外骨骼机器人辅助步态训练对脑卒中和脊髓损伤下肢功能康复效果的系统综述

doi:10.3969/j.issn.1006-9771.2025.08.007

Abstract

Abstract:

Objective To systematically evaluate robot-assisted gait training (RAGT) on motor function, ambulation and activities of daily living of patients after stroke and spinal cord injury (SCI), and to investigate the clinical value of different robotic technologies and control strategies.

Methods In accordance with PRISMA guidelines, relevant randomized controlled trials (RCTs) published between 2020 and 2024 were identified from databases including Scopus, Web of Science, PubMed, Cochrane Library and CNKI. The PEDro scale was used to assess methodological quality, and a comprehensive analysis was performed on the therapeutic effects of RAGT on walking ability, balance, lower limb muscle strength and functional independence.

Results Eight RCTs involving 702 participants were included, originating from countries such as China, Italy, India, Turkey and Poland. The population consisted of adult patients with various subtypes of stroke or SCI. These studies were published in journals across geriatric neuroscience, biosciences, medicine and sports science. Interventions involved three categories of lower limb exoskeleton including treadmill-based systems (end-effector and exoskeleton models), overground exoskeletons and specialized joint/platform-based robots. The training frequency was 20 to 45 minutes a time, once to twice a day, one to seven days a week, for a total of two to ten weeks. RAGT might significant improve gait parameters and lower limb muscle strength, though its impact on functional independence was heterogeneous. Adaptive control strategies (e.g., assist-as-needed) proved superior to fixed-parameter modes. Treadmill-based systems (e.g., Lokomat) were well-suited for early-stage rehabilitation, while overground exoskeletons (e.g., EKSO-GT) better facilitated adaptation to real-world environments.

Conclusion RAGT is an effective modality for improving gait and lower limb function of patients with stroke and SCI. The therapeutic outcome is contingent upon personalized setup of the exoskeleton and the implementation of adaptive control strategies. Different adaptive control modes have been developed for the three main types of lower limb exoskeleton. Rehabilitation training should consider the specific lower limb tasks with the robot's corresponding adaptive movement and control modes.

Key words: stroke, spinal cord injury, gait, lower limb motor function, exoskeleton, systematic review

CLC Number:

R741

WANG Xiaofeng, HU Mengqiao, WANG Yan, WEI Kun, XU Wenzhu, REN Dan, MA Ye. Effect of exoskeleton robot-assisted gait training on lower limb function after stroke and spinal cord injury: a systematic review[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(8): 914-921.

Figures/Tables 4

Table 1

Figure 1

Table 2

Table 3

Basic characteristics of included literatures"

纳入文献	国家	研究设计	样本特征(疾病、分期、n)	干预		主要结局指标	主要结局
纳入文献	国家	研究设计	样本特征(疾病、分期、n)	干预组	对照组	主要结局指标	主要结局
Li等^[15](2021)	中国	多中心、非劣效性、随机对照试验	脑卒中亚急性期 n = 130	设备：BEAR-H1 干预频率：每次30 min，每天2次，每周5 d 持续时间：4周	常规步行训练	6MWT FAC FMA-LE Vicon步态分析	运动功能 6MWT、FMA-LE、FAC、步频和步态周期改善功能独立性未提及
Hao等^[16] (2023)	中国	随机对照试验	卒中后偏瘫肢体痉挛 n = 99	设备：智能康复训练系统干预频率：15~30转/min，每次20 min，每天1次持续时间：10周	常规康复训练系统，脑机接口康复训练系统	改良Ashworth量表 BBS Fugl-Meyer评定量表 BI	运动功能平衡能力改善运动功能显著改善功能独立性日常生活活动能力提高痉挛程度改善
Tarnacka等^[17](2023)	波兰	单中心、单盲、随机对照试验	脊髓损伤亚急性期 n = 105	设备：EKSO-GT/Lokomat 干预频率：每次30 min，每周6 d 持续时间：7周	动态直立行走架训练	MS WISCI-II SCIM-III BI	运动功能步态功能改善运动评分提高功能独立性未提及
Meng等^[18](2022)	中国	单盲、随机对照试验	急性缺血性脑卒中 n = 192	设备：Walkbot 干预频率：每天 45 min，每周3 d 持续时间：4周	强化下肢训练常规康复治疗	6MWT FAC TUGT DTW Tinetti测试 BI SS-QOL 步态分析	运动功能步态参数改善身体活动能力增加功能独立性日常生活活动能力提高
Mıdık等^[19](2020)	土耳其	随机对照试验	不完全性创伤性脊髓损伤(男性) n = 30	设备：Lokomat Pro 干预频率：每次30 min，每周3次持续时间：5周	常规康复	LEMS SCIM-III WISCI-II	运动功能下肢运动功能显著改善功能独立性功能独立性有所提高
Pournajaf等^[20](2023)	意大利	随机对照试验	亚急性卒中 n = 89	设备：Lokomat-Pro和G-EO System^TM 干预频率：每次30 min，每周3~5次持续时间：6 周	物理治疗(如上肢康复、功能任务练习和肌肉强化)、言语治疗和/或职业治疗	10MWT 6MWT 改良BI	运动功能步态功能和耐力改善功能独立性日常生活活动能力提高
Elmas Bodur等^[21](2024)	土耳其	随机对照试验	脑卒中 n = 32	设备：ExoAthlet和Lokomat Free-D 干预频率：每次30 min，每周3次持续时间：8周	常规物理治疗	30秒椅子站立测试 6MWT SF-36	运动功能步态功能改善功能独立性生活质量提升
Gupta等^[22](2023)	印度	随机对照试验	慢性脑卒中 n = 25	设备：MARS 干预频率：每次30 min，每周5~6次持续时间：共2周	常规踝关节康复	10MWT 6MWT TUGT FAC 改良Rankin量表	运动功能步速和耐力显著提高功能独立性独立性得到改善

Table 3

References 26

[1]	GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet Neurol, 2021, 20(10): 795-820.
[2]	World Stroke Organization. World Stroke Organization Annual Report 2018[R/OL]. (2018-03-10)[2025-03-13]. https://www.world-stroke.org/assets/downloads/Annual_Report_2018_online_fnal_COMPRESSED.pdf.
[3]	FEIGIN V L, BRAININ M, NORRVING B, et al. World Stroke Organization: Global Stroke Fact Sheet 2025[J]. Int J Stroke, 2025, 20(2): 132-144. doi: 10.1177/17474930241308142 pmid: 39635884
[4]	BICKENBACH J, OFFICER A, SHAKESPEARE T, et al. International perspectives on spinal cord injury: summary[R]. Geneva: World Health Organization, 2013.
[5]	FEIGIN V L, BRAININ M, NORRVING B, et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2022[J]. Int J Stroke, 2022, 17(1): 18-29. doi: 10.1177/17474930211065917 pmid: 34986727
[6]	DIPIRO N D, EMBRY A E, FRITZ S L, et al. Effects of aerobic exercise training on fitness and walking-related outcomes in ambulatory individuals with chronic incomplete spinal cord injury[J]. Spinal Cord, 2016, 54(9): 675-681. doi: 10.1038/sc.2015.212 pmid: 26666508
[7]	MEHRHOLZ J, THOMAS S, ELSNER B. Treadmill training and body weight support for walking after stroke[J]. Cochrane Database Syst Rev, 2017, 8(8): Cd002840.
[8]	林星茹, 赵盈喆, 刘亚, 等. 东亚地区物理治疗师配置、教育培训与职业准入体系的比较研究[J]. 中国康复理论与实践, 2022, 28(11): 1334-1341. doi: 10.3969/j.issn.1006-9771.2022.11.013
	LIN X R, ZHAO Y Z, LIU Y, et al. Comparative study of physical therapist allocation, education and training, and professional accreditation system in East Asia[J]. Chin J Rehabil Theory Pract, 2022, 28(11): 1334-1341.
[9]	ALQAHTANI M S, COOPER G, DIVER C, et al. Exoskeletons for lower limb applications: a review[M]//BÁRTOLO P J, BIDANDA B. Bio-materials and prototyping applications in medicine. Cham: Springer International Publishing, 2021: 139-164.
[10]	GORGEY A S, WADE R, SUMRELL R, et al. Exoskeleton training may improve level of physical activity after spinal cord injury: a case series[J]. Top Spinal Cord Inj Rehabil, 2017, 23(3): 245-255. doi: 10.1310/sci16-00025 pmid: 29339900
[11]	MEHRHOLZ J, THOMAS S, WERNER C, et al. Electromechanical-assisted training for walking after stroke[J]. Cochrane Database Syst Rev, 2017, 5(4): CD006185.
[12]	SONG K J, CHUN M H, LEE J, et al. The effect of robot-assisted gait training on cortical activation in stroke patients: a functional near-infrared spectroscopy study[J]. NeuroRehabilitation, 2021, 49(1): 65-73. doi: 10.3233/NRE-210034 pmid: 33998555
[13]	PAGE M J, MCKENZIE J E, BOSSUYT P M, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews[J]. BMJ, 2021, 372(29): n71.
[14]	CASHIN A G, MCAULEY J H. Clinimetrics: Physiotherapy Evidence Database (PEDro) Scale[J]. J Physiother, 2020, 66(1): 59. doi: S1836-9553(19)30092-X pmid: 31521549
[15]	LI Y, FAN T, QI Q, et al. Efficacy of a novel exoskeletal robot for locomotor rehabilitation in stroke patients: a multi-center, non-inferiority, randomized controlled trial[J]. Front Aging Neurosci, 2021, 23(13): 706569c.
[16]	HAO M, FANG Q, WU B, et al. Rehabilitation effect of intelligent rehabilitation training system on hemiplegic limb spasms after stroke[J]. Open Life Sci, 2023, 18(1): 20220724.
[17]	TARNACKA B, KORCZYŃSKI B, FRASUŃSKA J. Impact of robotic-assisted gait training in subacute spinal cord injury patients on outcome measure[J]. Diagnostics (Basel), 2023, 13(11): 1966.
[18]	MENG G, MA X, CHEN P, et al. Effect of early integrated robot-assisted gait training on motor and balance in patients with acute ischemic stroke: a single-blinded randomized controlled trial[J]. Ther Adv Neurol Disord, 2022, 15(3): 17562864221123195.
[19]	MIDIK M, PAKER N, BUĞDAYCI D, et al. Effects of robot-assisted gait training on lower extremity strength, functional independence, and walking function in men with incomplete traumatic spinal cord injury[J]. Turk J Phys Med Rehabil, 2020, 66(1): 54-59.
[20]	POURNAJAF S, CALABRÒ R S, NARO A, et al. Robotic versus conventional overground gait training in subacute stroke survivors: a multicenter controlled clinical trial[J]. J Clin Med, 2023, 12(2): 439.
[21]	ELMAS BODUR B, ERDOĞANOĞLU Y, ASENA SEL S. Effects of robotic-assisted gait training on physical capacity, and quality of life among chronic stroke patients: a randomized controlled study[J]. J Clin Neurosci, 2024, 120(2): 129-137.
[22]	GUPTA A, PRAKASH N B, SANNYASI G, et al. Effect of overground gait training with 'Mobility Assisted Robotic System-MARS' on gait parameters in patients with stroke: a pre-post study[J]. BMC Neurol, 2023, 23(1): 296. doi: 10.1186/s12883-023-03357-6 pmid: 37558991
[23]	CALABRÒ R S, BILLERI L, CIAPPINA F, et al. Toward improving functional recovery in spinal cord injury using robotics: a pilot study focusing on ankle rehabilitation[J]. Expert Rev Med Devices, 2022, 19(1): 83-95.
[24]	CHEN S C, KANG J H, PENG C W, et al. Adjustable parameters and the effectiveness of adjunct robot-assisted gait training in individuals with chronic stroke[J]. Int J Environ Res Public Health, 2022, 19(13): 8186.
[25]	FIROUZI V, SEYFARTH A, SONG S, et al. Biomechanical models in the lower-limb exoskeletons development: a review[J]. J Neuroeng Rehabil, 2025, 22(1): 12. doi: 10.1186/s12984-025-01556-5 pmid: 39856714
[26]	RV M, RAKSHIT S. Deep reinforcement learning based control of lower limb exoskeleton[C]. Yokohama, Japan:2024 International Joint Conference on Neural Networks (IJCNN), 2024.

纳入文献	资格标准	随机分配	分配隐藏	基线相似	被试施盲	治疗师施盲	被试流失率< 15%	意向治疗分析	组间统计比较	报告点测量和变异量值	总分
Li等^[15](2021)	√	√	√	√	√		√	√	√	√	8
Hao等^[16](2023)	√	√	√	√	√	√	√	√	√	√	9
Tarnacka等^[17](2023)	√	√	√	√	√	√		√	√	√	8
Meng等^[18](2022)	√	√	√	√	√	√	√	√	√	√	9
Mıdık等^[19](2020)	√	√	√	√	√	√	√	√	√	√	9
Pournajaf等^[20](2023)	√	√	√	√	√	√		√	√	√	8
Elmas Bodur等^[21](2024)	√	√	√	√			√	√	√	√	7
Gupta等^[22](2023)	√	√	√	√			√	√	√	√	7

Effect of exoskeleton robot-assisted gait training on lower limb function after stroke and spinal cord injury: a systematic review

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