A central-peripheral approach to gait rehabilitation in chronic acquired brain injury: robotic training and motor imagery

Background Gait impairment is a major long-term consequence of acquired brain injury and remains difficult to treat in the chronic phase. Robot-assisted gait training can deliver high-intensity repetitive practice, but robotic assistance alone may not fully engage central motor processes; motor imagery may complement this limitation. Objective The primary aim was to evaluate the feasibility of an integrated protocol combining robotic gait training with structured motor imagery in adults with chronic acquired brain injury; a secondary, exploratory, aim was to characterize preliminary clinical signals and kinematic parameters observed in associated with the protocol. Methods Seven adults completed 12 sessions over 4 weeks (3 sessions/week, about 30 min of active robotic walking per session). Outcomes included gait kinematics at baseline, post-intervention, and 3-month follow-up, plus Berg Balance Scale and 6-Minute Walk Test at baseline and post-intervention. Gait variables were analysed during both single-task and dual-task walking. Results Clinical outcomes improved from baseline to post-intervention (Berg Balance Scale and 6-Minute Walk Test). For gait outcomes, session effects indicated improvement over time in temporal efficiency and phase organization on the more-affected limb, and task type effects were observed in key spatiotemporal variables, with expected dual-task costs maintained. Conclusions This preliminary study supports the feasibility of combining robotic gait training with motor imagery in chronic acquired brain injury and provides exploratory, hypothesis-generating signals of concurrent clinical and kinematic change, to be tested in future controlled studies.