Hemiparetic Stroke Rehabilitation with Exoskeletal Robot-Assisted Gait Training: Adaptation to an Ankle-Foot Orthosis and Difficulty Adjustment

Abstract

This case study details the rehabilitation of a man in his 40s with a right thalamic hemorrhage who began recovery in a rehabilitation ward 17 days post-symptom onset. Physical therapy mainly consisted of gait training using an exoskeletal gait-assist robot. Significant improvements were made in his abnormal gait pattern with ongoing adjustments in the training difficulty. However, the abnormal gait pattern resurfaced during the transition to an ankle-foot orthosis （AFO）. Consequently, the treatment strategy was shifted to using a knee─ankle-foot orthosis （KAFO） with unlocked knees, allowing further refinement of the difficulty level. This approach led to enhanced muscle strength and balance on the paralyzed side, and by day 72, the patient could walk independently with a short leg orthosis and cane. Gait speed and abnormal gait pattern also improved. Gait training using an exoskeletal walking aid robot contributed to the patient's reacquisition of gait ability. The strategic use of KAFO with an unlocked knee lock suggested to be effective in adjusting the difficulty level during the transition from robot-assisted gait to gait supported by AFO.