• Franco Molteni, Giulio Gasperini, Marina Gaffuri, Maria Colombo, Chiara Giovanzana, Chiara Lorenzon, Nico Farina, Giovanni Cannaviello, Stefano Scarano, Davide Proserpio, Davide Liberali, and Eleonora Guanziroli.
• Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy.
• Eur J Phys Rehabil Med. 2017 Oct 1; 53 (5): 676-684.

BackgroundRecovery 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.AimTo 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.DesignProspective, pilot pre-post, open label, non-randomized experimental study.SettingA single neurological rehabilitation center for inpatients and outpatients.PopulationTwenty-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.MethodsPatients 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.ResultsStatistically 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.ConclusionsTwelve 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.Clinical Rehabilitation ImpactTo plan a completely new individual tailored robotic rehabilitation strategy after stroke, including task-oriented over-ground gait training.

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