The eﬀects of robot-assisted gait training combined with non-invasive brain stimulation on lower limb function in patients with stroke and spinal cord injury: A systematic review and meta-analysis

Frontiers in Human Neuroscience, 2022 · DOI: 10.3389/fnhum.2022.969036 · Published: August 16, 2022

Assistive Technology Neurology Rehabilitation

Simple Explanation

This study investigates if combining robot-assisted gait training (RAGT) with non-invasive brain stimulation (NIBS) improves lower limb function in stroke and spinal cord injury (SCI) patients. The researchers analyzed data from multiple studies to see if the combined treatment was more effective than RAGT alone or sham stimulation. The results showed that the combined therapy improved lower limb function but not activities like gait velocity, suggesting a limited benefit for walking speed.

Study Duration

Not specified

Participants

104 patients with stroke and spinal cord injury

Evidence Level

Systematic Review and Meta-Analysis of RCTs

Key Findings

1
RAGT combined with NIBS significantly improved lower limb function compared to RAGT with sham stimulation.
2
The meta-analysis showed no significant improvement in lower limb activities (gait velocity) with the combined therapy.
3
Subgroup analyses failed to find a greater improvement in lower limb function of RAGT with tDCS compared to sham stimulation.

Research Summary

This meta-analysis demonstrated that RAGT therapy in combination with NIBS was eﬀective in patients with stroke and SCI. However, a greater improvement in lower limb function and activities were not observed using RAGT with tDCS compared to sham stimulation. Additional future studies related to RAGT combined with rTMS or diﬀerent NIBS implementations such as tACS and tRNS are warranted.

Practical Implications

Clinical Practice

Combining RAGT with NIBS may benefit lower limb function, but not necessarily gait velocity, in stroke and SCI patients.

Future Research

Further studies are needed to explore the effectiveness of rTMS and other NIBS techniques (tACS, tRNS) in conjunction with RAGT.

Treatment Protocols

Consider the duration, electrode size, number, and placement when using tDCS in combination with RAGT.

Study Limitations

1
Difficulty in comparing outcomes due to different clinical measurements used across studies.
2
Limited number of studies (five RCTs) included in the meta-analysis.
3
Insufficient studies related to RAGT therapy combined with tDCS and rTMS.

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