Proposal for a Robot Rehabilitation Strategy Tailored to the Recovery Stage of Gait Impairment After Subacute Stroke: A Preliminary Case Report

Robot-assisted gait training (RAGT) has been increasingly applied as an intervention method for stroke hemiplegia patients' abnormal gait patterns.We describe an intervention strategy that attempts the precise adjustment of tasks' difficulty according to the severity of gait impairment by progressively adapting two types of robots in accordance with the subject's recovery process.This case report describes a 53-year-old man who presented with left hemiplegia due to a right lacunar infarction.He was admitted to our rehabilitation hospital 14 days after stroke onset and underwent a staged gait-training program from days 14 to 77 after stroke onset, including treadmill-driven RAGT from days 16 to 28 and orthosis-mounted RAGT from days 55 to 69.At his initial assessment, the patient required assistance with walking due to moderate motor paralysis.In the early stages of intervention, a treadmill-driven robot was introduced with the goal of improving the patient's walking independence.Subsequently, after supervised walking had been achieved and residual gait abnormalities persisted during conventional gait training, the patient transitioned to flatground walking practice using an orthosis-mounted robot with the goal of optimizing walking patterns.The sequential intervention was associated with improvement in walking independence, with the Functional Ambulation Category increasing from 1 to 5 by discharge, and improvements in stiff-knee gait and toe clearance were also observed.These findings suggest that stage-specific selection of robotic devices according to therapeutic goals may be a feasible approach for addressing both walking independence and residual gait abnormalities after stroke.