Stroke is one of the leading causes of death in adults and results in severe disability.
Within the first 3 months after a stroke, 20% of patients use a wheelchair, and 70%
experience walking problems. Balance problems are among the most common issues after a
stroke, impacting a patient's ability to sit, stand, transfer, and walk, thereby creating
a risk of falls. Additionally, balance and walking quality are vital components, with
abnormalities potentially leading to abnormal walking patterns, reduced walking speed,
and spatiotemporal asymmetries. Therefore, improving balance and walking is a fundamental
goal in stroke rehabilitation and holds priority for many patients and their families.
Robot-assisted gait training (RAGT) is an emerging and promising technological approach
in stroke rehabilitation. RAGT provides safe, high-intensity, and task-oriented walking
training with ample repetitions. Repetitive tasks can enhance neuroplasticity and motor
learning, resulting in improved balance and walking speed.
Robotic systems come in two types: end-effector and exoskeleton. The Lokomat® FreeD
(Hocoma AG, Switzerland) is an exoskeleton-type robot. Unlike the conventional Lokomat,
the FreeD module allows pelvic translation to the right and left, along with rotation.
These coordinated pelvic movements are mechanically facilitated by the device during
walking. It is known that these movements are crucial for human walking and balance, and
with the FreeD module, these pelvic movements have become part of robot-assisted gait
training.
In a systematic review comparing Lokomat with conventional physiotherapy, it was reported
that Lokomat is equally effective in terms of balance. Another review found that patients
undergoing robot-assisted gait training showed better improvement in balance compared to
those not receiving this treatment. The literature supports Lokomat's positive effects on
both balance and walking.
In this research, virtual reality applications on Lokomat® will be integrated as part of
the exercises in the Lokomat group and virtual reality-based balance training using the
Balance Trainer will be employed for the Balance-Trainer group.
Patients will be allocated to the Lokomat and Balance-Trainer groups based on the
treatment they receive. Both systems are actively used in the hospital, which research
conduct, for the purpose of actively treating patients who meet the research criteria for
improving balance and walking in stroke survivors. Participants will engage in exercises
with Lokomat® or Balance Trainer for three weeks, five sessions per week, each session
lasting 30 minutes, totaling 15 sessions, in addition to their current rehabilitation
program.