Examination of Sustained Gait Speed During Extended Walking in Individuals With Chronic Stroke

Objectives

To determine if individuals with chronic stroke were able to sustain their peak gait speed during the 6-minute walk test (6MWT), and to explore this sustainability across community ambulation potential subgroups.

Design

Prospective cross-sectional study.

Setting

University-based research laboratory, hospitals, and stroke support groups.

Participants

A sample of individuals with chronic stroke (N=48) completed a series of questionnaires and physical outcome measures, including gait mat assessment, during a single visit.

Interventions

Not applicable; 1-time cross-sectional data collection.

Main Outcome Measures

During the 6MWT, we measured peak gait speed and end gait speed to assess sustainability, along with beginning gait speed, total distance walked, and rating of perceived exertion. We also assessed maximum gait speed during the 10-meter walk test (10MWT). Finally, we examined these gait outcomes across the subgroups.

Results

During the 6MWT, peak gait speed declined from .89m/s (SD=.38) to an end speed of .82m/s (SD=.36), whereas perceived exertion increased from 7.7 (SD=2.6) to 11.8 (SD=3.6). This peak gait speed was slower than the 10MWT maximum speed of 1.06m/s (SD=.51), but faster than the 6MWT beginning speed of .81m/s (SD=.34). The unlimited community ambulator subgroup was the primary contributor to sustainability differences.

Conclusions

Predicting community ambulation potential based on the discrete gait speed from the 10MWT and endurance based on the average from the 6MWT might be incomplete if gait speed sustainability is not also assessed.     

Understanding Therapeutic Benefits of Overground Bionic Ambulation: Exploratory Case Series in Persons With Chronic,Complete Spinal Cord Injury

Objective

To explore responses to overground bionic ambulation (OBA) training from an interdisciplinary perspective including key components of neuromuscular activation, exercise conditioning, mobility capacity, and neuropathic pain.

Design

Case series.

Setting

Academic research center.

Participants

Persons (N=3; 2 men, 1 woman) aged 26 to 38 years with complete spinal cord injury (SCI) (American Spinal Injury Association Impairment Scale grade A) between the levels of T1 and T10 for ≥1 year.

Intervention

OBA 3d/wk for 6 weeks.

Main Outcome Measures

To obtain a comprehensive understanding of responses to OBA, an array of measures were obtained while walking in the device, including walking speeds and distances, energy expenditure, exercise conditioning effects, and neuromuscular and cortical activity patterns. Changes in spasticity and pain severity related to OBA use were also assessed.

Results

With training, participants were able to achieve walking speeds and distances in the OBA device similar to those observed in persons with motor-incomplete SCI (10-m walk speed, .11–.33m/s; 2-min walk distance, 11–33m). The energy expenditure required for OBA was similar to walking in persons without disability (ie, 25%–41% of peak oxygen consumption). Subjects with lower soleus reflex excitability walked longer during training, but there was no change in the level or amount of muscle activity with training. There was no change in cortical activity patterns. Exercise conditioning effects were small or nonexistent. However, all participants reported an average reduction in pain severity over the study period ranging between −1.3 and 1.7 on a 0-to-6 numeric rating scale.

Conclusions

OBA training improved mobility in the OBA device without significant changes in exercise conditioning or in neuromuscular or cortical activity. However, pain severity was reduced and no severe adverse events were encountered during training. OBA therefore opens the possibility to reduce the common consequences of chronic, complete SCI such as reduced functional mobility and neuropathic pain.     

Evaluating the need for two incremental shuttle walk tests during a maintenance exercise program in people with COPD

Objective

To determine if there was an increase in walk distance when two incremental shuttle walk tests (ISWTs) were performed at the commencement of a maintenance exercise program (0 month) and at three, six and 12-month assessments.

Design

A prospective, longitudinal, repeated measures study in COPD.

Setting

Single site, hospital outpatient physiotherapy department.

Participants

Forty-eight participants (22 males) with COPD participated in the study: [baseline characteristics: mean (SD): FEV₁ 59 (19) % predicted; age 65 (8) years; BMI 26 (6) (kg/m²)].

Intervention

Participants completed two ISWTs at zero, three, six and twelve months.

Outcomes

Incremental shuttle walk distance (ISWD).

Results

There was a significant increase in walk distance between two ISWTs at zero month (17 metres (95% CI: 7 to 26) and three months (18 metres (95% CI: 6 to 30), but not at six or 12 months.

Conclusion

The increase in walk distance when a second ISWT was performed at zero and three months indicates the need to perform two ISWTs when participants are naïve to the test and at the three-month reassessment during a 12-month maintenance exercise program.     

Factors associated with ambulatory status 6 months after total hip arthroplasty

Objective

To identify an assessment tool and its cut-off point for indicating ambulatory status 6 months after total hip arthroplasty (THA).

Design

Cross-sectional study.

Setting

Kyoto University Hospital.

Participants

Eighty-eight patients who underwent unilateral THA.

Main outcome measure

Lower-extremity muscle strength, hip range of motion and hip pain were measured 6 months after THA. The patients were divided into two groups according to their ability to walk 6 months after THA: an independent ambulation group and a cane-assisted ambulation group.

Results

A stepwise multiple logistic regression analysis indicated that age and lower-extremity maximal load were significant variables affecting mid-term ambulatory status following THA. Receiver operating characteristic curve analyses revealed that ambulatory status following THA was indicated more accurately by leg extension strength (cut-off point = 8.24 N/kg, sensitivity = 92%, specificity = 82%, area under the curve = 0.93) than age.

Conclusion

Lower-limb load force with a cut-off point of 8.24 N/kg is a reliable assessment tool for indicating ambulatory status 6 months after primary THA.     

Influence of Inspiratory Muscle Weakness on Inspiratory Muscle Training Responses in Chronic Heart Failure Patients: A Systematic Review and Meta-Analysis

Objective

To determine whether the impact of inspiratory muscle weakness on inspiratory muscle training (IMT) affects inspiratory function and exercise capacity in chronic heart failure (CHF) patients.

Data Sources

Electronic searches were performed using the Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Cochrane Systematic Review, Embase, MEDLINE, and Physiotherapy Evidence Database (PEDro) databases up to August 2013.

Study Selection

Articles were included if participants had CHF and were >18 years old; the design was a randomized controlled trial; intervention was IMT; measurements were of inspiratory muscle function or exercise capacity; and the articles were published in English, Portuguese, or Spanish. Of the 1455 articles identified in the database searches, 9 studies met the inclusion criteria.

Data Extraction

Two independent reviewers selected and extracted information from articles and assessed the quality of the studies using the PEDro scale. The 2 reviewers discussed disagreements until consensus was achieved.

Data Synthesis

Meta-analyses compared IMT with controls/sham for maximal inspiratory pressure, sustained maximal inspiratory pressure, 6-minute walk distance, peak oxygen consumption, and minute ventilation after IMT. Subgroup analyses compared those with and without muscle weakness. CHF with inspiratory muscle weakness showed greater gains in the 6-minute walk distance and peak oxygen consumption compared with those with normative maximal inspiratory pressure. The mean quality analysis score was 7.1, and scores ranged from 6 to 10.

Conclusions

The results emphasize the importance of evaluating the inspiratory muscles to identify patients with CHF and inspiratory muscle weakness; subgroup that showed better results after IMT.     

Frontal plane compensatory strategies associated with self-selected walking speed in individuals post-stroke

Background

Approximately two out of three individuals post-stroke experience walking impairments. Frontal plane compensatory strategies (i.e. pelvic hiking and circumduction) are observed in post-stroke gait in part to achieve foot clearance in response to reduced knee flexion and ankle dorsiflexion. The objective of this study was to investigate the relationship between self-selected walking speed and the kinematic patterns related to paretic foot clearance during post-stroke walking.

Methods

Gait analysis was performed at self-selected walking speed for 21 individuals post-stroke. Four kinematic variables were calculated during the swing phase of the paretic limb: peak pelvic tilt (pelvic hiking), peak hip abduction (circumduction), peak knee flexion, and peak ankle dorsiflexion. Paretic joint angles were analyzed across self-selected walking speed as well as between functionally relevant ambulation categories (Household < 0.4 m/s, Limited Community 0.4–0.8 m/s, Community > 0.8 m/s).

Findings

While all subjects exhibited similar foot clearance, slower walkers exhibited greater peak pelvic hiking and less knee flexion, ankle dorsiflexion, and circumduction compared to faster walkers (P < .05). Additionally, four of the fastest walkers compensated for poor knee flexion and ankle dorsiflexion through large amounts of circumduction.

Interpretation

These findings suggest that improved gait performance after stroke, as measured by self-selected walking speed, is not necessarily always accomplished through gait patterns that more closely resemble healthy gait for all variables. It appears the ability to walk fast is achieved by either sufficient ankle dorsiflexion and knee flexion to achieve foot clearance or the employment of circumduction to overcome a deficit in either ankle dorsiflexion or knee flexion.     

Validity and Clinical Utility of Functional Assessments in Children With Cerebral Palsy

Objective

To examine the validity and clinical utility of functional assessments (1-minute walk test, 10-meter walk test, Timed Up & Go [TUG] test, Timed Up and Down Stairs [TUDS] test, sit-to-stand [STS] test, and lateral step-up [LSU] test).

Design

Cross-sectional study.

Setting

Four special schools for adolescents with physical disabilities.

Participants

Adolescents with spastic tetraplegia and diplegia (at levels I–III) were selected through convenience sampling (N=35; mean age, 14.97±2.03y).

Interventions

Not applicable.

Main Outcome Measures

GMFM-88 (dimensions D and E), 1-minute walk, 10-meter walk, TUG, TUDS, STS, and LSU tests. Data were analyzed using Pearson intercorrelations, multiple regression analysis, and multivariate analysis of variance (MANOVA).

Results

Significant moderate to high intercorrelations were found. Three significant positive predictors emerged (1-minute walk, 10-meter walk, and LSU) with the following regression equation: Y_{GMFM-88 (dimensions D and E)} = 5.708 + .402 × X_{1-minute walk} + .920 × X_LSU + .404 × X_{10-meter walk} The MANOVA was significant (Λ=.163, F=14.732, P<.001, η²=.596), and post hoc comparisons revealed significant differences across Gross Motor Function Classification System Expanded and Revised levels in all paired comparisons for the 1-minute walk and LSU tests. For the 10-meter walk test, significant differences were evident in the level I versus level III and level II versus level III comparisons. No significant differences were found in the 10-meter walk test between levels I and II.

Conclusions

These functional assessments (1-minute walk, LSU, and 10-meter walk tests) are simple to administer, quick, low cost, and user-friendly. Although these assessments are not a substitute for the criterion standard (GMFM-88), they may be used for a quick assessment in adolescents with cerebral palsy (levels I–III) either at school or during rehabilitation, especially when time is limited.     

Gait adaptation during walking on an inclined pathway following spinal cord injury

Background

Individuals with incomplete spinal cord injury need to be assessed in different environments. The objective of this study was to compare lower-limb power generation in subjects with spinal cord injury and healthy subjects while walking on an inclined pathway.

Methods

Eleven subjects with spinal cord injury and eleven healthy subjects walked on an inclined pathway at their natural gait speed and at slow gait speed (healthy subjects only). Ground reaction forces were recorded by force plates embedded in the inclined pathway and a 3-D motion analysis system recorded lower-limb motions. Data analysis included gait cycle parameters and joint peak powers. Differences were identified by student t-tests.

Findings

Gait cycle parameters were lower in spinal cord injury subjects compared to healthy subjects at natural speed but similar at slow gait speed. Subjects with spinal cord injury presented lower power at the ankle, knee and hip compared to healthy subjects at natural gait speed while only the power generation at push-off remained lower when the two groups performed at similar speed.

Interpretation

The most important differences are associated with the fact that individuals with spinal cord injury walk at a slower speed, except for the ankle power generation. This study demonstrated that, even with a good motor recovery, distal deficits remain and may limit the ability to adapt to uphill and downhill walking. Inclined pathways are indicated to train patients with spinal cord injury. Clinicians should focus on the speed of uphill and downhill walking and on the use of plantar flexors.     

Robotic Resistance/Assistance Training Improves Locomotor Function in Individuals Poststroke: A Randomized Controlled Study

Objective

To determine whether providing a controlled resistance versus assistance to the paretic leg at the ankle during treadmill training will improve walking function in individuals poststroke.

Design

Repeated assessment of the same patients with parallel design and randomized controlled study between 2 groups.

Setting

Research units of rehabilitation hospitals.

Participants

Patients (N=30) with chronic stroke.

Intervention

Subjects were stratified based on self-selected walking speed and were randomly assigned to the resistance or assistance training group. For the resistance group, a controlled resistance load was applied to the paretic leg at the ankle to resist leg swing during treadmill walking. For the assistance group, a load that assists swing was applied.

Main Outcome Measures

Primary outcome measures were walking speed and 6-minute walking distance. Secondary measures included clinical assessments of balance, muscle tone, and quality of life. Outcome measures were evaluated before and after 6 weeks of training and at 8 weeks' follow-up, and compared within group and between the 2 groups.

Results

After 6 weeks of robotic training, walking speed significantly increased for both groups, with no significant differences in walking speed gains observed between the 2 groups. In addition, 6-minute walking distance and balance significantly improved for the assistance group but not for the resistance group.

Conclusions

Applying a controlled resistance or an assistance load to the paretic leg during treadmill training may induce improvements in walking speed in individuals poststroke. Resistance training was not superior to assistance training in improving locomotor function in individuals poststroke.     

Health-Related Physical Fitness Measures: Reference Values and Reference Equations for Use in Clinical Practice

Objective

To provide reference values and reference equations for frequently used clinical field tests of health-related physical fitness for use in clinical practice.

Design

Cross-sectional design.

Setting

General community.

Participants

Convenience sample of volunteers (N=370) between 18 and 90 years of age were recruited from a wide range of settings (ie, work sites, schools, community centers for older adults) and different geographic locations (ie, urban, suburban, rural) in southeastern Norway.

Interventions

Not applicable.

Main Outcome Measures

The participants conducted 5 clinical field tests (6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, fingertip-to-floor test).

Results

The results of the field tests showed that performance remained unchanged until approximately 50 years of age; after that, performance deteriorated with increasing age. Grip strength (79%), meters walked in 6 minutes (60%), and seconds used on the stair test (59%) could be well predicted by age, sex, height, and weight in participants ≥50 years of age, whereas the performance on all tests was less well predicted in participants <50 years of age.

Conclusions

The reference values and reference equations provided in this study may increase the applicability and interpretability of the 6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, and fingertip-to-floor test in clinical practice.     

Different motor tasks impact differently on cognitive performance of older persons during dual task tests

Background

Dual task paradigm states that the introduction of a second task during a cognitive or motor performance results in a decreased performance in either task. Treadmill walk, often used in clinical applications of dual task testing, has never been compared to overground walk, to ascertain its susceptibility to interference from a second task. We compared the effects of overground and treadmill gait on dual task performance.

Methods

Gait kinematic parameters and cognitive performance were obtained in 29 healthy older adults (mean age 75 years, 14 females) when they were walking freely on a sensorized carpet or during treadmill walking with an optoelectronic system, in single task or dual task conditions, using alternate repetition of letters as a cognitive verbal task.

Findings

During overground walking, speed, cadence, step length stride length, and double support time (all with P value < 0.001) and cognitive performance (number of correct words, P < 0.001) decreased substantially from single to dual task testing. When subjects walked at a fixed speed on the treadmill, cadence decreased significantly (P = 0.005), whereas cognitive performance remained unaffected.

Interpretation

Both motor and cognitive performances decline during dual task testing with overground walking. Conversely, cognitive performance remains unaffected in dual task testing on the treadmill. In the light of current dual task paradigm, these findings may have relevant implication for our understanding of motor control, as they suggest that treadmill walk does not involve brain areas susceptible to interference from the introduction of a cognitive task.     

Relation Between Aerobic Capacity and Walking Ability in Older Adults With a Lower-Limb Amputation

Objectives

To determine the relative aerobic load, walking speed, and walking economy of older adults with a lower-limb prosthesis, and to predict the effect of an increased aerobic capacity on their walking ability.

Design

Cross-sectional.

Setting

Human motion laboratory at a rehabilitation center.

Participants

Convenience sample of older adults (n=36) who underwent lower-limb amputation because of vascular deficiency or trauma and able-bodied controls (n=21).

Interventions

Not applicable.

Main Outcome Measures

Peak aerobic capacity and oxygen consumption while walking were determined. The relative aerobic load and walking economy were assessed as a function of walking speed, and a data-based model was constructed to predict the effect of an increased aerobic capacity on walking ability.

Results

People with a vascular amputation walked at a substantially higher (45.2%) relative aerobic load than people with an amputation because of trauma. The preferred walking speed in both groups of amputees was slower than that of able-bodied controls and below their most economical walking speed. We predicted that a 10% increase in peak aerobic capacity could potentially result in a reduction in the relative aerobic load of 9.1%, an increase in walking speed of 17.3% and 13.9%, and an improvement in the walking economy of 6.8% and 2.9%, for people after a vascular or traumatic amputation, respectively.

Conclusions

Current findings corroborate the notion that, especially in people with a vascular amputation, the peak aerobic capacity is an important determinant for walking ability. The data provide quantitative predictions on the effect of aerobic training; however, future research is needed to experimentally confirm these predictions.     

Psychometric Properties of 2-Minute Walk Test: A Systematic Review

Objective

To systematically review the psychometric evidence on the 2-minute walk test (2MWT).

Data Sources

Electronic searches of databases including MEDLINE, CINAHL, Academic Search Premier, SPORTDiscus, PsycINFO, EMBASE, the Cochrane Library, and DARE were done until February 2014 using a combination of subject headings and free texts.

Study Selection

Studies were included if psychometric properties of the 2MWT were (1) evaluated; (2) written as full reports; and (3) published in English language peer-reviewed journals.

Data Extraction

A modified consensus-based standard for the selection of health measurement instruments checklist was used to rate the methodological quality of the included studies. A quality assessment for statistical outcomes was used to assess the measurement properties of the 2MWT.

Data Synthesis

Best-evidence synthesis was collated from 25 studies of 14 patient groups. Only 1 study was found that examined the 2MWT in the pediatric population. The testing procedures of the 2MWT varied across the included studies. Reliability, validity (construct and criterion), and responsiveness of the 2MWT also varied across different patient groups. Moderate to strong evidence was found for reliability, convergent validity, discriminative validity, and responsiveness of the 2MWT in frail elderly patients. Moderate to strong evidence for reliability, convergent validity, and responsiveness was found in adults with lower limb amputations. Moderate to strong evidence for validity (convergent and discriminative) was found in adults who received rehabilitation after hip fractures or cardiac surgery. Limited evidence for the psychometric properties of the 2MWT was found in other population groups because of methodological flaws.

Conclusions

There is inadequate breadth and depth of psychometric evidence of the 2MWT for clinical and research purposes—specifically, minimal clinically important changes and responsiveness. More good-quality studies are needed, especially in the pediatric population. Consensus on standardized testing procedures of the 2MWT is also required.     

The effect of a 3-month supervised exercise programme on gait parameters of patients with peripheral arterial disease and intermittent claudication

Background

The management of peripheral arterial disease with intermittent claudication includes angioplasty, pharmaceutical therapy, risk factor modification and exercise therapy. Supervised exercise programmes are used sporadically but may improve the distance that an individual with claudication can walk. The purpose of this study was to evaluate the effectiveness of a 3-month supervised exercise programme on improving gait parameters in patients with intermittent claudication.

Methods

12 participants were recruited (mean (SD) — age: 67.3 (6.8) years, height: 1.67 (0.09) m, mass: 79.4 (14.0) kg, ankle brachial pressure index: 0.73 (0.17)) from the local vascular unit and enrolled in a supervised exercise programme. Kinematic and kinetic data were collected at the following time points: pain-free walking, initial claudication pain, absolute claudication pain and after a patient-defined rest period. Data were collected before and after the 3-month supervised exercise programme.

Findings

No significant differences were found in any of the gait parameters post-intervention including pain-free walking speed (P = 0.274), peak hip extension (P = 0.125), peak ankle plantarflexion (P = 0.254), or first vertical ground reaction force peak (P=0.654). No significant gait differences were found across different levels of pain pre- or post-intervention.

Interpretation

The lack of improvement post-intervention observed suggests that the current exercise protocol was not tailored to elicit significant improvements in patients with intermittent claudication, specifically. The results indicate that exercise programmes may show improved results post-intervention if they are longer in duration and varied in intensity. Further research into more detailed muscle and biomechanical adaptations is needed to inform exercise programmes specific to this population.     

What Is the Relation Between Fear of Falling and Physical Activity in Older Adults?

Objective

To describe the association between fear of falling (FOF) and total daily activity in older adults.

Design

Cross-sectional observational study.

Setting

Ambulatory clinical research training center.

Participants

Community-dwelling older adults aged ≥64 years (N=78), who were independent in ambulation with or without an assistive device.

Interventions

Not applicable.

Main Outcome Measures

FOF was defined by self-reported fear ratings using the Survey of Activities and Fear of Falling in the Elderly and self-reported fear status determined by response to the following question: Are you afraid of falling? Physical function was assessed using the Late Life Function and Disability Instrument. Physical activity was recorded using an accelerometer worn on the waist for 7 consecutive days, and mean daily counts of activity per minute were averaged over the 7-day period.

Results

Fear ratings were related to total daily activity (r=−.26, P=.02). The relation was not as strong as the relation of function and physical activity (r=.45, P<.001). When stratified by exercise status or functional status, fear was no longer related to total daily activity. Physical function explained 19% of the variance in physical activity, whereas the addition of fear status did not add to the explained variance in physical activity.

Conclusions

FOF is related to total daily physical activity; however, FOF was not independently associated with physical activity when accounting for physical function. Some FOF may be reported as a limitation in function.     

Locomotion Improvement Using a Hybrid Assistive Limb in Recovery Phase Stroke Patients: A Randomized Controlled Pilot Study

Objective

To compare the efficacy of gait training using a single-leg version of the Hybrid Assistive Limb (HAL) on the paretic side with conventional gait training in individuals with subacute stroke.

Design

Randomized open controlled pilot trial.

Setting

Hospitalized care.

Participants

Convenience sample of 44 patients who met the criteria; 12 patients refused. After randomization (N=32), 10 patients withdrew and a total of 22 poststroke participants (HAL group: n=11; conventional group: n=11) completed the randomized controlled trial.

Interventions

All participants received twelve 20-minute sessions in 4 weeks of either HAL (wearing the single-leg version of the HAL on their paretic side) or conventional (performed by skilled and experienced physical therapists) gait training.

Main Outcome Measures

Outcome measures were evaluated prior to training and after 12 sessions. Functional Ambulation Category (FAC) was the primary outcome measure, whereas secondary outcome measures included maximum walking speed, timed Up and Go test, 6-minute walk distance, Short Physical Performance Battery, Fugl-Meyer Assessment of Lower Extremity, and isometric muscle strength (hip flexion and extension, knee flexion and extension).

Results

No participants withdrew because of adverse effects. Participants who received gait training with the HAL showed significantly more improvement in the FAC than those who received conventional gait training (95% confidence interval, .02–.88; P=.04). Secondary measures did not differ between the 2 groups.

Conclusions

The results obtained in this randomized controlled trial suggest that a gait training program with the HAL could improve independent walking more efficiently than conventional gait training.     

A Comparison of Robotic Walking Therapy and Conventional Walking Therapy in Individuals With Upper Versus Lower Motor Neuron Lesions: A Randomized Controlled Trial

Objective

To compare a walking reeducation program with robotic locomotor training plus overground therapy (LKOGT) to conventional overground training (OGT) in individuals with incomplete upper motor neuron (UMN) or lower motor neuron (LMN) injuries having either traumatic or nontraumatic nonprogressive etiology.

Design

Randomized open controlled trial with blind evaluation by an independent observer.

Setting

An inpatient spinal cord injury rehabilitation center.

Participants

A total of 88 adults within 6 months of spinal cord injury onset (group A, 44 with UMN injury, and group B, 44 with LMN injury) were graded on the American Spinal Injury Association Impairment Scale as C or D. Each of these groups was then randomly allocated to conditions 1 or 2.

Interventions

Condition 1: Subgroups A1 and B1 were treated with LKOGT for 60 minutes. Condition 2: Subgroups A2 and B2 received 60 minutes of conventional OGT 5 days per week for 8 weeks. Subjects with UMN and LMN were randomized into 2 training groups.

Main Outcome Measures

Ten-meter walk test and 6-minute walk test (6MWT). Walking Index for Spinal Cord Injury II, lower extremity motor score (LEMS), and the FIM-Locomotor were secondary outcome measures.

Results

By using the LKOGT program compared with OGT, we found significant differences in the 6MWT for groups A1 and B1. LKOGT also provided higher scores than did OGT in secondary outcomes such as the LEMS and the FIM-Locomotor.

Conclusions

Robotic-assisted step training yielded better results in the 6MWT and the LEMS in patients with UMN and LMN.