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.