The effects of robot-assisted gait training combined with non-invasive brain stimulation on lower limb function in patients with stroke and spinal cord injury: A systematic review and meta-analysis

Wataru Kuwahara; Shun Sasaki; Rieko Yamamoto; Michiyuki Kawakami; Fuminari Kaneko

doi:10.3389/fnhum.2022.969036

The effects of robot-assisted gait training combined with non-invasive brain stimulation on lower limb function in patients with stroke and spinal cord injury: A systematic review and meta-analysis

Front Hum Neurosci. 2022 Aug 16:16:969036. doi: 10.3389/fnhum.2022.969036. eCollection 2022.

Authors

Wataru Kuwahara^{1

2}, Shun Sasaki¹, Rieko Yamamoto^{1

3}, Michiyuki Kawakami¹, Fuminari Kaneko^{1

2}

Affiliations

¹ Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
² Department of Physical Therapy, Graduate School of Health Sciences, Tokyo Metropolitan University, Tokyo, Japan.
³ Department of Artificial Environment, Safety, Environment and System Engineering, Graduate School of Environment and Information Sciences, Yokohama National University, Kanagawa, Japan.

Abstract

Objective: This study aimed to investigate the effect of robot-assisted gait training (RAGT) therapy combined with non-invasive brain stimulation (NIBS) on lower limb function in patients with stroke and spinal cord injury (SCI).

Data sources: PubMed, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Web of Science were searched.

Study selection: Randomized controlled trials (RCTs) published as of 3 March 2021. RCTs evaluating RAGT combined with NIBS, such as transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), for lower limb function (e.g., Fugl-Meyer assessment for patients with stroke) and activities (i.e., gait velocity) in patients with stroke and SCI were included.

Data extraction: Two reviewers independently screened the records, extracted the data, and assessed the risk of bias.

Data synthesis: A meta-analysis of five studies (104 participants) and risk of bias were conducted. Pooled estimates demonstrated that RAGT combined with NIBS significantly improved lower limb function [standardized mean difference (SMD) = 0.52; 95% confidence interval (CI) = 0.06-0.99] but not lower limb activities (SMD = -0.13; 95% CI = -0.63-0.38). Subgroup analyses also failed to find a greater improvement in lower limb function of RAGT with tDCS compared to sham stimulation. No significant differences between participant characteristics or types of NIBS were observed.

Conclusion: This meta-analysis demonstrated that RAGT therapy in combination with NIBS was effective in patients with stroke and SCI. However, a greater improvement in lower limb function and activities were not observed using RAGT with tDCS compared to sham stimulation.

Keywords: lower limb; repetitive transcranial magnetic stimulation; robotics; spinal cord injury; stroke; transcranial direct current stimulation.

Publication types

Systematic Review