Stroke patients maintain benefits of robot therapy. (Reuters Health) - Stroke patients who have the most trouble walking may see lasting benefits from using machines that move their legs to simulate walking, say Italian researchers

Their study, although small, is one of the first to observe a benefit lasting at least two years in a group of stroke patients who used the machines, which are sometimes employed in conjunction with traditional physical therapy. The new findings should help doctors target which stroke patients will benefit the most from the machines according to lead author Dr. Giovanni Morone, of the Santa Lucia Foundation in Rome. "Robotic and electromechanical devices might play an important role, not for all patients, but for a selected kind of patients," said Morone in an email. The new findings, published in the journal Stroke, are based on the same group of 48 patients the researchers reported on in September, in the journal Neurorehabilitation and Neural Repair, where they suggested stroke patients who were most severely affected by a stroke also gained the most from the machines after three months of therapy. At the beginning of the study, each patient whose mobility was seriously compromised by a stroke started in the zero functional ambulation category (FAC). The FAC is a zero-to-five scale that ranks how much help a patient needs to walk. Patients with a zero score need the most help. After the three months of therapy the patients who used the machine significantly improved and moved up the scale to four, which meant they were able to walk with some assistance. Those who did not use the machine moved up the scale to two, which meant they still needed help with balance and coordination. Two years later, the patients who used the machine continued to improve to a near perfect score. The patients who did not use the machine also improved, but only to a level that still needed supervision. As for the group least affected by the stroke, they improved at about the same pace whether they used the machine or not. Therapeutic walking machines, like the one used in the study, have been around for a few decades and were originally developed for patients with spinal cord injuries, according to Dr. Bruce Dobkin, director of the Neurologic Rehabilitation and Research Program at UCLA in California. Typically, the machines support a patient's weight by placing them in a harness and a device similar to an elliptical trainer moves their legs. According to Dobkin, who was not involved in the new study, the goal was to "instill the movement in the nerve," but after years of studies the patients using the machines did just as well as those who went through traditional physical therapy. "It turned out they were equivalent and the strategy to ingrain more activity just wasn't working," said Dobkin. Dobkin said there are only a few hundred of these machines in use around the world and that they're still seen as inefficient. These results are likely not going to change that. The new findings are from a small group, Dobkin added, and it would be hard to apply the results to a larger population. However, he said the machines may be more useful someday if other medical advances that stimulate nerves are developed. "They may be part of a future solution," said Dobkin. "But they are only part of it."