaithanya K. ; Roth, Heidi Rebecca ; Hohl, Kristen ; Tapp, Annie ; Brennan, Kimberly ; Kocherginsky, Masha ; Williams, Kenton J. ; Takahashi, Hideaki ; Rymer, William Z. / Stride management assist exoskeleton vs functional gait training in stroke : A randomized trial. In: Neurology. 2019 ; Vol. 92, No. 3. pp. E263-E273.
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abstract = "ObjectiveTo test the hypothesis that gait training with a hip-assistive robotic exoskeleton improves clinical outcomes and strengthens the descending corticospinal drive to the lower limb muscles in persons with chronic stroke.MethodsFifty participants completed the randomized, single-blind, parallel study. Participants received over-ground gait training with the Honda Stride Management Assist (SMA) exoskeleton or intensity-matched functional gait training, delivered in 18 sessions over 6-8 weeks. Performance-based and self-reported clinical outcomes were measured at baseline, midpoint, and completion, and at a 3-month follow-up. Corticomotor excitability (CME) of 3 bilateral leg muscles was measured using transcranial magnetic stimulation.ResultsThe primary outcome, walking speed, improved for the SMA group by completion of the program (0.24 ± 0.14 m/s difference, p < 0.001). Compared to the functional group, SMA users had greater improvement in walking endurance (46.0{\%} ± 27.4{\%} vs 35.7{\%} ± 20.8{\%}, p = 0.033), took more steps during therapy days (4,366 ± 2,426 vs 3,028 ± 1,510; p = 0.013), and demonstrated larger changes in CME of the paretic rectus femoris (178{\%} ± 75{\%} vs 33{\%} ± 32{\%}, p = 0.010). Participants with hemorrhagic stroke demonstrated greater improvement in balance when using the SMA (24.7{\%} ± 20{\%} vs 6.8{\%} ± 6.7{\%}, p = 0.029).ConclusionsGait training with the SMA improved walking speed in persons with chronic stroke, and may promote greater walking endurance, balance, and CME than functional gait training.Clinicaltrials.gov identifierNCT01994395.Classification of evidenceThis study provides Class I evidence that gait training with a hip-assistive exoskeleton increases clinical outcomes and CME in persons with chronic stroke, but does not significantly improve walking speeds compared to intensity-matched functional gait training.",
author = "Arun Jayaraman and O'brien, {Megan K.} and Sangeetha Madhavan and Mummidisetty, {Chaithanya K.} and Roth, {Heidi Rebecca} and Kristen Hohl and Annie Tapp and Kimberly Brennan and Masha Kocherginsky and Williams, {Kenton J.} and Hideaki Takahashi and Rymer, {William Z}",
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Jayaraman, A, O'brien, MK, Madhavan, S, Mummidisetty, CK, Roth, HR, Hohl, K, Tapp, A, Brennan, K, Kocherginsky, M, Williams, KJ, Takahashi, H & Rymer, WZ 2019, 'Stride management assist exoskeleton vs functional gait training in stroke: A randomized trial', Neurology, vol. 92, no. 3, pp. E263-E273. https://doi.org/10.1212/WNL.0000000000006782

Stride management assist exoskeleton vs functional gait training in stroke : A randomized trial. / Jayaraman, Arun; O'brien, Megan K.; Madhavan, Sangeetha; Mummidisetty, Chaithanya K.; Roth, Heidi Rebecca; Hohl, Kristen; Tapp, Annie; Brennan, Kimberly; Kocherginsky, Masha; Williams, Kenton J.; Takahashi, Hideaki; Rymer, William Z.

In: Neurology, Vol. 92, No. 3, 15.01.2019, p. E263-E273.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Stride management assist exoskeleton vs functional gait training in stroke

T2 - A randomized trial

AU - Jayaraman, Arun

AU - O'brien, Megan K.

AU - Madhavan, Sangeetha

AU - Mummidisetty, Chaithanya K.

AU - Roth, Heidi Rebecca

AU - Hohl, Kristen

AU - Tapp, Annie

AU - Brennan, Kimberly

AU - Kocherginsky, Masha

AU - Williams, Kenton J.

AU - Takahashi, Hideaki

AU - Rymer, William Z

PY - 2019/1/15

Y1 - 2019/1/15

N2 - ObjectiveTo test the hypothesis that gait training with a hip-assistive robotic exoskeleton improves clinical outcomes and strengthens the descending corticospinal drive to the lower limb muscles in persons with chronic stroke.MethodsFifty participants completed the randomized, single-blind, parallel study. Participants received over-ground gait training with the Honda Stride Management Assist (SMA) exoskeleton or intensity-matched functional gait training, delivered in 18 sessions over 6-8 weeks. Performance-based and self-reported clinical outcomes were measured at baseline, midpoint, and completion, and at a 3-month follow-up. Corticomotor excitability (CME) of 3 bilateral leg muscles was measured using transcranial magnetic stimulation.ResultsThe primary outcome, walking speed, improved for the SMA group by completion of the program (0.24 ± 0.14 m/s difference, p < 0.001). Compared to the functional group, SMA users had greater improvement in walking endurance (46.0% ± 27.4% vs 35.7% ± 20.8%, p = 0.033), took more steps during therapy days (4,366 ± 2,426 vs 3,028 ± 1,510; p = 0.013), and demonstrated larger changes in CME of the paretic rectus femoris (178% ± 75% vs 33% ± 32%, p = 0.010). Participants with hemorrhagic stroke demonstrated greater improvement in balance when using the SMA (24.7% ± 20% vs 6.8% ± 6.7%, p = 0.029).ConclusionsGait training with the SMA improved walking speed in persons with chronic stroke, and may promote greater walking endurance, balance, and CME than functional gait training.Clinicaltrials.gov identifierNCT01994395.Classification of evidenceThis study provides Class I evidence that gait training with a hip-assistive exoskeleton increases clinical outcomes and CME in persons with chronic stroke, but does not significantly improve walking speeds compared to intensity-matched functional gait training.

AB - ObjectiveTo test the hypothesis that gait training with a hip-assistive robotic exoskeleton improves clinical outcomes and strengthens the descending corticospinal drive to the lower limb muscles in persons with chronic stroke.MethodsFifty participants completed the randomized, single-blind, parallel study. Participants received over-ground gait training with the Honda Stride Management Assist (SMA) exoskeleton or intensity-matched functional gait training, delivered in 18 sessions over 6-8 weeks. Performance-based and self-reported clinical outcomes were measured at baseline, midpoint, and completion, and at a 3-month follow-up. Corticomotor excitability (CME) of 3 bilateral leg muscles was measured using transcranial magnetic stimulation.ResultsThe primary outcome, walking speed, improved for the SMA group by completion of the program (0.24 ± 0.14 m/s difference, p < 0.001). Compared to the functional group, SMA users had greater improvement in walking endurance (46.0% ± 27.4% vs 35.7% ± 20.8%, p = 0.033), took more steps during therapy days (4,366 ± 2,426 vs 3,028 ± 1,510; p = 0.013), and demonstrated larger changes in CME of the paretic rectus femoris (178% ± 75% vs 33% ± 32%, p = 0.010). Participants with hemorrhagic stroke demonstrated greater improvement in balance when using the SMA (24.7% ± 20% vs 6.8% ± 6.7%, p = 0.029).ConclusionsGait training with the SMA improved walking speed in persons with chronic stroke, and may promote greater walking endurance, balance, and CME than functional gait training.Clinicaltrials.gov identifierNCT01994395.Classification of evidenceThis study provides Class I evidence that gait training with a hip-assistive exoskeleton increases clinical outcomes and CME in persons with chronic stroke, but does not significantly improve walking speeds compared to intensity-matched functional gait training.

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