A Rehabilitation Program of Exoskeleton-assisted Body Weight-Supported Treadmill Training with Non-immersive Virtual Reality for Stroke Patients

We explored whether combining exoskeleton-assisted treadmill training with game-based VR could enhance their task performance and balance in stroke survivors during early rehabilitation. It remains challenging to maintain patient engagement throughout intensive sessions, especially in early stroke recovery when fatigue and attention deficits are common. Our study suggests this combined approach may help stroke patients better manage balance during walking. This approach enhances both physical recovery and cognitive engagement, providing a richer and more effective rehab experience. Our findings support integrating multimodal technologies in stroke rehab and provide preliminary evidence to guide future randomized control trials.

[Narrator] To begin, turn both handles on the robotic arm counterclockwise to loosen them. Pull the exoskeleton outward to clear the treadmill runway and create space for the patient. Guide the patient onto the treadmill runway from the rear ramp to the front. For patients that are unable to walk, assist them in entering with a wheelchair and position them at the front. Lower the harness of the suspension system using the remote control. Adjust the harness to sit flush with or slightly below the back of the patient's head to ensure proper alignment. Then unstrap the harness to begin dressing the patient. If the patient is standing, apply the unfastened harness to the torso from behind. And secure the straps around the torso and thighs. Ensure all straps are comfortably tightened. If the patient is in a wheelchair, lift the torso slightly away from the back rest. Thread the unfastened harness around the torso and secure the straps comfortably. Wrap the leg straps around the thighs and fasten them. Now, elevate the weight-supported system to bring the patient into a standing position. Use the remote control to adjust the weight reduction as needed, and observe the data on the unit screen. Raise the patient slightly while ensuring that their feet do not hang. If the patient is in a wheelchair, gradually elevate them into a standing position using the suspension system. Once upright, remove the wheelchair from the runway. Adjust the weight reduction using the remote control as needed. Reset the exoskeleton by pushing it inward from its opened position. Then, rotate both handles clockwise to engage the immobilization device. Press down on the folded and suspended exoskeleton to shift it from a seated to a standing configuration. Then instruct the patient to lean back against the exoskeleton's torso support, and attach the thoracic anchorage straps around the patient's chest securely. Adjust the height of the exoskeleton to align the motor axis of the arms with the patient's hip and knee joints. Then secure the thigh and calf straps, ensuring a snug and safe fit. For exoskeleton operation, launch the control software on the computer. Enter the patient's basic information into the system. Adjust treatment parameters within the software. Set the walking speed to 1.5 kilometers per hour, duration to 20 minutes, and apply the default joint mobility settings for both hips and knees. Then click on Start to begin therapy. Next, launch the ZEPU gait training and evaluation software on the computer. Select the game option to activate the VR training mode. Guide the patient during exoskeleton-assisted movement. When one leg is in the swing phase, instruct the patient to actively control it. When the leg is ready for propulsion, instruct the patient to forcefully propel it and perform hip flexion. The Berg Balance Scale score showed a statistically significant increase from 43.88 to 48.38 after four weeks of treatment. The Timed Up and Go test time decreased from 21.88 seconds to 17.63 seconds, indicating improvement without statistical significance. The Functional Independence Measure score increased from 92.75 to 98.75, reflecting a clinically positive trend, though not statistically significant.