UBC Theses and Dissertations
Walking once again : use of a robotic exoskeleton during subacute stroke rehabilitation to promote functional recovery Louie, Dennis Riley
Stroke is a leading cause of adult disability, typically resulting in mental and physical impairments that can affect functional abilities such as walking. Recovering the ability to walk is an important goal for stroke survivors, having implications for long-term health and functional outcomes. Population trends and new medical interventions have resulted in changes in mortality and disablement, warranting an update of the prevalence of leg and walking impairment after stroke; interventions to optimize walking recovery after stroke also remain a key priority for research. Powered robotic exoskeletons, a new generation of electromechanical devices that can support and move the lower limbs to walk overground, may be a novel intervention to achieve higher-intensity walking practice and rehabilitation gains for patients after stroke. The aims of this dissertation were to characterize the current state of leg and walking impairment after stroke, as well as to investigate the role of exoskeletons, both their efficacy and acceptability, in stroke rehabilitation. A cohort study first established that approximately half of patients surviving a first-ever stroke are unable to walk, affecting their discharge disposition after acute hospitalization. The second study, a scoping review, mapped the existing research surrounding the use of powered exoskeletons for overground gait retraining and highlighted a need for more rigorous trials in the subacute stroke population. The third and fourth studies were conducted concurrently as a mixed methods trial to investigate the use of powered exoskeletons for gait retraining with non-ambulatory patients during subacute stroke rehabilitation. In the randomized controlled trial, no greater benefit was achieved by using a powered exoskeleton for walking recovery compared to standard physical therapy care. However, the qualitative component, an interview-based study exploring how patients and therapists react to using an exoskeleton for intensive rehabilitation, revealed that the technology is viewed highly favorably. In summary, these studies, which focused on non-ambulatory patients, indicate an ongoing need to target walking recovery after stroke and suggest that powered exoskeletons are a welcome option to achieve repetitive walking practice. Further work is needed to clarify which patients will truly benefit, and to what extent, from this intervention.
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