ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurorehabilitation
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1655409
This article is part of the Research TopicNew methods in neurorehabilitationView all 20 articles
Combine Effects of Robotic Assisted Gait Training with Transcranial Magnetic Stimulation on Gait metrics and Balance in Stroke Patients: A Pilot Randomized Control
Provisionally accepted
- Chongqing Medical University, Chongqing, China
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Abstract: Background and Objective: Stroke often causes gait and balance impairments due to disrupted neural control. While robotic-assisted gait training (RAGT) improves motor function, combining it with low-frequency transcranial magnetic stimulation (LF-rTMS) may enhance neuroplasticity and recovery. This pilot RCT investigates the feasibility and synergistic effects of RAGT + LF-rTMS on gait and balance in stroke patients. Materials and Methods: This pilot RCT included 21 stroke patients randomized into three groups: RAGT + active LF-rTMS, RAGT + sham rTMS, and control (standard physiotherapy). RAGT used an exoskeleton with adjustable speed (0.8–1.8 km/h) and body-weight support (40–60%). LF-rTMS (1 Hz, 80% RMT) targeted the unaffected hemisphere's M1. Outcomes included 3D gait analysis (spatiotemporal metrics), dynamic balance (COP sway), and clinical scales (FMA-LE, BBS, MMT). Results: The RAGT+TMS group demonstrated more improvements in balance (BBS: Δ22.58 vs. Δ15.40 in RAGT+sham TMS; P=0.05) and motor function (FMA: Δ5.86 vs. Δ1.61; P=0.04) compared to other groups. Gait analysis revealed significant left step length increases in RAGT+TMS (Δ6.86cm, P=0.04), while balance metrics showed reduced postural sway (oscillation length: Δ-25.01cm, P=0.04). All groups improved temporally (P<0.01), but RAGT+TMS yielded synergistic enhancements in functional recovery. Conclusion: This study demonstrates that combined RAGT and LF-rTMS significantly enhances post-stroke motor recovery, yielding clinically superior improvements in balance (BBS), gait symmetry, and postural control compared to RAGT alone or conventional therapy. The synergistic effects highlight TMS's potential to augment neuroplasticity when paired with robotic training. While further large-scale trials are needed, these findings support integrating dual-modality approaches for comprehensive stroke rehabilitation.
Keywords: Robotic Assisted Gait Training (RAGT), Trans-cranial Magnetic Stimulation (TMS), stroke rehabilitation, Gait recovery, Postural Balance, hemiparesis, Motor cortex excitability, interhemispheric inhibition
Received: 27 Jun 2025; Accepted: 09 Oct 2025.
Copyright: © 2025 Jehangir, Ahmad, Feng, Yin, Juan and Fatima. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Irfan Ahmad, 27irfanpeace@gmail.com
Ying Yin, 300735@cqmu.edu.cn
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