Early Robotic Gait Training After Stroke

The 10MWT assesses gait speed over a short duration. Gait speed (m/s) is correlated with ability to mobilize in the community, capacity to perform activities of daily living, and risk of falls, re-hospitalization, and cognitive decline. The 10MWT can be used to categorize individuals according to their ambulatory ability: household ambulators (<0.4 m/s), limited community ambulators (0.4 to 0.8 m/s), and community ambulators (>0.8 m/s). Score changes >0.16 m/s exceed the MCID. Normal gait speed for adults older than 50 years is >1.27 m/s.

The FAC assesses functional ambulation in patients undergoing rehabilitation and has excellent reliability, good predictive validity, and good responsiveness in patients with stroke. Scores range from 0 (unable to walk) to 5 (independent walking anywhere). After 4 weeks of rehabilitation, FAC scores ≥4 predict community ambulation at 6 months with 100% sensitivity and 78% specificity.

The Section GG CARE is utilized in post-acute care settings for tracking progress across the continuum of care and is conducted at admission and discharge. The CARE addresses self-care (GG0130, 8 items) and functional mobility (GG0170, 17 items). Scores for each item range from 1 (dependent) to 6 (independent). Total scores for the CARE have strong positive correlations with total scores for the Functional Independence Measure.

The 6MWT assesses distance walked over 6 minutes as a sub-maximal test of walking capacity. Endurance (captured as walking capacity) is essential to participate in community-based activities. With excellent test-retest reliability (ICC = 0.99) for people with stroke, the established MCID is 34.4 meters.

The mRS measures the degree of disability or dependence in the daily activities of people who have had a stroke. The mRS is an ordinal scale with 6 categories ranging from 0 (no symptoms) to 5 (complete physical dependence).

The STREAM assesses upper and lower limb motor function along with basic mobility in people with stroke and has a very high inter-rater reliability (ICC = 0.96). MCID values have been established for the upper extremity (2.2 points), lower extremity (1.9 points), and mobility (4.8 points) subscales.

The 5TSST assesses lower extremity strength and is an indicator of postural control. People with stroke who score >15 seconds are considered at risk for falls. Normal scores for individuals aged 60-80 years range from 11.4 to 12.7 seconds. The 5TSST has demonstrated excellent test-retest reliability (ICC = 0.95) with an established MDC95 of 2.3 seconds.

The BBS is a 14-item objective measure that assesses static balance and fall risk in adults. With excellent reliability (ICC = 0.95), the BBS has a large responsiveness for acute stroke (effect size = 0.85) and a minimal detectable change of 6.9 points. Scores <45/56 indicate a risk of falling.

The SIS-16 assesses 4 dimensions of health-related QOLs specific to people who have had a stroke. It includes subscales that assess strength, hand function, mobility, and activities of daily living via 5-point Likert scales.

The Borg RPE is a 15-point scale with verbal descriptors to standardize perceived exertion across tasks and individuals. Participants will be asked to provide a self-reported intensity level on the Borg Rating of Perceived Exertion Scale during RGT and UC gait training sessions. A self-report of 12 to 14 on the RPE indicates moderate intensity.

The Ekso device records several data points for each session including number of steps, "Up" time (the amount of time spent standing in the device), "Walk" time (the amount of time spent walking in the device), and device assistance scores. While all of these data values will be recorded to describe each RGT session and tracked to monitor progression of the RGT intervention, the number of steps per session will be utilized as an indicator of RGT session intensity.

Distance walked will be recorded to describe each UC session, tracked to monitor progression of the UC intervention, and utilized as an indicator of UC session intensity.

To supplement the study's measurements of RGT efficacy (10-meter walk test [gait speed], 6-minute walk test [gait endurance], and Functional Ambulation Category [gait independence]), the investigators will additionally measure gait quality. Improvements in quality of gait after a stroke are associated with gains in balance and functional mobility. Further, return to participation in life roles is largely associated with a patients' perspective on their recovery. Therefore, the most impactful way to capture gait quality for each participant will be to use a measure of self-report. Specifically, gait quality will be measured weekly on a visual analog scale from 1 ("my walking is the worst it has ever been") to 10 ("my walking is just like before my stroke").

Pain after stroke is common and can result in reduced participation in activity. This change will allow the investigators to monitor the impact of pain on gait outcomes. Pain will be assessed following each RGT and UC session using a pain visual analog scale, as per standard of care in the investigators' inpatient rehabilitation hospital.

Number of adverse events occurring at baseline through study completion.

Subjects will provide feedback on their tolerance of treatment sessions via a questionnaire that measures tolerability on a scale 0 (not tolerable at all) to 10 (maximally tolerable). A higher score means greater tolerability in robotic gait training.

The number of sessions attended divided by the number of scheduled sessions.