Effect of overground gait training with ‘Mobility Assisted Robotic System-MARS’ on gait parameters in patients with stroke: a pre-post study

(2023) 23:296 Gupta et al. BMC Neurology https://doi.org/10.1186/s12883-023-03357-6 BMC Neurology Open Access RESEARCH Effect of overground gait training with ‘Mobility Assisted Robotic System‑MARS’ on gait parameters in patients with stroke: a pre‑post study Anupam Gupta1*, Navin B. Prakash1, Gourav Sannyasi1, Faiz Mohamad1, Preethi Honavar1, S. Jotheeswaran1, Meeka Khanna1 and Subasree Ramakrishnan2 Abstract Objective To observe the effect of overground gait training with ‘Mobility Assisted Robotic System-MARS’ on gait parameters in patients with stroke. Patients & methods This prospective pre-post study was conducted in a tertiary teaching research hospital with 29 adult stroke patients, with age up to 65 years. Patients fulfilling the inclusion criteria were divided in 2 groups based on the duration of stroke (≤ 6 months-sub-acute & > 6 months-chronic stroke) and provided overground gait training with MARS robot for 12 sessions (1 h/session) over a period of 2–3 weeks. Primary outcome measures were; 10-Meter walk test-10MWT, 6-min’ walk test-6MWT and Timed up & Go-TUG tests. Secondary outcome measures were Functional Ambulation Category-FAC, Modified Rankin Scale-MRS and Scandinavian Stroke Scale-SSS. Results No adverse events were reported. Twenty-five patients who were able to perform 10-MWT at the beginning of study were included in the final analysis with 12 in sub-acute and 13 in chronic stroke group. All primary and secondary outcome measures showed significant improvement in gait parameters at the end of the training (p < 0.05) barring 10-Meter walk test in sub-acute stroke group (p = 0.255). Chronic stroke group showed significant minimum clinically important difference-MCID difference in endurance (6MWT) at the end of the training and both groups showed better ‘minimal detectable change-MDC’ in balance (TUG) at the end of the training. Conclusions Patients in both the groups showed significant improvement in walking speed, endurance, balance and independence at the end of the training with overground gait training with MARS Robot. Clinical trial registry National Clinical Trial Registry of India (CTRI/2021/08/035695,16/08/2021). Keywords Stroke, Overground gait training, MARS robot, Gait parameters *Correspondence: Anupam Gupta 1 Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India 2 Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India Introduction Stroke is the second leading cause of mortality, comprising 11.8% of all deaths worldwide, and the third most common cause of combined disability and death worldwide [1]. Locomotor disability is one of the significant barriers to community ambulation in stroke survivors and may manifest as reduced gait speed and endurance, recurrent falls, poor balance, and difficulty to perform © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Gupta et al. BMC Neurology (2023) 23:296 activities of daily living [2]. Hence, recovery of gait is considered a top priority in rehabilitation of individuals with stroke. In the acute phase of recovery, frequent, intensive, repetitive and task-specific training with active patient participation has been proposed to enhance neuroplasticity that facilitates gait and functional recovery [3, 4]. In recent years, stroke rehabilitation programs have incorporated use of several robotic devices, which provide more intensive and repetitive training compared to conventional approaches. A common characteristic of gait training robot is to partially support the body weight and aid in locomotion. Robotic devices can facilitate early mobilization of non-ambulatory patients and improve outcomes in the sub-acute phase of stroke [5]. The other advantages of robotic devices are their ability to deliver high repetitions of intensive gait training with reduced effort of the therapist, less energy-consumption, and greater cardiorespiratory efficiency of the patient. Treadmill-based robotics includes both end-effector devices and exoskeleton systems, which executes gait training on a treadmill with body weight support. In end-effector devices (e.g., G-EO- RehaTechnology, Switzerland), moveable footplates attached to the patient’s feet simulate gait pattern. The exoskeleton treadmill system (e.g., Lokomat, Walkbot) moves joints, such as the hip, knee, and ankle, in a controlled manner during the gait training [6]. A systematic review suggested that patients who receive robotic-assisted treadmill gait training and physiotherapy after stroke might attain more independent walking than patients who receive only conventional training [5]. However, there was no difference in gait speed and endurance between robotic and conventional gait training with equal intensity and duration [5, 7, 8]. Despite the effectiveness of robot-assisted treadmill training, overground gait training is required to transfer the acquired skills to practical use in patients, improving the gait speed and endurance. Robotic Treadmill training does not permit the patient to experience realworld gait obstacles, such as walking on uneven terrain, stepping over objects, and stair climbing. Moreover, on treadmill robotics, patients walk with a pre-set speed and body weight support, creating an atmosphere where the patient might have less control in initiating each step and lack of alteration in visuospatial flow. These elements challenge optimum overground walking [9]. Therefore, stroke patients need to put more active effort into generating steps to walk and maintaining balance with the help or supervision during overground gait training. Traditionally, overground walking training is conducted using lower limb orthosis, walking aids such as cane/walker/ hemiwalker etc., and therapists’ assistance [10]. However, Page 2 of 8 due to increased need of stroke patients and dearth (...truncated)