Soft robotic exoskeleton training improved gait speed and stride length in people with Parkinson disease over four weeks.
Photo by Anastase Maragos / Unsplash
Key Takeaway
Consider soft robotic exoskeleton training as a potential adjunct to conventional rehabilitation for gait improvement in Parkinson disease.
This randomized controlled pilot study evaluated the effects of soft robotic exoskeleton training in 56 people with Parkinson disease. The intervention group received conventional rehabilitation combined with soft robotic exoskeleton (SER) training five times per week for 20 minutes per session over four weeks. The comparator group received conventional rehabilitation alone. Follow-up occurred at four weeks.
The primary outcomes were gait speed and stride length. Secondary outcomes included swing phase percentage, ankle joint range of motion, Unified Parkinson Disease Rating Scale scores, Montreal Cognitive Assessment, balance subscale scores, Barthel Index scores, and reaction times. Left stride length increased by a mean of 0.15 m (95% CI 0.09-0.21; P<.001). Right stride length increased by a mean of 0.15 m (95% CI 0.10-0.21; P<.001).
Left ankle dorsiflexion increased by a mean of 2.84 degrees (95% CI 2.32-3.36; P<.001). Left swing phase percentage increased by a mean of 1.56% (95% CI 0.44-2.68; P=.01). Right swing phase percentage increased by a mean of 1.6% (95% CI 0.62-2.62; P=.002). Unified Parkinson Disease Rating Scale Part III total score decreased by a mean of 2.80 points. Balance subscale scores decreased by a mean of 0.40 points (P<.001). Montreal Cognitive Assessment scores increased by a mean of 1.23 points (95% CI 0.77-1.68; P<.01). Barthel Index scores increased by a mean of 6.84 points (95% CI 4.22-9.46; P<.001).
Between-group analyses showed the experimental group demonstrated greater improvements in gait speed (P=.04), balance reaction time (P=.04), and maximum movement distance (P=.048). Safety data, adverse events, serious adverse events, discontinuations, and tolerability were not reported. Funding or conflicts were not reported. Limitations were not reported. The study was a pilot, so results should be interpreted with caution.
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View Original Abstract ↓
BACKGROUND: Balance and gait disorders in Parkinson disease (PD) impair motor function and quality of life.
OBJECTIVE: Evidence on soft exoskeleton robots (SERs) for PD rehabilitation is limited. This study evaluated the impact of SERs on motor dysfunction in PD.
METHODS: A total of 56 people with PD (July 2023 to May 2024) were randomized to 2 groups: the control group (n=25, 44.6%) received conventional rehabilitation, and the experimental group (n=31, 55.4%) received conventional rehabilitation combined with SER training (ChiCTR2500111990). Training occurred 5 times per week for 20 minutes each session over 4 weeks. Primary outcomes included gait speed and stride length, while secondary outcomes assessed the percentage of swing phase, ankle joint range of motion, Unified Parkinson Disease Rating Scale total and motor scores, and Montreal Cognitive Assessment. Paired sample t tests (2-tailed) were used for within-group pre- and postintervention comparisons, and independent sample t tests (2-tailed) were used for between-group comparisons. Correlation analyses were conducted between gait parameters and improvements in ankle mobility.
RESULTS: After 4 weeks, the experimental group showed significant improvements in gait and balance. Specifically, left stride length increased by a mean of 0.15 (SD 0.16; 95% CI 0.09-0.21) m (P<.001), right stride length by a mean of 0.15 (SD 0.15; 95% CI 0.10-0.21) m (P<.001), left ankle dorsiflexion by a mean of 2.84 (SD 1.46; 95% CI 2.32-3.36) degrees (P<.001), left swing phase percentage by a mean of 1.56% (SD 3.05%; 95% CI 0.44-2.68; P=.01), and right swing phase percentage by a mean of 1.6% (SD 2.72%; 95% CI 0.62-2.62; P=.002). The Unified Parkinson Disease Rating Scale Part III total score decreased by a mean of 2.80 (SD 3.98) points, and balance subscale scores decreased by a mean of 0.40 (0.58) points (P<.001). Montreal Cognitive Assessment scores increased by a mean of 1.23 (1.23; 95% CI 0.77-1.68) points (P<.01), and Barthel Index scores increased by a mean of 6.84 (7.14; 95% CI 4.22-9.46) points (P<.001). Other measures such as balance reaction time, reaction speed, maximum movement distance, and movement direction control showed significant improvement (P<.01). Compared to the control group, the experimental group demonstrated greater improvements in gait speed (P=.04), balance reaction time (P=.04), and maximum movement distance (P=.048). Correlation analysis revealed that improvements in left ankle dorsiflexion were positively correlated with improvements in gait speed, stride length, and swing phase duration (P<.05).
CONCLUSIONS: SER-assisted training significantly improves gait, balance, and PD symptoms. Our work integrates multidimensional assessments (gait analysis, balance metrics, and clinical scales) and reveals that gains in ankle mobility directly correlate with gait improvements, suggesting a key mechanism. This study contributes by establishing SER as an effective adjunct to conventional therapy, supported by comprehensive quantitative data.
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