Using machines to assist training might improve upper and lower limb function after stroke. Scientific evidence for the benefits of electromechanical-assisted training, however, is required to justify the large equipment and human resource costs needed to implement electromechanical-assisted gait devices, as well as to confirm the safety and acceptance of this type of training.
Therefore, this talk provides an update of the best available evidence from Cochrane reviews about electromechanical and robotic-assisted gait and arm training devices for improving motor function and activities after stroke.
In three updated Cochrane reviews we included 67 randomised trials involving 3657 participants for electromechanical-assisted gait and 34 randomised trials involving 3657 participants for electromechanical-assisted arm training.
Electromechanical-and robotic assisted gait training in combination with physiotherapy increases the odds of non-ambulatory patients becoming independent in walking. Although currently direct comparisons between different devices are lacking, indirect comparisons suggests higher walking speed and walking endurance in favor of end-effector devices compared with exoskeletons. Non-ambulatory patients benefit mostly from an electromechanical-assisted gait approach. We did not found any evidence for wearable exoskeletons or bionic suits.
In already ambulatory patients after stroke a treadmill training approach might increase walking speed and walking endurance, but therapists should apply higher intensities of treadmill training. Treadmill training should therefore be used when people after stroke can walk independently and when improvement of walking speed and endurance is the aim of therapy.
Electromechanical and robot-assisted arm and hand training after stroke might improve activities of daily living, arm and hand function, and arm and hand muscle strength. These devices can be applied as a rehabilitation tool, however, we still do not know when or how often they should be used.