Background: Stroke incidence rises with age. A stroke can severely affect walking ability, requiring therapy. Robot-assisted walking therapy (ROB) has been advocated as one form of walking rehabilitation in stroke patients. However, its comparative efficacy remains controversial and three-group comparisons are scant. We compared the effects of ROB, walking training therapy without a robot (WTT) and standard treatment therapy (STT) on clinical and mobility outcomes in acute ischemic stroke patients. Methods: Individuals (n = 45, 71 % males, age 64.4y ±6.34), who have recently experienced an ischemic stroke, were randomized to ROB, WTT or STT. Clinical and mobility outcomes were assessed before and after each intervention (3 weeks, 5 sessions/week) and after 5 weeks of no-intervention follow-up. Results: Outcomes did not differ between groups at baseline (p > 0.05). Modified Rankin Scale (primary outcome), improved (p < 0.05) after ROB and WTT vs. STT. These improvements were retained relative to baseline (p < 0.05) after follow-up. Barthel index, Berg Balance Scale, 10-m walking speed, the distance while walking with and without the robot for six minutes, and center pressure velocity in standing improved most after ROB (all p < 0.001), exceeding the changes after WTT which in turn were greater than the changes after STT (p ≤ 0.040). Conclusion: Older adults shortly after an ischemic stroke can quickly learn to walk with a soft robot and retain substantial clinical and mobility improvements at follow-up.

Background: Comparative efficacy of rehabilitation interventions in persons with acute ischemic stroke (PwS) is limited. This randomized trial assessed the immediate and lasting effects of five interventions on clinical and mobility outcomes in 75 PwS. Methods: Five days after stroke, 75 PwS were randomized into five groups: physical therapy (CON, standard care, once daily); walking with a soft robotic exoskeleton (ROB, once daily); agility exergaming once (EXE1, once daily) or twice daily (EXE2, twice daily); and combined EXE1+ROB in two daily sessions. Interventions were performed 5 days per week for 3 weeks. Outcomes were assessed at baseline, post-intervention, and after 5 weeks of detraining. Results: Modified Rankin Scale (primary outcome) and Barthel Index showed no changes. EXE1, EXE2, ROB, and EXE1+ROB outperformed standard care (CON) in five secondary outcomes (Berg balance scale, 10m walking speed, 6-min walk test with/without robot, standing balance), with effects sustained after 5 weeks. Dose effects (EXE1 vs. EXE2) were minimal, while EXE1+ROB showed additive effects in 6-min walk tests. Conclusions: These novel comparative data expand evidence-based options for therapists to design individualized rehabilitation plans for PwS. Further confirmation is needed.

Background: Beam walking is a new test to estimate dynamic balance. We characterized dynamic balance measured by the distance walked on beams of different widths in five age groups of healthy adults (20, 30, 40, 50, 60 years) and individuals with neurological conditions (i.e., Parkinson, multiple sclerosis, stroke, age: 66.9 years) and determined if beam walking distance predicted prospective falls over 12 months. Methods: Individuals with (n = 97) and without neurological conditions (n = 99, healthy adults, age 20–60) participated in this prospective longitudinal study. Falls analyses over 12 months were conducted. The summed distance walked under single (walking only) and dual-task conditions (walking and serial subtraction by 7 between 300 to 900) on three beams (4, 8, and 12-cm wide) was used in the analyses. Additional functional tests comprised grip strength and the Short Physical Performance Battery. Results: Beam walking distance was unaffected on the 12-cm-wide beam in the healthy adult groups. The distance walked on the 8-cm-wide beam decreased by 0.34 m in the 20-year-old group. This reduction was ~ 3 × greater, 1.1 m, in the 60-year-old group. In patients, beam walking distances decreased sharply by 0.8 m on the 8 versus 12 cm beam and by additional 1.6 m on the 4 versus 8 cm beam. Beam walking distance under single and dual-task conditions was linearly but weakly associated with age (R² = 0.21 for single task, R² = 0.27 for dual-task). Age, disease, and beam width affected distance walked on the beam. Beam walking distance predicted future falls in the combined population of healthy adults and patients with neurological conditions. Based on receiver operating characteristic curve analyses using data from the entire study population, walking ~ 8.0 of the 12 m maximum on low-lying beams predicted future fallers with reasonable accuracy. Conclusion: Balance beam walking is a new but worthwhile measure of dynamic balance to predict falls in the combined population of healthy adults and patients with neurological conditions. Future studies are needed to evaluate the predictive capability of beam walking separately in more homogenous populations. Clinical Trial Registration Number NCT03532984.

Objective: To determine the effects of exergaming (EXE) on quality of life (QOL), motor, and clinical symptoms in multiple sclerosis (MS). We compared the effects of EXE, balance (BAL), cycling (CYC), proprioceptive neuromuscular facilitation (PNF), and a standard care wait-listed control group on clinical and motor symptoms and quality of life (QOL) in people with MS (PwMS) and determined the effects of subsequent maintenance programs for 2 years in a hospital setting. Design: A randomized controlled trial, using before-after test design. Setting: University hospital setting. Participants: Of 82 outpatients with MS, 70 were randomized (N=70), and 68 completed the study. Interventions: The initial high-intensity and high-frequency interventions consisted of 25 one-hour sessions over 5 weeks. After the 5-week-long initial intervention, the 2-year-long maintenance programs followed, consisting of 3 sessions per week, each for 1 hour. Main Outcome Measures: The primary outcome: Multiple Sclerosis Impact Scale (MSIS-29). Secondary outcomes: Measures 5 aspects of health-related QOL (EuroQol 5-Dimension questionnaire), Beck Depression Inventory, 6-minute walk test (6MWT), Berg Balance Scale (BBS), Tinetti Assessment Tool (TAT), and static BAL (center of pressure). Results: MSIS-29 improved most in EXE (11 points), BAL (6), and CYC (6) (all P<.05). QOL improved most in EXE (3 points), CYC, and BAL (2) (all P<.05). TAT and BBS improved significantly (P<.05) but similarly (P>.05) in EXE, BAL, and CYC. 6MWT improved most in EXE (57m), BAL (32m), and CYC (19m) (all P<.001). Standing sway did not change. Maintenance programs further increased the initial exercise-induced gains, robustly in EXE. Conclusions: A total of 25 sessions of EXE, BAL, CYC, and PNF, in this order, improved clinical and motor symptoms and QOL, and subsequent 2-year-long thrice weekly maintenance programs further slowed symptom worsening and improved QOL. EXE was the most and PNF was the least effective to improve clinical symptoms, motor function, and QOL in PwMS.

Introduction: There are scant data to demonstrate that the long-term non-pharmaceutical interventions can slow the progression of motor and non-motor symptoms and lower drug dose in Parkinson's disease (PD). Methods: After randomization, the Exercise-only (E, n = 19) group completed an initial 3-week-long, 15-session supervised, high-intensity sensorimotor agility exercise program designed to improve the postural stability. The Exercise + Maintenance (E + M, n = 22) group completed the 3-week program and continued the same program three times per week for 6 years. The no exercise and no maintenance control (C, n = 26) group continued habitual living. In each patient, 11 outcomes were measured before and after the 3-week initial exercise program and then, at 3, 6, 12, 18, 24, 36, 48, 60, and 72 months. Results: The longitudinal linear mixed effects modeling of each variable was fitted with maximum likelihood estimation and adjusted for baseline and covariates. The exercise program strongly improved the primary outcome, Motor Experiences of Daily Living, by ~7 points and all secondary outcomes [body mass index (BMI), disease and no disease-specific quality of life, depression, mobility, and standing balance]. In E group, the detraining effects lasted up to 12 months. E+M group further improved the initial exercise-induced gains up to 3 months and the gains were sustained until year 6. In C group, the symptoms worsened steadily. By year 6, levodopa (L-dopa) equivalents increased in all the groups but least in E + M group. Conclusion: A short-term, high-intensity sensorimotor agility exercise program improved the PD symptoms up to a year during detraining but the subsequent 6-year maintenance program was needed to further increase or sustain the initial improvements in the symptoms, quality of life, and drug dose.