# Does robotic training help to improve a stroke patient´s results in Berg Balance Scale compared to conventional physiotherapy?

> An article by physiotherapy students on the BIP week theme of neurology.

## Introduction to the Blended Intensive Program (BIP)
Evidence-Based Physical Therapy (EBP) uses the best research evidence with clinical expertise and user’s preferences to produce the most appropriate and effective care. At week 43 in 2024, we had a Blended Intensive program (BIP) in the Czech Republic, at Charles University, about EBP. This program opened with welcome words from the president of The European Network of Physiotherapy in Higher Education (ENPHE) and was followed by the basis of EBP and teachers who highlighted the main challenges in different Physical Therapy fields.

More than 43 physiotherapy students and 8 teachers from five universities (Savonia University of Applied Sciences, Finland; Universidade da Coruña, Spain; Charles University, Prague; Universidad Europea de Madrid, Spain; and CEERRF, France) actively participated in this week. Students worked together and wrote articles devoted to the following themes: Evidence-Based in sport, prevention, injuries, neurological diseases, respiratory diseases, cardiovascular diseases, children, and older adults.

## Project Background and Methodology
Patients recovering from stroke often face challenges with stability and walking, while new advancements in rehabilitation technology offer promising ways to improve therapy. We narrowed our research question to examine how different physiotherapy methods affect results on the Berg Balance Scale (BBS), a tool commonly used to measure balance in stroke patients. We compared traditional physiotherapy sessions—which include strengthening exercises, manual therapy, and techniques to help with upright positioning—with robot-assisted physiotherapy.

### PICO Framework
*   **P (Population/Problem):** Patients with a stroke
*   **I (Intervention):** Robotic training
*   **C (Comparison):** Conventional physiotherapy
*   **O (Outcome of judgement):** BBS results

We established eligibility criteria, including the use of Randomized Controlled Trials (RCTs). Using the search terms "RAGT (robotic assisted gait training) AND CPT (conventional physiotherapy)" in PubMed, we identified seven articles. After reviewing titles, we excluded two, leaving five studies for analysis.

## Selected Studies
The five selected studies compared robotic-assisted gait training (RAGT) with conventional physiotherapy (CPT):

1.  **Yun et al. (2018):** 36 participants. Stroke patients with lateropulsion. Intervention: RAGT and CPT, 30 minutes, 5 times/week for 3 weeks.
2.  **Kang et al. (2021):** 30 participants (SUBAR group) and 15 control group (CPT). Intervention: SUBAR-AGT and CPT, 30 min, 10 sessions, 3 weeks.
3.  **Marcia et al. (2018):** 19 participants. Stroke with ataxia: 7 robot-assisted, 7 therapist-assisted. Intervention: RAGT and CPT, 60 min, 3 times/week, 5 months.
4.  **Lee et al. (2022):** 47 participants. Post-stroke divided into 4 groups (CPT and RAGT). Intervention: 30 min, 10 sessions, 4 weeks.
5.  **Bang et al. (2016):** 18 participants. Stroke. 9 RAGT, 9 CPT. Intervention: 1h/day, 20 sessions, 5 days/week, 4 weeks.

## Results and Discussion
Our results were not conclusive. The studies varied significantly in participant numbers, session length, frequency, and overall rehabilitation duration. Some studies combined conventional therapy with robot-assisted sessions, while others assigned patients to distinct groups, making it difficult to identify clear patterns.

We applied strict quality criteria, including only RCTs published within the last ten years. While robotic training showed some benefits in BBS scores, the intensity and length of training require better control in future research. Robot-assisted physiotherapy may help reduce therapist workload and alleviate patient fear of falling. Ultimately, the success of therapy likely depends on the facility's approach and patient motivation, though robot-assisted physiotherapy appears to be a valuable addition to traditional rehabilitation.

## Authors
*   **Kristiina Koponen**, physiotherapy student, Savonia University of Applied Sciences, Kuopio, Finland.
*   **Alicia Piñeiro**, physiotherapy student, University of A Coruña, A Coruña, Spain.
*   **Eliška Nikodemová**, physiotherapy student, Charles University, Czech Republic.
*   **José Tamargo**, physiotherapy student, Universidad Europea de Madrid, Spain.
*   **Sabrina Said**, physiotherapy student, CEERRF, France.
*   **Dagmar Pavlu**, Physiotherapist, Assoc. Prof. Charles University, Czech Republic.
*   **Ivana Vláčilová**, Physiotherapist, PhD., Charles University, Czech Republic.
*   **Marja Äijö**, PT, PhD Principal Lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences, Kuopio, Finland.
*   **Veronica Robles García**, PhD. PT. OT. Lecturer, University of A Coruña, A Coruña, Spain.
*   **Beatriz Martínez Toledo**, PT. Lecturer at University of A Coruña, A Coruña, Spain.
*   **Montserrat Fernández Pereira**, PT, Lecturer at University of A Coruña, A Coruña, Spain.
*   **Lorena Canosa Carro**, PT, MSc, PhD. Lecturer at Universidad Europea de Madrid, Spain.
*   **Adrien Pallot**, PT, MSc, Lecturer at CEERRF, France.

## References
1. Kang, C. J., Chun, M. H., Lee, J., & Lee, J. Y. (2021). Effects of robot (SUBAR)-assisted gait training in patients with chronic stroke: Randomized controlled trial. *Medicine*, 100(48), e27974.
2. Belas Dos Santos M, Barros de Oliveira C, Dos Santos A, Garabello Pires C, Dylewski V, Arida RM. (2018). A Comparative Study of Conventional Physiotherapy versus Robot-Assisted Gait Training Associated to Physiotherapy in Individuals with Ataxia after Stroke. *Behav Neurol*.
3. Lee J, Chun MH, Seo YJ, Lee A, Choi J, Son C. (2022). Effects of a lower limb rehabilitation robot with various training modes in patients with stroke: A randomized controlled trial. *Medicine (Baltimore)*, 101(44), e31590.
4. Yun, M, Joo, M. Kim, S-C. & Kim, M-S. (2018). Robot-assisted gait training effectively improved lateropulsion in subacute stroke patients: a single-blinded randomized controlled trial. *Eur J Phys Rehabil Med*, 54(6), 827-836.
5. Bang, Dae-Hyouk; Shin, Won-Seob. (2016). Effects of robot-assisted gait training on spatiotemporal gait parameters and balance in patients with chronic stroke: A randomized controlled pilot trial. *NeuroRehabilitation*, 38(4), 343–349.