title: Wearable robotic exoskeleton for overground gait training in sub-acute and chronic hemiparetic stroke patients: preliminary results.
abstract: BACKGROUND
  Recovery of therapeutic or functional ambulatory capacity in post-stroke patients is a primary goal of rehabilitation. Wearable powered exoskeletons allow patients with gait dysfunctions to perform over-ground gait training, even immediately after the acute event.
  
  
  OBJECTIVE
  To investigate the feasibility and the clinical effects of an over-ground walking training with a wearable powered exoskeleton in sub-acute and chronic stroke patients.
  
  
  METHODS
  Prospective, pilot pre-post, open label, non-randomized experimental study.
  
  
  METHODS
  A single neurological rehabilitation center for inpatients and outpatients.
  
  
  METHODS
  Twenty-three post-stroke patients were enrolled: 12 sub-acute (mean age: 43.8±13.3 years, 5 male and 7 female, 7 right hemiparesis and 5 left hemiparesis) and 11 chronic (mean age: 55.5±15.9 years, 7 male and 4 female, 4 right hemiparesis and 7 left hemiparesis) patients.
  
  
  METHODS
  Patients underwent 12 sessions (60 min/session, 3 times/week) of walking rehabilitation training using Ekso™, a wearable bionic suit that enables individuals with lower extremity disabilities and minimal forearm strength to stand up, sit down and walk over a flat hard surface with a full weight-bearing reciprocal gait. Clinical evaluations were performed at the beginning of the training period (t0), after 6 sessions (t1) and after 12 sessions (t2) and were based on the Ashworth scale, Motricity Index, Trunk Control Test, Functional Ambulation Scale, 10-Meter Walking Test, 6-Minute Walking Test, and Walking Handicap Scale. Wilcoxon's test (P<0.05) was used to detect significant changes.
  
  
  RESULTS
  Statistically significant improvements were observed at the three assessment periods for both groups in Motricity Index, Functional Ambulation Scale, 10-meter walking test, and 6-minute walking test. Sub-acute patients achieved statistically significant improvement in Trunk Control Test and Walking Handicap Scale at t0-t2. Sub-acute and chronic patient did not achieve significant improvement in Ashworth scale at t0-t2.
  
  
  CONCLUSIONS
  Twelve sessions of over-ground gait training using a powered wearable robotic exoskeleton improved ambulatory functions in sub-acute and chronic post-stroke patients. Large, randomized multicenter studies are needed to confirm these preliminary data.
  
  
  CONCLUSIONS
  To plan a completely new individual tailored robotic rehabilitation strategy after stroke, including task-oriented over-ground gait training.
authors.affiliation: Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Molteni
authors.affiliation: Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Gasperini
authors.affiliation: Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Gaffuri
authors.affiliation: Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Colombo
authors.affiliation: Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Giovanzana
authors.affiliation: Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Lorenzon
authors.affiliation: Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy.
authors.forename: Nico
authors.initials: N
authors.lastname: Farina
authors.affiliation: Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cannaviello
authors.affiliation: Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Scarano
authors.affiliation: Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Proserpio
authors.affiliation: Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Liberali
authors.affiliation: Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy - eleonora.guanziroli@gmail.com.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Guanziroli
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015331:Cohort Studies; D000067190:Exoskeleton Device / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000534:rehabilitation*; D006429:Hemiplegia / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000175:diagnosis*; D000071939:Stroke Rehabilitation / Q000379:methods*; D016896:Treatment Outcome