title: An observational report of intensive robotic and manual gait training in sub-acute stroke.
abstract: BACKGROUND
  The use of automated electromechanical devices for gait training in neurological patients is increasing, yet the functional outcomes of well-defined training programs using these devices and the characteristics of patients that would most benefit are seldom reported in the literature. In an observational study of functional outcomes, we aimed to provide a benchmark for expected change in gait function in early stroke patients, from an intensive inpatient rehabilitation program including both robotic and manual gait training.
  
  
  METHODS
  We followed 103 sub-acute stroke patients who met the clinical inclusion criteria for Body Weight Supported Robotic Gait Training (BWSRGT). Patients completed an intensive 8-week gait-training program comprising robotic gait training (weeks 0-4) followed by manual gait training (weeks 4-8). A change in clinical function was determined by the following assessments taken at 0, 4 and 8 weeks (baseline, mid-point and end-point respectively): Functional Ambulatory Categories (FAC), 10 m Walking Test (10 MWT), and Tinetti Gait and Balance Scales.
  
  
  RESULTS
  Over half of the patients made a clinically meaningful improvement on the Tinetti Gait Scale (> 3 points) and Tinetti Balance Scale (> 5 points), while over 80% of the patients increased at least 1 point on the FAC scale (0-5) and improved walking speed by more than 0.2 m/s. Patients responded positively in gait function regardless of variables gender, age, aetiology (hemorrhagic/ischemic), and affected hemisphere. The most robust and significant change was observed for patients in the FAC categories two and three. The therapy was well tolerated and no patients withdrew for factors related to the type or intensity of training.
  
  
  CONCLUSIONS
  Eight-weeks of intensive rehabilitation including robotic and manual gait training was well tolerated by early stroke patients, and was associated with significant gains in function. Patients with mid-level gait dysfunction showed the most robust improvement following robotic training.
authors.affiliation: Functional Rehabilitation Department, Neurorehabilitation Hospital Institut Guttmann, Badalona, Barcelona, Spain. lconesa@guttmann.com
authors.forename: Lucas
authors.initials: L
authors.lastname: Conesa
authors.forename: Úrsula
authors.initials: Ú
authors.lastname: Costa
authors.forename: Eva
authors.initials: E
authors.lastname: Morales
authors.forename: Dylan J
authors.initials: DJ
authors.lastname: Edwards
authors.forename: Mar
authors.initials: M
authors.lastname: Cortes
authors.forename: Daniel
authors.initials: D
authors.lastname: León
authors.forename: Montserrat
authors.initials: M
authors.lastname: Bernabeu
authors.forename: Josep
authors.initials: J
authors.lastname: Medina
mesh_terms: D005081:Exercise Therapy / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005684:Gait; D020233:Gait Disorders, Neurologic / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012371:Robotics / Q000295:instrumentation / Q000379:methods; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation