Electromechanical‐assisted training for walking after stroke
Background Electromechanical‐ and robot‐assisted gait‐training devices are used in rehabilitation and might help to improve walking after stroke. This is an update of a Cochrane Review first published in 2007 and previously updated in 2017. Objectives Primary • To determine whether electromechanical...
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| creator | Mehrholz, Jan Mehrholz, Jan Thomas, Simone Kugler, Joachim Pohl, Marcus Elsner, Bernhard |
| description | Background
Electromechanical‐ and robot‐assisted gait‐training devices are used in rehabilitation and might help to improve walking after stroke. This is an update of a Cochrane Review first published in 2007 and previously updated in 2017.
Objectives
Primary
• To determine whether electromechanical‐ and robot‐assisted gait training versus normal care improves walking after stroke
Secondary
• To determine whether electromechanical‐ and robot‐assisted gait training versus normal care after stroke improves walking velocity, walking capacity, acceptability, and death from all causes until the end of the intervention phase
Search methods
We searched the Cochrane Stroke Group Trials Register (last searched 6 January 2020); the Cochrane Central Register of Controlled Trials (CENTRAL; 2020 Issue 1), in the Cochrane Library; MEDLINE in Ovid (1950 to 6 January 2020); Embase (1980 to 6 January 2020); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 20 November 2019); the Allied and Complementary Medicine Database (AMED; 1985 to 6 January 2020); Web of Science (1899 to 7 January 2020); SPORTDiscus (1949 to 6 January 2020); the Physiotherapy Evidence Database (PEDro; searched 7 January 2020); and the engineering databases COMPENDEX (1972 to 16 January 2020) and Inspec (1969 to 6 January 2020). We handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trial authors in an effort to identify further published, unpublished, and ongoing trials.
Selection criteria
We included all randomised controlled trials and randomised controlled cross‐over trials in people over the age of 18 years diagnosed with stroke of any severity, at any stage, in any setting, evaluating electromechanical‐ and robot‐assisted gait training versus normal care.
Data collection and analysis
Two review authors independently selected trials for inclusion, assessed methodological quality and risk of bias, and extracted data. We assessed the quality of evidence using the GRADE approach. The primary outcome was the proportion of participants walking independently at follow‐up.
Main results
We included in this review update 62 trials involving 2440 participants. Electromechanical‐assisted gait training in combination with physiotherapy increased the odds of participants becoming independent in walking (odds ratio (random effects) 2.01, 95% confidence interval (CI) 1.51 to 2.69; 38 studies, 1567 participants; P |
| doi_str_mv | 10.1002/14651858.CD006185.pub5 |
| format | Article |
| fullrecord | <record><control><sourceid>wiley_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8189995</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>CD006185.pub5</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5365-b745e5805942f0b0406b31ab772759b9bec2b28ea0b0f0e3b425f87240d485233</originalsourceid><addsrcrecordid>eNqFkM1OAjEUhRujEURfwfAC4G07nWk3JIr4k5C40XXTljtQGWZIO0rY-Qg-o0_iTBCjblz1JCffl9tDyDmFIQVgFzRJBZVCDsfXAGmThusXKw5Ity0GbXP4I3fISYzPADxVLDsmHc5BUZpCl4wmBbo6VCt0C1N6Z4qPt3cTo481zvp1ML705byfV6G_McWyzSavMfRjAy3xlBzlpoh49vX2yNPN5HF8N5g-3N6PL6cDJ3hzg80SgUKCUAnLwUICqeXU2CxjmVBWWXTMMomm6XJAbhMmcpmxBGaJFIzzHhntvM0vVzhzWDanFXod_MqEra6M17-b0i_0vHrVkkqllGgE6U7gQhVjwPybpaDbRfV-Ub1ftDW24NUO3PgCt9pVbhFMif9gfySf3yN-uA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Electromechanical‐assisted training for walking after stroke</title><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><source>Cochrane Library</source><creator>Mehrholz, Jan ; Mehrholz, Jan ; Thomas, Simone ; Kugler, Joachim ; Pohl, Marcus ; Elsner, Bernhard</creator><creatorcontrib>Mehrholz, Jan ; Mehrholz, Jan ; Thomas, Simone ; Kugler, Joachim ; Pohl, Marcus ; Elsner, Bernhard</creatorcontrib><description>Background
Electromechanical‐ and robot‐assisted gait‐training devices are used in rehabilitation and might help to improve walking after stroke. This is an update of a Cochrane Review first published in 2007 and previously updated in 2017.
Objectives
Primary
• To determine whether electromechanical‐ and robot‐assisted gait training versus normal care improves walking after stroke
Secondary
• To determine whether electromechanical‐ and robot‐assisted gait training versus normal care after stroke improves walking velocity, walking capacity, acceptability, and death from all causes until the end of the intervention phase
Search methods
We searched the Cochrane Stroke Group Trials Register (last searched 6 January 2020); the Cochrane Central Register of Controlled Trials (CENTRAL; 2020 Issue 1), in the Cochrane Library; MEDLINE in Ovid (1950 to 6 January 2020); Embase (1980 to 6 January 2020); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 20 November 2019); the Allied and Complementary Medicine Database (AMED; 1985 to 6 January 2020); Web of Science (1899 to 7 January 2020); SPORTDiscus (1949 to 6 January 2020); the Physiotherapy Evidence Database (PEDro; searched 7 January 2020); and the engineering databases COMPENDEX (1972 to 16 January 2020) and Inspec (1969 to 6 January 2020). We handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trial authors in an effort to identify further published, unpublished, and ongoing trials.
Selection criteria
We included all randomised controlled trials and randomised controlled cross‐over trials in people over the age of 18 years diagnosed with stroke of any severity, at any stage, in any setting, evaluating electromechanical‐ and robot‐assisted gait training versus normal care.
Data collection and analysis
Two review authors independently selected trials for inclusion, assessed methodological quality and risk of bias, and extracted data. We assessed the quality of evidence using the GRADE approach. The primary outcome was the proportion of participants walking independently at follow‐up.
Main results
We included in this review update 62 trials involving 2440 participants. Electromechanical‐assisted gait training in combination with physiotherapy increased the odds of participants becoming independent in walking (odds ratio (random effects) 2.01, 95% confidence interval (CI) 1.51 to 2.69; 38 studies, 1567 participants; P < 0.00001; I² = 0%; high‐quality evidence) and increased mean walking velocity (mean difference (MD) 0.06 m/s, 95% CI 0.02 to 0.10; 42 studies, 1600 participants; P = 0.004; I² = 60%; low‐quality evidence) but did not improve mean walking capacity (MD 10.9 metres walked in 6 minutes, 95% CI ‐5.7 to 27.4; 24 studies, 983 participants; P = 0.2; I² = 42%; moderate‐quality evidence). Electromechanical‐assisted gait training did not increase the risk of loss to the study during intervention nor the risk of death from all causes. Results must be interpreted with caution because (1) some trials investigated people who were independent in walking at the start of the study, (2) we found variation between trials with respect to devices used and duration and frequency of treatment, and (3) some trials included devices with functional electrical stimulation. Post hoc analysis showed that people who are non‐ambulatory at the start of the intervention may benefit but ambulatory people may not benefit from this type of training. Post hoc analysis showed no differences between the types of devices used in studies regarding ability to walk but revealed differences between devices in terms of walking velocity and capacity.
Authors' conclusions
People who receive electromechanical‐assisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than people who receive gait training without these devices. We concluded that eight patients need to be treated to prevent one dependency in walking. Specifically, people in the first three months after stroke and those who are not able to walk seem to benefit most from this type of intervention. The role of the type of device is still not clear. Further research should consist of large definitive pragmatic phase 3 trials undertaken to address specific questions about the most effective frequency and duration of electromechanical‐assisted gait training, as well as how long any benefit may last. Future trials should consider time post stroke in their trial design.</description><identifier>ISSN: 1465-1858</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD006185.pub5</identifier><identifier>PMID: 33091160</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Bias ; Cause of Death ; Combined Modality Therapy ; Confidence Intervals ; Electric Stimulation Therapy ; Equipment Design ; Exercise Therapy ; Gait ; Heart & circulation ; Impairment ; Medicine General & Introductory Medical Sciences ; Neurology ; Odds Ratio ; Orthotic Devices ; Prevention & treatment of complications ; PREVENTION AND TREATMENT OF COMPLICATIONS FOLLOWING STROKE ; Randomized Controlled Trials as Topic ; Robotics ; Standing instability and gait disturbance ; Stroke ; Stroke Rehabilitation ; Walking ; Walking Speed</subject><ispartof>Cochrane database of systematic reviews, 2020-10, Vol.2020 (10)</ispartof><rights>Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5365-b745e5805942f0b0406b31ab772759b9bec2b28ea0b0f0e3b425f87240d485233</citedby><cites>FETCH-LOGICAL-c5365-b745e5805942f0b0406b31ab772759b9bec2b28ea0b0f0e3b425f87240d485233</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids></links><search><creatorcontrib>Mehrholz, Jan</creatorcontrib><creatorcontrib>Mehrholz, Jan</creatorcontrib><creatorcontrib>Thomas, Simone</creatorcontrib><creatorcontrib>Kugler, Joachim</creatorcontrib><creatorcontrib>Pohl, Marcus</creatorcontrib><creatorcontrib>Elsner, Bernhard</creatorcontrib><title>Electromechanical‐assisted training for walking after stroke</title><title>Cochrane database of systematic reviews</title><description>Background
Electromechanical‐ and robot‐assisted gait‐training devices are used in rehabilitation and might help to improve walking after stroke. This is an update of a Cochrane Review first published in 2007 and previously updated in 2017.
Objectives
Primary
• To determine whether electromechanical‐ and robot‐assisted gait training versus normal care improves walking after stroke
Secondary
• To determine whether electromechanical‐ and robot‐assisted gait training versus normal care after stroke improves walking velocity, walking capacity, acceptability, and death from all causes until the end of the intervention phase
Search methods
We searched the Cochrane Stroke Group Trials Register (last searched 6 January 2020); the Cochrane Central Register of Controlled Trials (CENTRAL; 2020 Issue 1), in the Cochrane Library; MEDLINE in Ovid (1950 to 6 January 2020); Embase (1980 to 6 January 2020); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 20 November 2019); the Allied and Complementary Medicine Database (AMED; 1985 to 6 January 2020); Web of Science (1899 to 7 January 2020); SPORTDiscus (1949 to 6 January 2020); the Physiotherapy Evidence Database (PEDro; searched 7 January 2020); and the engineering databases COMPENDEX (1972 to 16 January 2020) and Inspec (1969 to 6 January 2020). We handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trial authors in an effort to identify further published, unpublished, and ongoing trials.
Selection criteria
We included all randomised controlled trials and randomised controlled cross‐over trials in people over the age of 18 years diagnosed with stroke of any severity, at any stage, in any setting, evaluating electromechanical‐ and robot‐assisted gait training versus normal care.
Data collection and analysis
Two review authors independently selected trials for inclusion, assessed methodological quality and risk of bias, and extracted data. We assessed the quality of evidence using the GRADE approach. The primary outcome was the proportion of participants walking independently at follow‐up.
Main results
We included in this review update 62 trials involving 2440 participants. Electromechanical‐assisted gait training in combination with physiotherapy increased the odds of participants becoming independent in walking (odds ratio (random effects) 2.01, 95% confidence interval (CI) 1.51 to 2.69; 38 studies, 1567 participants; P < 0.00001; I² = 0%; high‐quality evidence) and increased mean walking velocity (mean difference (MD) 0.06 m/s, 95% CI 0.02 to 0.10; 42 studies, 1600 participants; P = 0.004; I² = 60%; low‐quality evidence) but did not improve mean walking capacity (MD 10.9 metres walked in 6 minutes, 95% CI ‐5.7 to 27.4; 24 studies, 983 participants; P = 0.2; I² = 42%; moderate‐quality evidence). Electromechanical‐assisted gait training did not increase the risk of loss to the study during intervention nor the risk of death from all causes. Results must be interpreted with caution because (1) some trials investigated people who were independent in walking at the start of the study, (2) we found variation between trials with respect to devices used and duration and frequency of treatment, and (3) some trials included devices with functional electrical stimulation. Post hoc analysis showed that people who are non‐ambulatory at the start of the intervention may benefit but ambulatory people may not benefit from this type of training. Post hoc analysis showed no differences between the types of devices used in studies regarding ability to walk but revealed differences between devices in terms of walking velocity and capacity.
Authors' conclusions
People who receive electromechanical‐assisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than people who receive gait training without these devices. We concluded that eight patients need to be treated to prevent one dependency in walking. Specifically, people in the first three months after stroke and those who are not able to walk seem to benefit most from this type of intervention. The role of the type of device is still not clear. Further research should consist of large definitive pragmatic phase 3 trials undertaken to address specific questions about the most effective frequency and duration of electromechanical‐assisted gait training, as well as how long any benefit may last. Future trials should consider time post stroke in their trial design.</description><subject>Bias</subject><subject>Cause of Death</subject><subject>Combined Modality Therapy</subject><subject>Confidence Intervals</subject><subject>Electric Stimulation Therapy</subject><subject>Equipment Design</subject><subject>Exercise Therapy</subject><subject>Gait</subject><subject>Heart & circulation</subject><subject>Impairment</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Neurology</subject><subject>Odds Ratio</subject><subject>Orthotic Devices</subject><subject>Prevention & treatment of complications</subject><subject>PREVENTION AND TREATMENT OF COMPLICATIONS FOLLOWING STROKE</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Robotics</subject><subject>Standing instability and gait disturbance</subject><subject>Stroke</subject><subject>Stroke Rehabilitation</subject><subject>Walking</subject><subject>Walking Speed</subject><issn>1465-1858</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><recordid>eNqFkM1OAjEUhRujEURfwfAC4G07nWk3JIr4k5C40XXTljtQGWZIO0rY-Qg-o0_iTBCjblz1JCffl9tDyDmFIQVgFzRJBZVCDsfXAGmThusXKw5Ity0GbXP4I3fISYzPADxVLDsmHc5BUZpCl4wmBbo6VCt0C1N6Z4qPt3cTo481zvp1ML705byfV6G_McWyzSavMfRjAy3xlBzlpoh49vX2yNPN5HF8N5g-3N6PL6cDJ3hzg80SgUKCUAnLwUICqeXU2CxjmVBWWXTMMomm6XJAbhMmcpmxBGaJFIzzHhntvM0vVzhzWDanFXod_MqEra6M17-b0i_0vHrVkkqllGgE6U7gQhVjwPybpaDbRfV-Ub1ftDW24NUO3PgCt9pVbhFMif9gfySf3yN-uA</recordid><startdate>20201022</startdate><enddate>20201022</enddate><creator>Mehrholz, Jan</creator><creator>Mehrholz, Jan</creator><creator>Thomas, Simone</creator><creator>Kugler, Joachim</creator><creator>Pohl, Marcus</creator><creator>Elsner, Bernhard</creator><general>John Wiley & Sons, Ltd</general><scope>7PX</scope><scope>RWY</scope><scope>ZYTZH</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20201022</creationdate><title>Electromechanical‐assisted training for walking after stroke</title><author>Mehrholz, Jan ; Mehrholz, Jan ; Thomas, Simone ; Kugler, Joachim ; Pohl, Marcus ; Elsner, Bernhard</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5365-b745e5805942f0b0406b31ab772759b9bec2b28ea0b0f0e3b425f87240d485233</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Bias</topic><topic>Cause of Death</topic><topic>Combined Modality Therapy</topic><topic>Confidence Intervals</topic><topic>Electric Stimulation Therapy</topic><topic>Equipment Design</topic><topic>Exercise Therapy</topic><topic>Gait</topic><topic>Heart & circulation</topic><topic>Impairment</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Neurology</topic><topic>Odds Ratio</topic><topic>Orthotic Devices</topic><topic>Prevention & treatment of complications</topic><topic>PREVENTION AND TREATMENT OF COMPLICATIONS FOLLOWING STROKE</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Robotics</topic><topic>Standing instability and gait disturbance</topic><topic>Stroke</topic><topic>Stroke Rehabilitation</topic><topic>Walking</topic><topic>Walking Speed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mehrholz, Jan</creatorcontrib><creatorcontrib>Mehrholz, Jan</creatorcontrib><creatorcontrib>Thomas, Simone</creatorcontrib><creatorcontrib>Kugler, Joachim</creatorcontrib><creatorcontrib>Pohl, Marcus</creatorcontrib><creatorcontrib>Elsner, Bernhard</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Cochrane Library (Open Aceess)</collection><collection>CrossRef</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mehrholz, Jan</au><au>Mehrholz, Jan</au><au>Thomas, Simone</au><au>Kugler, Joachim</au><au>Pohl, Marcus</au><au>Elsner, Bernhard</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Electromechanical‐assisted training for walking after stroke</atitle><jtitle>Cochrane database of systematic reviews</jtitle><date>2020-10-22</date><risdate>2020</risdate><volume>2020</volume><issue>10</issue><issn>1465-1858</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>Background
Electromechanical‐ and robot‐assisted gait‐training devices are used in rehabilitation and might help to improve walking after stroke. This is an update of a Cochrane Review first published in 2007 and previously updated in 2017.
Objectives
Primary
• To determine whether electromechanical‐ and robot‐assisted gait training versus normal care improves walking after stroke
Secondary
• To determine whether electromechanical‐ and robot‐assisted gait training versus normal care after stroke improves walking velocity, walking capacity, acceptability, and death from all causes until the end of the intervention phase
Search methods
We searched the Cochrane Stroke Group Trials Register (last searched 6 January 2020); the Cochrane Central Register of Controlled Trials (CENTRAL; 2020 Issue 1), in the Cochrane Library; MEDLINE in Ovid (1950 to 6 January 2020); Embase (1980 to 6 January 2020); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to 20 November 2019); the Allied and Complementary Medicine Database (AMED; 1985 to 6 January 2020); Web of Science (1899 to 7 January 2020); SPORTDiscus (1949 to 6 January 2020); the Physiotherapy Evidence Database (PEDro; searched 7 January 2020); and the engineering databases COMPENDEX (1972 to 16 January 2020) and Inspec (1969 to 6 January 2020). We handsearched relevant conference proceedings, searched trials and research registers, checked reference lists, and contacted trial authors in an effort to identify further published, unpublished, and ongoing trials.
Selection criteria
We included all randomised controlled trials and randomised controlled cross‐over trials in people over the age of 18 years diagnosed with stroke of any severity, at any stage, in any setting, evaluating electromechanical‐ and robot‐assisted gait training versus normal care.
Data collection and analysis
Two review authors independently selected trials for inclusion, assessed methodological quality and risk of bias, and extracted data. We assessed the quality of evidence using the GRADE approach. The primary outcome was the proportion of participants walking independently at follow‐up.
Main results
We included in this review update 62 trials involving 2440 participants. Electromechanical‐assisted gait training in combination with physiotherapy increased the odds of participants becoming independent in walking (odds ratio (random effects) 2.01, 95% confidence interval (CI) 1.51 to 2.69; 38 studies, 1567 participants; P < 0.00001; I² = 0%; high‐quality evidence) and increased mean walking velocity (mean difference (MD) 0.06 m/s, 95% CI 0.02 to 0.10; 42 studies, 1600 participants; P = 0.004; I² = 60%; low‐quality evidence) but did not improve mean walking capacity (MD 10.9 metres walked in 6 minutes, 95% CI ‐5.7 to 27.4; 24 studies, 983 participants; P = 0.2; I² = 42%; moderate‐quality evidence). Electromechanical‐assisted gait training did not increase the risk of loss to the study during intervention nor the risk of death from all causes. Results must be interpreted with caution because (1) some trials investigated people who were independent in walking at the start of the study, (2) we found variation between trials with respect to devices used and duration and frequency of treatment, and (3) some trials included devices with functional electrical stimulation. Post hoc analysis showed that people who are non‐ambulatory at the start of the intervention may benefit but ambulatory people may not benefit from this type of training. Post hoc analysis showed no differences between the types of devices used in studies regarding ability to walk but revealed differences between devices in terms of walking velocity and capacity.
Authors' conclusions
People who receive electromechanical‐assisted gait training in combination with physiotherapy after stroke are more likely to achieve independent walking than people who receive gait training without these devices. We concluded that eight patients need to be treated to prevent one dependency in walking. Specifically, people in the first three months after stroke and those who are not able to walk seem to benefit most from this type of intervention. The role of the type of device is still not clear. Further research should consist of large definitive pragmatic phase 3 trials undertaken to address specific questions about the most effective frequency and duration of electromechanical‐assisted gait training, as well as how long any benefit may last. Future trials should consider time post stroke in their trial design.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>33091160</pmid><doi>10.1002/14651858.CD006185.pub5</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Bias Cause of Death Combined Modality Therapy Confidence Intervals Electric Stimulation Therapy Equipment Design Exercise Therapy Gait Heart & circulation Impairment Medicine General & Introductory Medical Sciences Neurology Odds Ratio Orthotic Devices Prevention & treatment of complications PREVENTION AND TREATMENT OF COMPLICATIONS FOLLOWING STROKE Randomized Controlled Trials as Topic Robotics Standing instability and gait disturbance Stroke Stroke Rehabilitation Walking Walking Speed |
| title | Electromechanical‐assisted training for walking after stroke |
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