title: Overground walking training with the i-Walker, a robotic servo-assistive device, enhances balance in patients with subacute stroke: a randomized controlled trial.
abstract: BACKGROUND
  Patients affected by mild stroke benefit more from physiological overground walking training than walking-like training performed in place using specific devices. The aim of the study was to evaluate the effects of overground robotic walking training performed with the servo-assistive robotic rollator (i-Walker) on walking, balance, gait stability and falls in a community setting in patients with mild subacute stroke.
  
  
  METHODS
  Forty-four patients were randomly assigned to two different groups that received the same therapy in two daily 40-min sessions 5 days a week for 4 weeks. Twenty sessions of standard therapy were performed by both groups. In the other 20 sessions the subjects enrolled in the i-Walker-Group (iWG) performed with the i-Walker and the Control-Group patients (CG) performed the same amount of conventional walking oriented therapy. Clinical and instrumented gait assessments were made pre- and post-treatment. The follow-up observation consisted of recording the number of fallers in the community setting after 6 months.
  
  
  RESULTS
  Treatment effectiveness was higher in the iWG group in terms of balance improvement (Tinetti: 68.4 ± 27.6 % vs. 48.1 ± 33.9 %, p = 0.033) and 10-m and 6-min timed walking tests (significant interaction between group and time: F(1,40) = 14.252, p = 0.001; and F(1,40) = 7.883, p = 0.008, respectively). When measured, latero-lateral upper body accelerations were reduced in iWG (F = 4.727, p = 0.036), suggesting increased gait stability, which was supported by a reduced number of falls at home.
  
  
  CONCLUSIONS
  A robotic servo-assisted i-Walker improved walking performance and balance in patients affected by mild/moderate stroke, leading to increased gait stability and reduced falls in the community.
  
  
  BACKGROUND
  This study was registered on anzctr.org.au (July 1, 2015; ACTRN12615000681550 ).
authors.affiliation: Clinical Laboratory of Experimental Neurorehabilitation, I.R.C.C.S, Fondazione Santa Lucia, Rome, Italy. g.morone@hsantalucia.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Morone
authors.affiliation: Behavioural and Clinical Neurology Laboratory, I.R.C.C.S, Fondazione Santa Lucia, Rome, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Annicchiarico
authors.affiliation: Clinical Laboratory of Experimental Neurorehabilitation, I.R.C.C.S, Fondazione Santa Lucia, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Iosa
authors.affiliation: Behavioural and Clinical Neurology Laboratory, I.R.C.C.S, Fondazione Santa Lucia, Rome, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Federici
authors.affiliation: Clinical Laboratory of Experimental Neurorehabilitation, I.R.C.C.S, Fondazione Santa Lucia, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Paolucci
authors.affiliation: Universitat Politècnica de Catalunya Barcelona, Barcelona, Spain.
authors.forename: Ulises
authors.initials: U
authors.lastname: Cortés
authors.affiliation: Behavioural and Clinical Neurology Laboratory, I.R.C.C.S, Fondazione Santa Lucia, Rome, Italy.|Department of Neuroscience, "Tor Vergata" University, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Caltagirone
mesh_terms: D000368:Aged; D005081:Exercise Therapy / Q000295:instrumentation*; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D004856:Postural Balance; D012371:Robotics / Q000295:instrumentation*; D012656:Self-Help Devices; D020521:Stroke; D000071939:Stroke Rehabilitation / Q000295:instrumentation*; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*
keywords: Floor training; Gait; Rehabilitation; Robotic-assisted therapy; i-Walker