Walkbot Robotic Training for Improvement in Gait

Walkbot Robotic Training for Improvement in Gait in Sub-Acute Stroke

This clinical study will involve up to 30 ischemic stroke inpatients during their stay at Burke Rehabilitation Hospital. Participants will be randomized to receive 30 additional minutes of therapy every day, for a total of 2 weeks (14 days). One group will receive 30 minutes of standard physical therapy focused on pre-gait or gait training activities, while the experimental group will receive 30 minutes of Walkbot with Augmented Reality. Both groups will receive the same time in therapy aimed at gait training.

Study Overview

• Status: Completed
• Conditions: Ischemic Stroke; Gait, Hemiplegic
• Intervention / Treatment: Device: Walkbot; Behavioral: Physical Therapy

Detailed Description

This controlled clinical study will involve 30 ischemic stroke inpatients during their stay at Burke Rehabilitation Hospital (typical inpatient arrives 7 days post-stroke and is admitted for ~16 days).

Stroke inpatients will be sequentially randomized into one of two groups within the first week after admission. Both Groups will receive 30 additional minutes of therapy every day, for a total of 2 weeks (14 days). Group A will enroll 15 patients who will receive usual inpatient care including at least one 60-minute session of physical therapy per day, and an additional 30-minute session of standard physical therapy focused on pre-gait and/or gait training activities 5-days per week during the duration of their stay (14 days). Group B will enroll 15 patients who receive usual inpatient care that includes at least one 60-minute session of physical therapy and an additional 30-minute session of Walkbot with Augmented Reality 5-days per week during the duration of their stay (14 days). Both groups will receive the same time in therapy aimed at gait training. The extra therapy group will not exceed more than 15 minutes of pregait training before starting to walk the patient, and will spend at least 15 minutes doing active gait training per session. Patients in the treatment group will receive 30 minutes of total training on the Walkbot, excluding setup time. Primary and secondary outcomes will be collected, prior to the first therapy session. Follow up outcome measures will be collected within two days after the final interventional (study) therapy session. The amount of therapists needed for each session will be logged for every patient after Walkbot training or extra physical therapy. Borg rating of perceived exertion will be taken after each session from the patients, and NASA Task Load Index will be completed by the therapists (ie therapist load). Outcomes will be analyzed for significant differences.

• Study Type: Interventional
• Enrollment (Anticipated): 30
• Phase: Phase 3

Contacts and Locations

Study Locations

• United States
  • New York
    • White Plains, New York, United States, 10605
      • Burke Medical Research Institute

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years to 97 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Cortical/subcortical ischemic stroke
• 1st time clinical stroke presentation, or prior stroke with no residual deficits affecting ambulation
• Ability to follow 2 step commands
• Fugl Meyer Sensory Score > 2
• Suitability for gait training as assessed clinically (ability to ambulate at least one step with a device/assistance)
• Height 132 cm- 200 cm; hip-knee joint length: 33 cm- 48 cm; knee joint-foot: 33 cm-48 cm

Exclusion Criteria:

• Cerebellar/brainstem stroke
• Body weight >135 kg
• Uncontrolled high blood pressure (stage 2) higher than 160 (systolic)/ 100 (diastolic)
• Cardiopulmonary system impairments affecting the ambulation test.
• Integumentary impairment: skin breakdown and bedsore around the loading area of the suspension belt
• No previous robotic intervention for ambulation training
• Significant and persistent mental illness.
• A fixed contracture or deformity in lower extremity.
• Bone instability (non-consolidated fractures, unstable spinal column, severe osteoporosis necessitating treatment with bisphosphonates).
• Other neurodegenerative disorders (Amyotrophic lateral sclerosis, Parkinsonian disorder).
• Modified Ashworth scale >3 in affected leg.
• Significant back or leg pain that creates an inability to tolerate movement.
• Decreased sensation that will impair patient's ability to percept whether the device is properly fitted
• Aphasia of a degree that would prevent the patient from communicating discomfort.
• Inability to tolerate the Walkbot device or ambulation therapy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Walkbot Training; This group will receive usual inpatient care that includes at least one 60-minute session of physical therapy and an additional 30-minute session of Walkbot with Augmented Reality 5-days per week during the duration of their stay (14 days).	Device: Walkbot; Walkbot is a Robot Assisted Gait Training System. This system is designed to maximize muscle strength, range of joint motion, and gait function while participants engage in a virtual reality game.
Active Comparator: Physical Therapy; This group will receive usual inpatient care including at least one 60-minute session of physical therapy per day, and an additional 30-minute session of standard physical therapy focused on pre-gait and/or gait training activities 5-days per week during the duration of their stay (14 days).	Behavioral: Physical Therapy; 30-minute session of standard physical therapy focused on pre-gait and/or gait training activities 5-days per week during the duration of their stay (14 days).
No Intervention: Usual Care Physical Therapy; Participants in this group will receive usual inpatient care including at least one 60-minute session of physical therapy per day.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Fugl Meyer Assessment	Lower extremity impairment measure	Discharge evaluation (within 2 days after last session)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
NIH Stroke Scale	Quantitative measure of stroke-related neurological deficit; The scale is comprised of 11 items with a maximal score of 42 and minimum of 0. Higher scores indicate severe stroke.	Baseline assessment and discharge evaluation within 2 days after last session
Modified Ashworth Scale	Measure of spasticity; Each muscle assessed is scored between 0-4, with 4 indicating rigid limbs or very severely affected.	Baseline assessment and discharge evaluation within 2 days after last session
Functional Ambulation Classification	Clinical measure of mobility	Baseline assessment and discharge evaluation within 2 days after last session
6 Minute Walk Test	Measures the distance that a patient can walk on a flat, hard surface in a period of 6 minutes.	Baseline assessment and discharge evaluation within 2 days after last session
10 Meter Walk Test	Examines gait speed	Baseline assessment and discharge evaluation within 2 days after last session
Timed Up and Go	Assesses mobility in both static and dynamic balance	Baseline assessment and discharge evaluation within 2 days after last session
Berg Balance Scale	Assesses balance during a series of 14 tasks; higher scores indicate greater independence.	Baseline assessment and discharge evaluation within 2 days after last session
Burke Lateropulsion Scale	5 item scale measures lateropulsion or "Pusher Syndrome" by assessing reaction to change in postural position; 0 = no lateropulsion, 17= maximum score.	Baseline assessment and discharge evaluation within 2 days after last session
Beck Depression Inventory	21 question, multiple choice, self-report inventory to assess depression; score of 0= minimal depression, 63= severe depression.	Baseline assessment and discharge evaluation within 2 days after last session

Collaborators and Investigators

• Sponsor: Burke Medical Research Institute
• Collaborators: P&S Mechanics Co., Ltd.
• Investigators: Principal Investigator: Kathleen Friel, PhD, Burke Medical Research Institute

Publications and helpful links

General Publications

• Park C, Oh-Park M, Bialek A, Friel K, Edwards D, You JSH. Abnormal synergistic gait mitigation in acute stroke using an innovative ankle-knee-hip interlimb humanoid robot: a preliminary randomized controlled trial. Sci Rep. 2021 Nov 24;11(1):22823. doi: 10.1038/s41598-021-01959-z.

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2016
• Primary Completion (Actual): December 1, 2018
• Study Completion (Actual): December 1, 2019

Study Registration Dates

• First Submitted: May 15, 2018
• First Submitted That Met QC Criteria: May 31, 2018
• First Posted (Actual): June 13, 2018

Study Record Updates

• Last Update Posted (Actual): January 14, 2020
• Last Update Submitted That Met QC Criteria: January 13, 2020
• Last Verified: January 1, 2020

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Cerebrovascular Disorders; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurologic Manifestations; Stroke; Ischemic Stroke; Gait Disorders, Neurologic
• Other Study ID Numbers: BRC532

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No
• IPD Plan Description: No plan to share individual participant data with other researchers at this time.

Drug and device information, study documents

• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: No