Functional Mobility Outcomes Following Robotic-Assisted Gait Training with Rise&Walk® in Inpatient Stroke Rehabilitation: A Retrospective Pilot Study

Functional Mobility Outcomes Following Robotic-Assisted Gait Training with Rise&Walk® in Inpatient Stroke Rehabilitation: A Retrospective Pilot Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Functional Mobility Outcomes Following Robotic-Assisted Gait Training with Rise&Walk® in Inpatient Stroke Rehabilitation: A Retrospective Pilot Study Julie Hartman, Luke Benda, John Costantine, Shaun Fant This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7266083/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Robotic-assisted gait training (RAGT) may enhance mobility recovery after stroke, but real-world inpatient data on clinical implementation remain limited. Objective: To evaluate whether integration of the Rise&Walk® end-effector robotic system improves functional mobility outcomes compared to conventional therapy in an inpatient stroke rehabilitation unit. Methods: This retrospective cohort study reviewed charts of stroke inpatients admitted between June and December 2024 at a regional inpatient rehabilitation facility. Patients who received robotic-assisted therapy with the Rise&Walk system (n = 13) were compared to those who received standard-of-care physical therapy (n = 32), hereafter the Standard Care group. Rise&Walk participants received 2–8 sessions per stay (mean: 4.2). Outcomes included seven Section GG mobility items, the Berg Balance Scale (BBS), and the 10-Meter Walk Test (10MWT) at comfortable and fast speeds. Ordinal logistic regression models adjusted for baseline scores estimated cumulative odds of improvement on GG items. Due to small sample sizes (Rise&Walk: n = 5, Standard Care: n = 9), BBS and 10MWT results are reported descriptively. Summed Section GG gains were compared to a ≥16-point threshold for clinically meaningful improvement. Results: The Rise&Walk group showed greater odds of improvement on all GG mobility items, with statistically significant effects for Chair-to-Bed Transfer (cumulative odds ratio [cOR] = 18.4, p = .009), Walk 10 Feet (cOR = 6.8, p = .025), and Walk 50 Feet + 2 Turns (cOR = 7.7, p = .011). Other items showed large but non-significant effects (e.g., Sit-to-Stand: cOR = 13.3, p = .053). Clinically meaningful GG gains (≥16 points) occurred in 12 of 13 Rise&Walk participants (92%) versus 17 of 32 in the Standard Care group (53%) ( p = .017). Although underpowered for hypothesis testing, descriptive results for BBS and 10MWT favored Rise&Walk: BBS improvement was 24.4 ± 14.9 vs. 18.3 ± 11.4 points; 10MWT gains were 0.35 vs. 0.23 m/s (comfortable) and 0.54 vs. 0.31 m/s (fast). Conclusions: Use of the Rise&Walk system was associated with greater mobility gains than standard therapy. These findings support feasibility and potential benefit of robotic gait training in inpatient rehabilitation and warrant confirmation in randomized trials. robotic-assisted gait training stroke rehabilitation neurological rehabilitation high intensity gait training task specific training gait training Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Stroke remains one of the leading causes of long-term adult disability in the United States, with persistent impairments in gait and balance significantly impacting independence and quality of life. Early and intensive gait rehabilitation has been shown to enhance neuroplasticity and functional recovery [ 1 ]; however, delivering high-repetition, task-specific training in real-world inpatient settings is often constrained by therapist availability, safety concerns, and patient endurance. Gait training is a cornerstone of stroke rehabilitation, yet conventional therapy can be limited by the physical demands placed on clinicians and patients alike. Robotic-assisted gait training (RAGT) offers a promising solution by enabling patients to walk repetitively, for longer durations, and under safe, supported conditions. Meta-analyses and clinical guidelines support its effectiveness in improving walking speed, endurance, and independence particularly during the early stages of stroke recovery [ 2 – 5 ]. Despite these promising outcomes, most RAGT studies have been conducted in controlled research environments, leaving limited evidence on the feasibility, implementation, and functional impact of robotic gait technology in typical inpatient rehabilitation settings [ 2 ]. From an operational standpoint, hospital systems are increasingly required to demonstrate not only clinical effectiveness but also cost-effectiveness through measurable patient outcomes. Section GG functional mobility scores are standardized assessments mandated by the Centers for Medicare & Medicaid Services (CMS). These scores have emerged as key indicators of inpatient rehabilitation performance and are used nationally for quality reporting and reimbursement [ 6 ]. Improvements in Section GG scores are directly tied to CMS’s value-based purchasing model, where higher functional gains can lead to increased reimbursement and favorable facility performance metrics. Technologies that can meaningfully improve GG scores may therefore offer both clinical and economic value by enhancing patient recovery while supporting institutional financial outcomes. Additionally, current robotic gait technologies face several critical limitations: prolonged setup times, strict patient selection criteria, restrictive linear movement paths, lack of upper extremity integration, and steep clinical learning curves [ 7 , 8 ]. These barriers often limit accessibility, reduce patient engagement, and prevent the delivery of high-intensity, neuroplasticity-driven training shown to be essential for meaningful recovery after neurological injury. The Rise&Walk® was specifically designed to overcome these challenges. Its end-effector design enables rapid setup and allows for greater degrees of freedom, promoting more natural variability and active muscle recruitment during walking. Unlike prior systems, Rise&Walk® integrates adjustable handguides that facilitate coordinated arm swing, marking the first time upper extremity involvement is dynamically incorporated into robotic gait therapy. Variable assistance modes, including full robotic support, active assist, manual guidance, and resistance training, empower therapists to tailor interventions precisely to each patient's functional level and recovery goals while safely applying principles of high-intensity, task-specific training without requiring large therapy teams. The integrated rating of perceived exertion (RPE) based training structure further enhances dosing precision by allowing real-time intensity adjustment based on patient-reported exertion, supporting individualized progression toward higher effort levels. Through these innovations, Rise&Walk® represents a transformational leap in robotic rehabilitation bringing efficient, scalable, intensity-driven gait therapy into real-world clinical practice. This retrospective pilot study examines the impact of Rise&Walk integration on real-world functional mobility outcomes, as measured by Section GG scores, in an inpatient stroke rehabilitation unit compared to standard physical therapy without robotic assistance. By evaluating changes in nationally reported functional mobility metrics, this study also provides preliminary insight into the potential operational and economic value of robotic gait technology to support both clinical improvement and hospital performance outcomes. Methods Study Design and Setting This study employed a retrospective chart review conducted at a regional inpatient rehabilitation facility. The review encompassed data collected between June 1, 2024, and December 31, 2024. The protocol received exempt status from the healthcare system’s Institutional Review Board, effective April 14, 2025. Inclusion Criteria Participants were eligible for inclusion if they met the following criteria: First-ever stroke diagnosis within 6 weeks of admission Medical clearance for weight-bearing activity and cardiorespiratory exercise Ability to ambulate a minimum of 10 meters with or without physical assistance Ability to tolerate upright standing for at least 10 minutes Exclusion Criteria Patients were excluded if they met any of the following: Pre-stroke inability to ambulate Bilateral stroke presentation Severe musculoskeletal, behavioral, or cognitive impairments that would preclude safe participation in gait training Presence of severe medical conditions contraindicating physical exertion (e.g., uncontrolled seizures, advanced diabetes, or osteoporosis) Intervention Rise&Walk Participants in the Rise&Walk group received robotic-assisted gait training using the Rise&Walk® end-effector robotic device in place of some conventional physical therapy sessions. This study was not powered to detect small between-group differences but aimed to identify trends and inform future prospective designs. As a feasibility-driven pilot analysis, the primary goal was to evaluate the integration and impact of robotic gait training in a typical inpatient setting and generate preliminary data for future randomized trials. The Rise&Walk therapy was delivered 2 to 8 times per patient per stay (4.2 sessions on average) for the duration of the patient’s inpatient stay. Session durations ranged from 7 to 35 minutes. Session frequency and duration were determined by the physical therapist's judgment, patient tolerance, and patient and therapist availability. Therapists tailored treatment parameters in real time, including: Body-weight support adjustment (10%−100%) Step direction variability (forward, backward) Assistance (resistance, manual modes, active assist, full robotic assist) Speed modulation (.5−1.8mph) Clinical applications (isometric holds, dual tasking, intervals) To ensure appropriate dosing and intensity, therapists recorded their patients’ Modified Borg Rating of Perceived Exertion (RPE) [ 9 ] every 5 minutes using the integrated software interface. Therapists aimed to maintain moderate-to-vigorous intensity (RPE 6–10) on the Modified Borg 0–10 scale for the majority of each session, adjusting parameter settings accordingly. Standard Care Participants in the Standard Care group received standard-of-care physical therapy, including overground gait training using parallel bars, manual facilitation techniques, transfer training, recumbent stepping, and other customary interventions based on clinical judgment. Outcomes Primary Outcomes Functional mobility was assessed using the Centers for Medicare & Medicaid Services (CMS) Section GG mobility items [ 6 ]. The following seven mobility activities were evaluated at admission and discharge: 4-Step: Ability to safely ascend and descend four steps. 12-Step: Ability to ascend and descend twelve steps, reflecting stair navigation capacity. Chair to Bed Transfer: Ability to safely transfer between a bed and chair or wheelchair. Sit to Stand: Ability to rise to a standing position from a seated position without assistance. Walk 10 feet: Ability to walk at least 10 feet once standing. Walk 50 feet + 2 Turns: Ability to walk 50 feet and navigate two turns. Walk 150 feet: Ability to walk 150 feet independently. Section GG scores were collected as part of routine clinical documentation and represent standardized, federally mandated measures used for quality reporting and reimbursement in inpatient rehabilitation facilities. Each task is rated on a 6-point scale (1 = dependent, 6 = independent), with higher scores indicating greater functional independence. Improvements in Section GG scores are not only clinically meaningful but also operationally important for hospital performance evaluations. Secondary Outcomes Additional functional assessments included: Berg Balance Scale (BBS) A 14-item objective measure assessing static and dynamic balance abilities. The maximum score is 56, with higher scores indicating better balance. The BBS is widely validated in stroke populations and correlates with fall risk and mobility outcomes [ 10 ]. 10-Meter Walk Test (10MWT) [ 11 ] Walking speed was assessed over a 10-meter distance under two conditions Comfortable Speed: Self-selected natural walking pace. Fast Speed: Maximal safe walking pace. Walking speed is a highly sensitive and reliable indicator of functional ambulation status and has been linked to community ambulation potential and quality of life following stroke. Data & Analysis Key methods for data summarization, statistical modeling, and visualization are outlined below. Additional technical details and full statistical procedures are provided in the Additional File 1. Data Management All data were de-identified prior to analysis. Outcome data were collected using a combination of the Uniform Data System for Medical Rehabilitation (UDS Pro®) and paper medical records, which were securely entered and managed to ensure patient confidentiality and compliance with HIPAA guidelines. Baseline Characteristics Baseline data including age, sex, and admission scores for Section GG mobility items, Berg Balance Scale (BBS), and 10-Meter Walk Test (10MWT) were summarized using counts and percentages for categorical variables, medians and interquartile ranges for ordinal or skewed data, and means with standard deviations for normally distributed data. Group differences at baseline were described using Cliff’s delta, a nonparametric effect size measure. Values of Cliff’s delta were interpreted using conventional thresholds: negligible (< 0.147), small (0.147–0.33), moderate (0.33–0.474), and large (≥ 0.474), acknowledging that these are heuristic guidelines. Hypothesis testing (i.e., p-values) for baseline differences was not performed, as such tests are sensitive to sample size and do not convey the magnitude or clinical relevance of group imbalances. Primary Outcome Assessment Ordinal logistic regression models adjusted for baseline scores were used to analyze individual Section GG mobility items at discharge. Changes in a composite mobility score were evaluated using mixed-effects quantile regression, incorporating a random intercept for each participant to account for within-subject correlations across Section GG items. Alluvial plots visualize score changes from admission to discharge. Statistical significance was defined as p < .05, with no adjustments for multiple comparisons given the exploratory nature of this pilot study. Secondary Outcome Assessment Due to limited data, BBS and 10MWT results are presented descriptively as means ± standard deviations and visualized with boxplots. Assessment of Clinical Importance Clinically meaningful improvements were assessed in two ways: by the total change in Section GG scores summed across all items, with ≥ 16 points indicating meaningful recovery [ 12 ], and by the proportion of participants who met established Minimal Clinically Important Difference (MCID) thresholds for the Berg Balance Scale (BBS) and 10-Meter Walk Test (10MWT). These MCID thresholds were 7.1 points for BBS, 0.10 m/s for 10MWT at comfortable speed, and 0.14 m/s at fast speed [ 8 , 9 ]. Software Analyses were conducted in R version 4.4.2 using RStudio (2024.09.1 Build 394). Data cleaning utilized ‘tidyverse’; ordinal logistic regression and mixed-effects quantile regression models were performed with the ‘MASS’ and ‘lqmm’ packages, respectively. Visualizations were created using ‘ggplot2’ and ‘ggalluvial’. Results Participant Flow and Analytic Sets Between 1 June and 31 December 2024, 45 consecutive stroke in-patients satisfied all eligibility criteria and completed admission-to-discharge Section GG assessments; these individuals formed the primary analytic cohort (Rise&Walk: n = 13; Standard Care: n = 32). Secondary balance and gait-speed measures (BBS and 10MWT) were available for a subset of 14 of those patients (Rise&Walk n = 5; Standard Care: n = 9) because these tests were documented only when time and staffing permitted in routine practice. No patients were lost to follow-up or excluded after allocation, so all available cases were analysed. Baseline Characteristics Baseline characteristics for both groups are summarized in Table 1 . The median age was 72 (IQR: 61.5–80.75) in the Standard Care group and 66 (IQR: 53–72) in the Rise&Walk group. The Standard Care group also had a lower proportion of males, with 47% (15 of 32) compared to 69% (9 of 13) in the Rise&Walk group. Despite these demographic differences, the groups were generally well-matched on baseline Section GG mobility items, with Cliff’s delta values ranging from 0.02 to 0.13, reflecting only minimal differences in distributions. These correspond to probabilities ranging from approximately 51–56% that a randomly selected participant from the Rise&Walk group would have a higher score than one from the Standard Care group—suggesting negligible baseline imbalance in functional status and a roughly equal likelihood of higher scores across groups. For context, the median scores for Walk 10 ft, Walk 50 ft + 2 turns, Walk 150 ft, 4 Steps, and 12 Steps were each 1, indicating that the typical patient in both groups was completely dependent for these mobility tasks at baseline. For Sit-to-Stand and Chair-to-Bed Transfer, the median scores were 3 in the Standard Care group and 3 and 2, respectively, in the Rise&Walk group—implying that patients generally required moderate to substantial assistance with these transfers. Among the subset of patients with available admission data for the BBS and 10MWT, BBS scores were similar between groups (Standard Care: 24.0 ± 10.3 vs. Rise&Walk: 23.0 ± 17.8). However, moderate imbalances were observed in both the slow-paced and fast-paced 10MWT, with the Rise&Walk group performing worse on average (slow-paced: 0.43 ± 0.21 m/s vs. 0.25 ± 0.24 m/s; fast-paced: 0.58 ± 0.23 m/s vs. 0.35 ± 0.32 m/s, Standard Care vs. Rise&Walk, respectively). Table 1 Baseline Characteristics of Rise&Walk and Standard Care Groups at Admission. Variable Standard Care (N = 32) Rise&Walk (N = 13) Difference (Cliff’s Δ or % Diff) Age, years 72 (61.5–80.75) [29–92] 66 (53–72) [47–82] 0.24 Male sex, n / N (%) 15 / 32 (47%) 9 / 13 (69%) + 22% Section GG mobility items Sit-to-Stand 3 (1–3) 3 (2–3) 0.02 Chair-to-Bed 3 (1–3) 2 (2–3) -0.03 Walk 10 ft 1 (1–3) 1 (1–2) 0.09 Walk 50 ft + 2 turns 1 (1–3) 1 (1–1) 0.10 Walk 150 ft 1 (1–1) 1 (1–1) 0.12 4 Steps 1 (1–3) 1 (1–1) 0.13 12 Steps 1 (1–1) 1 (1–1) 0.12 Total 11 (7.25–17.75) [7–28] 11 (9–15.5) [7–21] 0.04 Berg Balance Scale† 24.0 ± 10.3 [9–42] 23.0 ± 17.8 [3–42] < 0.01 10 MWT Comfortable, m/s† 0.43 ± 0.21 [0.07–0.78] 0.25 ± 0.24 [0–0.51] 0.38 10 MWT Fast, m/s† 0.58 ± 0.23 [0.18–0.97] 0.35 ± 0.32 [0–0.64] 0.40 Data are presented as n/N (%) for categorical variables, median (IQR) [min–max] for non-normally distributed numeric or ordinal variables and mean ± SD [min–max] for normally distributed variables. The “Difference” column reports Cliff’s delta for ordinal and continuous variables, representing the probability that a randomly selected patient from the Rise&Walk group has a higher score than one from the Standard Care group, minus the reverse probability. For sex, the difference is reported as the absolute difference in percentages. † Administered in a smaller subsample (Standard Care n = 9, Rise&Walk n = 5) Primary Outcomes - Section GG Mobility Both groups demonstrated significant improvements in all Section GG mobility items from admission to discharge ( p < .001). However, the Rise&Walk group showed consistently greater improvement compared to the Standard Care group across all mobility items. After adjusting for baseline admission scores, statistically significant differences favoring the Rise&Walk group were observed for Chair-to-Bed Transfer (cOR = 18.4, p = .009), Walk 10 Feet (cOR = 6.8, p = .025), and Walking 50 Feet + 2 turns (cOR = 7.7, p = .011). These cumulative odds ratios from the ordinal logistic regression models represent the odds of being in a higher category of mobility function at discharge relative to all lower categories. For instance, a cOR of 18.4 for Chair-to-Bed Transfer indicates that participants in the Rise&Walk group had 18.4 times greater odds of achieving improved mobility scores at discharge compared to the Standard Care group, after controlling for baseline scores. An alluvial diagram illustrating these improvements stratified by group is presented in Fig. 1. Although other items did not achieve statistical significance at the α = 0.05 level, all remaining effect sizes were relatively large, ranging from cOR = 2.4 (12 Steps; p = .199) to cOR = 13.3 (Sit-to-Stand; p = .053). Results of each ordinal regression are summarized in Table 2 , and summary statistics for each Section GG item are detailed in Additional File 2 . When summing change scores across all seven Section GG mobility items, the Rise&Walk group achieved an estimated total functional gain of median of 26 points (IQR: 21.5–27), compared to 16.5 points (11.25–21) in the Standard Care group (Fig. 2). When adjusting for baseline function, the predicted median total improvement from admission to discharge, estimated via mixed-effects quantile regression, was significantly greater in the Rise&Walk group compared to the Standard Care group (median difference = 6.5 points, p = .01) In the Rise&Walk group, 12 of 13 participants (92%) met the ≥ 16-point MCID threshold, compared to 17 of 32 participants (53%) in the Standard Care group (Fig. 3). This represents a significantly higher rate of clinically meaningful improvement in the Rise&Walk group, with a 39-percentage point difference ( p = .017). Table 2 Ordinal Regression Results Comparing Mobility Outcomes Between Rise&Walk and Standard Care. Variable Cumulative Odds Ratio P value Significance Sit-to-Stand 13.3 .053 Chair-to-Bed 18.4 .009 ** Walk 10 ft 6.8 .025 * Walk 50 ft + 2 turns 7.7 .011 * Walk 150 ft 3.1 .082 4 Steps 3.8 .056 12 Steps 2.4 .199 Results are from separate ordinal logistic regression models evaluating mobility outcomes at discharge. The primary effect sizes are reported is the cumulative odds ratio (cOR), which estimates the odds that a participant in the Rise&Walk group will achieve a higher functional mobility category compared to the Standard Care group, adjusting for baseline admission scores. Values greater than 1.0 indicate higher odds of improvement in the Rise&Walk group, while values less than 1.0 indicate higher odds in the Standard Care group. * p < 0.05, ** p < 0.01, *** p < 0.001 Secondary Outcomes - Balance & Gait Speed Metrics for balance (BBS) and gait speed (10MWT) were available for only a subset of participants, including 9 in the Standard Care group and 5 in the Rise&Walk group. Inferential analyses were not performed, as the limited sample precludes adequate adjustment for baseline differences, which appeared particularly important for comparisons involving the 10MWT (see Table 1 ). Overall, the direction of results favored the Rise&Walk group for both balance and gait speed. Descriptively, the mean change in BBS scores from baseline was 18.3 ± 11.4 in the Standard Care group and 24.4 ± 14.9 in the Rise&Walk group (mean difference: 6.1 points). For the 10MWT at comfortable speed, mean change was 0.23 ± 0.25 m/s in the Standard Care group and 0.35 ± 0.28 m/s in the Rise&Walk group (mean difference: 0.12 m/s). At fast speed, the mean change was 0.31 ± 0.33 m/s versus 0.54 ± 0.27 m/s, respectively (mean difference: 0.23 m/s). A summary of these balance and gait speed outcomes is provided in Table 3 and visualized in Fig. 4. Table 3 Mean change from admission scores at discharge for balance and gait speed. Outcome Standard Care: Mean Change Rise&Walk: Mean Change Mean Difference in Change BBS 18.3 24.4 6.1 10MWT (Comfortable speed, m/s) 0.23 0.35 0.12 10MWT (Fast speed, m/s) 0.31 0.54 0.23 10MWT = 10-Meter Walk Test; BBS = Berg Balance Scale Notably, all participants in the Rise&Walk group exceeded the MCID for both the BBS and 10MWT (fast speed), with 4 out of 5 (80%) also exceeding the threshold for the comfortable pace 10MWT, reflecting consistent and substantial functional gains. In contrast, 7 out of 9 (78%) of the Standard Care group met the MCID for BBS, and 6 out of 9 (67%) met the thresholds for both gait speed measures (Fig. 4). Length of Stay The mean length of stay was 16.7 ± 5.2 days (range: 7–10) in the Standard Care group and 19.2 ± 5.3 days (range: 10–24) in the Rise&Walk group. Although the Rise&Walk group had a longer average stay by 2.5 days, this difference was not statistically significant ( p = .154). Adverse Events No device-related or therapy-related adverse events were reported. All scheduled Section GG assessments were completed; secondary outcome documentation was missing only when therapy time constraints precluded testing. Discussion The findings of this pilot study suggest that robotic-assisted gait training with Rise&Walk® may offer meaningful advantages over conventional therapy for improving short-distance mobility and functional transfers in patients with recent stroke. Specifically, the Rise&Walk group demonstrated significantly greater gains in three Section GG mobility items, including Chair to Bed Transfer, Walk 10 ft, and Walk 50 ft plus 2 Turns. Furthermore, the directionality of results consistently favored Rise&Walk-assisted therapy over conventional physical therapy across all individual mobility outcomes. Although the samples were too small to determine any statistically meaningful differences in BBS or 10MWT outcomes, the directionality of results also favored Rise&Walk therapy over conventional physical therapy. Both groups exceeded the 16-point threshold for clinically meaningful improvement in Section GG mobility on average [ 12 ]; however, a greater proportion of participants in the Rise&Walk group met this threshold (92% vs. 53%), representing a 39-percentage point difference. Additionally, the Rise&Walk group demonstrated a significantly higher predicted median improvement in individual scores. This finding reinforces the potential clinical significance of Rise&Walk integration in promoting more robust inpatient mobility recovery, particularly within typical resource-constrained rehabilitation environments. These results align with existing literature supporting the efficacy of robotic-assisted gait training (RAGT) in subacute stroke populations [ 2 – 5 ], particularly in enhancing walking speed and independence. However, unlike many prior RAGT trials conducted in highly controlled research environments, this study provides preliminary real-world evidence for the feasibility and impact of robotic integration within a typical inpatient rehabilitation setting. Importantly, these improvements were achieved with only 4.2 sessions per length of stay on average, underscoring the potential for scalable integration into clinical workflows without requiring full replacement of conventional therapy. Additionally, this study offers preliminary insight into the application of a novel, technology-integrated Rating of Perceived Exertion (RPE) tracking method to guide robotic training dosage. The Rise&Walk software enabled therapists to document and adjust training intensity in real time based on patient-reported exertion, allowing for individualized progression. Although the Modified Borg scale has been validated for monitoring exercise intensity in stroke populations, its application in robotic rehabilitation settings remains an emerging area of study. Previous studies support incorporating intensity thresholds into robotic rehabilitation, highlighting the need for further validation of scalable dosing models.[ 5 , 13 ] This approach represents an important step toward establishing dose-response relationships in robotic gait training, a critical gap in current research. From a clinical implementation perspective, the Rise&Walk device allowed therapists to provide high-repetition, intensive gait training with minimal physical strain, supporting both patient and clinician safety an increasingly important factor given the prevalence of musculoskeletal injuries among rehabilitation professionals.[ 14 ] The device’s ability to accommodate seated, standing, and walking modes further supports flexible use for patients across the functional spectrum, including those who require frequent rest or exhibit limited upright tolerance early in recovery. Limitations Several limitations must be acknowledged. The non-randomized, retrospective design introduces potential selection bias, and intervention fidelity (e.g., actual session frequency or duration) varied across patients. There were also small but potentially meaningful baseline imbalances regarding age and sex. Given the small sample size, adequately controlling for these imbalances was not possible; therefore, future work should aim to address this limitation with larger, more balanced samples. Another limitation is that, although patients in the Rise&Walk group demonstrated improved Section GG mobility outcomes, this group also had a longer length of stay (albeit non-significant), which could have influenced the results. Furthermore, there was variability in the delivery of Rise&Walk therapy, ranging from 2 to 8 sessions per patient per stay (mean of 4.2 sessions). We lacked adequate data linking session counts to individual patient IDs, so we were unable to model the relationship between the number of sessions and improvement. However, it is reasonable to hypothesize that patients receiving more sessions may have experienced better outcomes, highlighting the need to balance treatment dose and effect in future studies. The sample also spanned a wide age range, from 29 to 92 years. Given the small sample size, it was difficult to fully account for disparate improvements by age, and outliers in this distribution may impact modeling results. Future studies should aim to model the effect of age more precisely. Finally, the small sample size and single-site setting limit the generalizability of the findings. Nonetheless, these limitations are balanced by the study’s real-world clinical context and detailed functional outcome data, providing a valuable foundation for future prospective trials. Conclusion These preliminary findings support the integration of robotic-assisted gait training, specifically with the Rise&Walk device, as a feasible and potentially impactful adjunct to conventional stroke rehabilitation. The ability to deliver individualized, intensive, and safe mobility training within the resource constraints of an inpatient setting represents a meaningful advancement for both patients and clinicians. Future research should prioritize adequately powered randomized controlled trials to confirm these findings, optimize dosing strategies, and evaluate long-term outcomes including community ambulation and healthcare utilization Declarations Disclosure This study was supported in part by an affiliated healthcare organization. The views expressed in this publication are those of the author(s) and do not necessarily reflect the official views of the supporting institution or its affiliates.” Competing Interests Luke Benda is the CEO and co-founder of Healing InnovationsJulie Hartman is an employee of Healing innovationsJulie & Luke were not involved in data collection or final data analysis Human Ethics and Consent to Participate Declarations This retrospective chart review study was approved by the [Methodist Healthcare Institutional Review Board and Research Operations Committee], which granted a waiver of informed consent due to the use of de-identified data. (IRB Protocol #2313076-1 and 2313076-2). Funding Declaration The authors received no funding for this work. Author Contribution J.H: Responsible for study design, wrote manuscript, assisted with data analysis review, manuscript submissionL.B: Assisted with manuscript, assisted with data analysis reviewJ.C.: Assisted with manuscript review, data collection, preliminary data-analysisS.F.: Organized Study team, data collection, reviewed manuscript Acknowledgement Acknowledgements The authors acknowledge Superior Medical Experts, Inc. for editorial assistance, statistical support, and contributions to data interpretation and manuscript preparation Availability of data and materials References Billinger SA, Arena R, Bernhardt J, et al. Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(8):2532–53. 10.1161/STR.0000000000000022 . Mehrholz J, Thomas S, Elsner B. Electromechanical-assisted training for walking after stroke. Cochrane Database Syst Rev. 2020;10(10):CD006185. 10.1002/14651858.CD006185.pub5 . Calabrò RS, Naro A, Russo M, et al. Shaping neuroplasticity by using powered exoskeletons in patients with stroke: a randomized clinical trial. J Neuroeng Rehabil. 2018;15(1):35. 10.1186/s12984-018-0384-2 . Bruni MF, Melegari C, De Cola MC, et al. What does best evidence tell us about robotic gait rehabilitation in stroke patients: a systematic review. J Clin Neurosci. 2018;48:11–7. 10.1016/j.jocn.2017.10.073 . Sarı D, Çolak TK, Batur EB, Baltacı G. Effects of robotic rehabilitation on walking ability and functional independence in stroke patients: a systematic review. Turk J Phys Med Rehabil. 2021;67(1):1–9. 10.5606/tftrd.2021.6546 . Centers for Medicare & Medicaid Services. Section GG Functional Abilities and Goals: Quick Tips. CMS.gov. Accessed April 2025. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments Marchal-Crespo L, Reinkensmeyer DJ. Review of control strategies for robotic movement training after neurologic injury. J Neuroeng Rehabil. 2009;6:20. 10.1186/1743-0003-6-20 . Gupta A, Prakash NB, Honavar PR. Gait Training with Robotic Exoskeleton Assisted Rehabilitation System in Patients with Incomplete Traumatic and Non-Traumatic Spinal Cord Injury: A Pilot Study and Review of Literature. Ann Indian Acad Neurol. 2023;26(1):43–50. 10.4103/aian.aian_1003_22 . Shirley Ryan AbilityLab. (2018, April 16). Borg Rating Scale of Perceived Exertion . Rehabilitation Measures Database. Retrieved April 28, 2025, from. Shirley Ryan AbilityLab. (2020, June 30). Berg Balance Scale . Rehabilitation Measures Database. Retrieved April 28, 2025, from https://www.sralab.org/rehabilitation-measures/berg-balance-scale Academy of Neurologic Physical Therapy. (2019). 10 Meter Walk Test (10MWT) Pocket Guide . Retrieved April 28, 2025, from https://www.neuropt.org/docs/default-source/cpgs/core-outcome-measures/10mwt-pocket-guide-proof8-(2)28db36a5390366a68a96ff00001fc240.pdf​ Middleton A, Graham JE, Ottenbacher KJ. Functional status is associated with 30-day potentially preventable hospital readmissions after inpatient rehabilitation among Medicare beneficiaries with stroke. Med Care. 2018;56(9):739–44. 10.1097/MLR.0000000000000955 . Heran M, Mongeon D, Thiel A. Robotic-assisted gait training and neuroplasticity in stroke: A systematic review. Brain Res. 2024;1802:148304. https://doi.org/10.1016/j.brainres.2024.148304 . American Physical Therapy Association. Safe Patient Handling and Mobility in Physical Therapy. APTA.org. Published 2020. Accessed. April 2025. https://www.apta.org Additional Declarations Competing interest reported. Luke Benda is the CEO and co-founder of Healing Innovations Julie Hartman is an employee of Healing innovations Julie & Luke were not involved in data collection or final data analysis Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7266083","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":498375320,"identity":"d4412bb1-2e49-4e65-b90c-9408689e2657","order_by":0,"name":"Julie Hartman","email":"data:image/png;base64,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","orcid":"","institution":"Healing Innovations Inc","correspondingAuthor":true,"prefix":"","firstName":"Julie","middleName":"","lastName":"Hartman","suffix":""},{"id":498375321,"identity":"1827292b-a985-42ce-8af3-5181e79d542a","order_by":1,"name":"Luke Benda","email":"","orcid":"","institution":"Healing Innovations Inc","correspondingAuthor":false,"prefix":"","firstName":"Luke","middleName":"","lastName":"Benda","suffix":""},{"id":498375322,"identity":"d0862c22-ce7f-40d6-b33c-6906cbca5505","order_by":2,"name":"John Costantine","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"John","middleName":"","lastName":"Costantine","suffix":""},{"id":498375323,"identity":"106d2e5f-2bef-4d54-9250-1d1693d4ccd6","order_by":3,"name":"Shaun Fant","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Shaun","middleName":"","lastName":"Fant","suffix":""}],"badges":[],"createdAt":"2025-08-01 00:08:09","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7266083/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7266083/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88891915,"identity":"3550b72b-e23d-4c40-b83c-ca17cdd0214b","added_by":"auto","created_at":"2025-08-12 12:53:02","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":106904,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAlluvial diagrams of Section GG mobility improvement: Rise\u0026amp;Walk vs. Standard Care groups. \u003c/strong\u003eThese items—Chair to Bed Transfer \u003cstrong\u003e(A)\u003c/strong\u003e, Walk 10 Feet \u003cstrong\u003e(B)\u003c/strong\u003e, and Walk 50 Feet with Two Turns \u003cstrong\u003e(C)\u003c/strong\u003e—showed statistically significant improvements from baseline in the Rise\u0026amp;Walk group compared to the Standard Care group. Each diagram depicts the flow of changes (as percentages) in individual ordinal-scale scores from admission to discharge for a given patient, stratified by group. The ordinal scores range from 1 (dependent) to 6 (independent) and are displayed on each y-axis as percentages of the total scores within each group. The ordinal scores range from 1 (dependent) to 6 (independent) and are displayed on each y-axis as percentages of the total scores within the Rise\u0026amp;Walk group; for example, the top-left panel for Chair to Bed Transfer shows all participants had a score of 1 at admission, which shifted to scores of 4 or 6 at discharge; the majority of those with a score of 2 at admission improved to 6, while a minority shifted to 4; and all participants with scores of 3 or 4 at admission reached a score of 6 by discharge.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7266083/v1/cbd9650b78f5e11b5c1ddaed.jpg"},{"id":88893959,"identity":"32593959-8cbe-40cd-9be2-efb2e2a39d61","added_by":"auto","created_at":"2025-08-12 13:01:02","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":85752,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOverall improvement in Section GG mobility items by group\u003c/strong\u003e. Data reflect composite values, presented either as the overall percentage of each individual ordinal score across all mobility items or as total summed scores transformed to numeric values. The top panel \u003cstrong\u003e(A)\u003c/strong\u003edisplays an alluvial diagram illustrating the flow of changes (as percentages) in individual scores from admission to discharge, stratified by group. The bottom panel \u003cstrong\u003e(B)\u003c/strong\u003e shows boxplots of the total summed mobility scores at admission and discharge. Each box represents the interquartile range (IQR), with the horizontal line indicating the median and whiskers extending to 1.5 times the IQR.\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7266083/v1/a3675dcdf3b612b680734c61.jpg"},{"id":88891917,"identity":"4bc12e2d-7574-4964-8a6d-787c18c4d8b6","added_by":"auto","created_at":"2025-08-12 12:53:02","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":65142,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eProportion of patients achieving MCID (≥16 points) in Section GG total score during rehabilitation\u003c/strong\u003e. The bar plot compares the percentage of participants meeting or exceeding the MCID threshold in the Standard Care group (53%, 17 of 32 patients) and the Rise\u0026amp;Walk group (92%, 12 of 13 patients). Higher proportions in the Rise\u0026amp;Walk group indicate greater functional gains. MCID threshold based on established recovery criteria [12].\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7266083/v1/7874b07bf3105fc2be8d9810.jpg"},{"id":88893960,"identity":"50bbf2ba-5e48-4d9d-b7af-a1ce78a8038c","added_by":"auto","created_at":"2025-08-12 13:01:02","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":79174,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGroup differences in secondary outcomes: Berg Balance Scale and 10-meter walk tests. \u003c/strong\u003eThe top panel \u003cstrong\u003e(A)\u003c/strong\u003e displays boxplots representing the change scores from admission to discharge for each secondary outcome. Each box shows the interquartile range (IQR), with the horizontal line indicating the median, whiskers extending to 1.5 times the IQR, and the “x” marking the mean value. The bottom panel \u003cstrong\u003e(B)\u003c/strong\u003e presents bar plots highlighting the percentage of patients who met the clinically relevant Minimal Clinically Important Difference (MCID) values by group (see Methods for details).\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7266083/v1/fe24ee65dd47cdf2842a4ff0.jpg"},{"id":99799427,"identity":"04ec8a27-3f21-4395-ac28-e332174c0b7a","added_by":"auto","created_at":"2026-01-08 13:49:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1373492,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7266083/v1/d0d383d4-eef0-417d-985c-e68b4c625ee6.pdf"}],"financialInterests":"Competing interest reported. Luke Benda is the CEO and co-founder of Healing Innovations\nJulie Hartman is an employee of Healing innovations\n\nJulie \u0026 Luke were not involved in data collection or final data analysis","formattedTitle":"\u003cp\u003eFunctional Mobility Outcomes Following Robotic-Assisted Gait Training with Rise\u0026amp;Walk® in Inpatient Stroke Rehabilitation: A Retrospective Pilot Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eStroke remains one of the leading causes of long-term adult disability in the United States, with persistent impairments in gait and balance significantly impacting independence and quality of life. Early and intensive gait rehabilitation has been shown to enhance neuroplasticity and functional recovery [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]; however, delivering high-repetition, task-specific training in real-world inpatient settings is often constrained by therapist availability, safety concerns, and patient endurance.\u003c/p\u003e\u003cp\u003eGait training is a cornerstone of stroke rehabilitation, yet conventional therapy can be limited by the physical demands placed on clinicians and patients alike. Robotic-assisted gait training (RAGT) offers a promising solution by enabling patients to walk repetitively, for longer durations, and under safe, supported conditions. Meta-analyses and clinical guidelines support its effectiveness in improving walking speed, endurance, and independence particularly during the early stages of stroke recovery [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e–\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite these promising outcomes, most RAGT studies have been conducted in controlled research environments, leaving limited evidence on the feasibility, implementation, and functional impact of robotic gait technology in typical inpatient rehabilitation settings [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. From an operational standpoint, hospital systems are increasingly required to demonstrate not only clinical effectiveness but also cost-effectiveness through measurable patient outcomes.\u003c/p\u003e\u003cp\u003eSection GG functional mobility scores are standardized assessments mandated by the Centers for Medicare \u0026amp; Medicaid Services (CMS). These scores have emerged as key indicators of inpatient rehabilitation performance and are used nationally for quality reporting and reimbursement [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Improvements in Section GG scores are directly tied to CMS’s value-based purchasing model, where higher functional gains can lead to increased reimbursement and favorable facility performance metrics. Technologies that can meaningfully improve GG scores may therefore offer both clinical and economic value by enhancing patient recovery while supporting institutional financial outcomes.\u003c/p\u003e\u003cp\u003eAdditionally, current robotic gait technologies face several critical limitations: prolonged setup times, strict patient selection criteria, restrictive linear movement paths, lack of upper extremity integration, and steep clinical learning curves [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These barriers often limit accessibility, reduce patient engagement, and prevent the delivery of high-intensity, neuroplasticity-driven training shown to be essential for meaningful recovery after neurological injury.\u003c/p\u003e\u003cp\u003eThe Rise\u0026amp;Walk® was specifically designed to overcome these challenges. Its end-effector design enables rapid setup and allows for greater degrees of freedom, promoting more natural variability and active muscle recruitment during walking. Unlike prior systems, Rise\u0026amp;Walk® integrates adjustable handguides that facilitate coordinated arm swing, marking the first time upper extremity involvement is dynamically incorporated into robotic gait therapy. Variable assistance modes, including full robotic support, active assist, manual guidance, and resistance training, empower therapists to tailor interventions precisely to each patient's functional level and recovery goals while safely applying principles of high-intensity, task-specific training without requiring large therapy teams.\u003c/p\u003e\u003cp\u003eThe integrated rating of perceived exertion (RPE) based training structure further enhances dosing precision by allowing real-time intensity adjustment based on patient-reported exertion, supporting individualized progression toward higher effort levels. Through these innovations, Rise\u0026amp;Walk® represents a transformational leap in robotic rehabilitation bringing efficient, scalable, intensity-driven gait therapy into real-world clinical practice.\u003c/p\u003e\u003cp\u003eThis retrospective pilot study examines the impact of Rise\u0026amp;Walk integration on real-world functional mobility outcomes, as measured by Section GG scores, in an inpatient stroke rehabilitation unit compared to standard physical therapy without robotic assistance. By evaluating changes in nationally reported functional mobility metrics, this study also provides preliminary insight into the potential operational and economic value of robotic gait technology to support both clinical improvement and hospital performance outcomes.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eStudy Design and Setting\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study employed a retrospective chart review conducted at a regional inpatient rehabilitation facility. The review encompassed data collected between June 1, 2024, and December 31, 2024. The protocol received exempt status from the healthcare system’s Institutional Review Board, effective April 14, 2025.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion Criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants were eligible for inclusion if they met the following criteria:\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eFirst-ever stroke diagnosis within 6 weeks of admission\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMedical clearance for weight-bearing activity and cardiorespiratory exercise\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAbility to ambulate a minimum of 10 meters with or without physical assistance\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAbility to tolerate upright standing for at least 10 minutes\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e\u003cb\u003eExclusion Criteria\u003c/b\u003e\u003c/p\u003e\u003cp\u003ePatients were excluded if they met any of the following:\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ePre-stroke inability to ambulate\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eBilateral stroke presentation\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eSevere musculoskeletal, behavioral, or cognitive impairments that would preclude safe participation in gait training\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ePresence of severe medical conditions contraindicating physical exertion (e.g., uncontrolled seizures, advanced diabetes, or osteoporosis)\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e\u003cb\u003eIntervention\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eRise\u0026amp;Walk\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants in the Rise\u0026amp;Walk group received robotic-assisted gait training using the Rise\u0026amp;Walk® end-effector robotic device in place of some conventional physical therapy sessions. This study was not powered to detect small between-group differences but aimed to identify trends and inform future prospective designs. As a feasibility-driven pilot analysis, the primary goal was to evaluate the integration and impact of robotic gait training in a typical inpatient setting and generate preliminary data for future randomized trials. The Rise\u0026amp;Walk therapy was delivered 2 to 8 times per patient per stay (4.2 sessions on average) for the duration of the patient’s inpatient stay. Session durations ranged from 7 to 35 minutes. Session frequency and duration were determined by the physical therapist's judgment, patient tolerance, and patient and therapist availability.\u003c/p\u003e\u003cp\u003eTherapists tailored treatment parameters in real time, including:\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eBody-weight support adjustment (10%−100%)\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eStep direction variability (forward, backward)\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAssistance (resistance, manual modes, active assist, full robotic assist)\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eSpeed modulation (.5−1.8mph)\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eClinical applications (isometric holds, dual tasking, intervals)\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003eTo ensure appropriate dosing and intensity, therapists recorded their patients’ Modified Borg Rating of Perceived Exertion (RPE) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] every 5 minutes using the integrated software interface. Therapists aimed to maintain moderate-to-vigorous intensity (RPE 6–10) on the Modified Borg 0–10 scale for the majority of each session, adjusting parameter settings accordingly.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStandard Care\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants in the Standard Care group received standard-of-care physical therapy, including overground gait training using parallel bars, manual facilitation techniques, transfer training, recumbent stepping, and other customary interventions based on clinical judgment.\u003c/p\u003e\u003cp\u003e\u003cb\u003eOutcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePrimary Outcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFunctional mobility was assessed using the Centers for Medicare \u0026amp; Medicaid Services (CMS) Section GG mobility items [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The following seven mobility activities were evaluated at admission and discharge:\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e4-Step: Ability to safely ascend and descend four steps.\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003e12-Step: Ability to ascend and descend twelve steps, reflecting stair navigation capacity.\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eChair to Bed Transfer: Ability to safely transfer between a bed and chair or wheelchair.\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eSit to Stand: Ability to rise to a standing position from a seated position without assistance.\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eWalk 10 feet: Ability to walk at least 10 feet once standing.\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eWalk 50 feet + 2 Turns: Ability to walk 50 feet and navigate two turns.\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eWalk 150 feet: Ability to walk 150 feet independently.\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003eSection GG scores were collected as part of routine clinical documentation and represent standardized, federally mandated measures used for quality reporting and reimbursement in inpatient rehabilitation facilities. Each task is rated on a 6-point scale (1 = dependent, 6 = independent), with higher scores indicating greater functional independence. Improvements in Section GG scores are not only clinically meaningful but also operationally important for hospital performance evaluations.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSecondary Outcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAdditional functional assessments included:\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eBerg Balance Scale (BBS)\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eA 14-item objective measure assessing static and dynamic balance abilities. The maximum score is 56, with higher scores indicating better balance. The BBS is widely validated in stroke populations and correlates with fall risk and mobility outcomes [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e10-Meter Walk Test (10MWT) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eWalking speed was assessed over a 10-meter distance under two conditions\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eComfortable Speed: Self-selected natural walking pace.\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eFast Speed: Maximal safe walking pace. Walking speed is a highly sensitive and reliable indicator of functional ambulation status and has been linked to community ambulation potential and quality of life following stroke.\u003c/span\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e\u003cb\u003eData \u0026amp; Analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eKey methods for data summarization, statistical modeling, and visualization are outlined below. Additional technical details and full statistical procedures are provided in the \u003cb\u003eAdditional File 1.\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eData Management\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll data were de-identified prior to analysis. Outcome data were collected using a combination of the Uniform Data System for Medical Rehabilitation (UDS Pro®) and paper medical records, which were securely entered and managed to ensure patient confidentiality and compliance with HIPAA guidelines.\u003c/p\u003e\u003cp\u003e\u003cb\u003eBaseline Characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBaseline data including age, sex, and admission scores for Section GG mobility items, Berg Balance Scale (BBS), and 10-Meter Walk Test (10MWT) were summarized using counts and percentages for categorical variables, medians and interquartile ranges for ordinal or skewed data, and means with standard deviations for normally distributed data. Group differences at baseline were described using Cliff’s delta, a nonparametric effect size measure. Values of Cliff’s delta were interpreted using conventional thresholds: negligible (\u0026lt; 0.147), small (0.147–0.33), moderate (0.33–0.474), and large (≥ 0.474), acknowledging that these are heuristic guidelines. Hypothesis testing (i.e., p-values) for baseline differences was not performed, as such tests are sensitive to sample size and do not convey the magnitude or clinical relevance of group imbalances.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePrimary Outcome Assessment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOrdinal logistic regression models adjusted for baseline scores were used to analyze individual Section GG mobility items at discharge. Changes in a composite mobility score were evaluated using mixed-effects quantile regression, incorporating a random intercept for each participant to account for within-subject correlations across Section GG items. Alluvial plots visualize score changes from admission to discharge. Statistical significance was defined as p \u0026lt; .05, with no adjustments for multiple comparisons given the exploratory nature of this pilot study.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSecondary Outcome Assessment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDue to limited data, BBS and 10MWT results are presented descriptively as means ± standard deviations and visualized with boxplots.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAssessment of Clinical Importance\u003c/b\u003e\u003c/p\u003e\u003cp\u003eClinically meaningful improvements were assessed in two ways: by the total change in Section GG scores summed across all items, with ≥ 16 points indicating meaningful recovery [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], and by the proportion of participants who met established Minimal Clinically Important Difference (MCID) thresholds for the Berg Balance Scale (BBS) and 10-Meter Walk Test (10MWT). These MCID thresholds were 7.1 points for BBS, 0.10 m/s for 10MWT at comfortable speed, and 0.14 m/s at fast speed [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eSoftware\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAnalyses were conducted in R version 4.4.2 using RStudio (2024.09.1 Build 394). Data cleaning utilized ‘tidyverse’; ordinal logistic regression and mixed-effects quantile regression models were performed with the ‘MASS’ and ‘lqmm’ packages, respectively. Visualizations were created using ‘ggplot2’ and ‘ggalluvial’.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eParticipant Flow and Analytic Sets\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBetween 1 June and 31 December 2024, 45 consecutive stroke in-patients satisfied all eligibility criteria and completed admission-to-discharge Section GG assessments; these individuals formed the primary analytic cohort (Rise\u0026amp;Walk: n\u0026thinsp;=\u0026thinsp;13; Standard Care: n\u0026thinsp;=\u0026thinsp;32). Secondary balance and gait-speed measures (BBS and 10MWT) were available for a subset of 14 of those patients (Rise\u0026amp;Walk n\u0026thinsp;=\u0026thinsp;5; Standard Care: n\u0026thinsp;=\u0026thinsp;9) because these tests were documented only when time and staffing permitted in routine practice. No patients were lost to follow-up or excluded after allocation, so all available cases were analysed.\u003c/p\u003e\u003cp\u003e\u003cb\u003eBaseline Characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBaseline characteristics for both groups are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The median age was 72 (IQR: 61.5\u0026ndash;80.75) in the Standard Care group and 66 (IQR: 53\u0026ndash;72) in the Rise\u0026amp;Walk group. The Standard Care group also had a lower proportion of males, with 47% (15 of 32) compared to 69% (9 of 13) in the Rise\u0026amp;Walk group. Despite these demographic differences, the groups were generally well-matched on baseline Section GG mobility items, with Cliff\u0026rsquo;s delta values ranging from 0.02 to 0.13, reflecting only minimal differences in distributions. These correspond to probabilities ranging from approximately 51\u0026ndash;56% that a randomly selected participant from the Rise\u0026amp;Walk group would have a higher score than one from the Standard Care group\u0026mdash;suggesting negligible baseline imbalance in functional status and a roughly equal likelihood of higher scores across groups. For context, the median scores for Walk 10 ft, Walk 50 ft\u0026thinsp;+\u0026thinsp;2 turns, Walk 150 ft, 4 Steps, and 12 Steps were each 1, indicating that the typical patient in both groups was completely dependent for these mobility tasks at baseline. For Sit-to-Stand and Chair-to-Bed Transfer, the median scores were 3 in the Standard Care group and 3 and 2, respectively, in the Rise\u0026amp;Walk group\u0026mdash;implying that patients generally required moderate to substantial assistance with these transfers.\u003c/p\u003e\u003cp\u003eAmong the subset of patients with available admission data for the BBS and 10MWT, BBS scores were similar between groups (Standard Care: 24.0\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3 vs. Rise\u0026amp;Walk: 23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;17.8). However, moderate imbalances were observed in both the slow-paced and fast-paced 10MWT, with the Rise\u0026amp;Walk group performing worse on average (slow-paced: 0.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21 m/s vs. 0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24 m/s; fast-paced: 0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23 m/s vs. 0.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32 m/s, Standard Care vs. Rise\u0026amp;Walk, respectively).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBaseline Characteristics of Rise\u0026amp;Walk and Standard Care Groups at Admission.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStandard Care\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRise\u0026amp;Walk\u003c/p\u003e\u003cp\u003e(N\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDifference\u003c/p\u003e\u003cp\u003e(Cliff\u0026rsquo;s Δ or % Diff)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72 (61.5\u0026ndash;80.75)\u003c/p\u003e\u003cp\u003e[29\u0026ndash;92]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66 (53\u0026ndash;72)\u003c/p\u003e\u003cp\u003e[47\u0026ndash;82]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale sex, n / N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 / 32 (47%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 / 13 (69%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e+\u0026thinsp;22%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSection GG mobility items\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSit-to-Stand\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (1\u0026ndash;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (2\u0026ndash;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChair-to-Bed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (1\u0026ndash;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (2\u0026ndash;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWalk 10 ft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (1\u0026ndash;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1\u0026ndash;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWalk 50 ft\u0026thinsp;+\u0026thinsp;2 turns\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (1\u0026ndash;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1\u0026ndash;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWalk 150 ft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (1\u0026ndash;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1\u0026ndash;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4 Steps\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (1\u0026ndash;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1\u0026ndash;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12 Steps\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (1\u0026ndash;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1\u0026ndash;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (7.25\u0026ndash;17.75)\u003c/p\u003e\u003cp\u003e[7\u0026ndash;28]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (9\u0026ndash;15.5)\u003c/p\u003e\u003cp\u003e[7\u0026ndash;21]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBerg Balance Scale\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24.0\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3\u003c/p\u003e\u003cp\u003e[9\u0026ndash;42]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.0\u0026thinsp;\u0026plusmn;\u0026thinsp;17.8\u003c/p\u003e\u003cp\u003e[3\u0026ndash;42]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10 MWT Comfortable, m/s\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.21\u003c/p\u003e\u003cp\u003e[0.07\u0026ndash;0.78]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.24\u003c/p\u003e\u003cp\u003e[0\u0026ndash;0.51]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10 MWT Fast, m/s\u0026dagger;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.23\u003c/p\u003e\u003cp\u003e[0.18\u0026ndash;0.97]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.32\u003c/p\u003e\u003cp\u003e[0\u0026ndash;0.64]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eData are presented as n/N (%) for categorical variables, median (IQR) [min\u0026ndash;max] for non-normally distributed numeric or ordinal variables and mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD [min\u0026ndash;max] for normally distributed variables.\u003c/p\u003e\u003cp\u003eThe \u0026ldquo;Difference\u0026rdquo; column reports Cliff\u0026rsquo;s delta for ordinal and continuous variables, representing the probability that a randomly selected patient from the Rise\u0026amp;Walk group has a higher score than one from the Standard Care group, minus the reverse probability. For sex, the difference is reported as the absolute difference in percentages.\u003c/p\u003e\u003cp\u003e\u0026dagger; Administered in a smaller subsample (Standard Care n\u0026thinsp;=\u0026thinsp;9, Rise\u0026amp;Walk n\u0026thinsp;=\u0026thinsp;5)\u003c/p\u003e\u003cp\u003e\u003cb\u003ePrimary Outcomes - Section GG Mobility\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBoth groups demonstrated significant improvements in all Section GG mobility items from admission to discharge (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001). However, the Rise\u0026amp;Walk group showed consistently greater improvement compared to the Standard Care group across all mobility items. After adjusting for baseline admission scores, statistically significant differences favoring the Rise\u0026amp;Walk group were observed for Chair-to-Bed Transfer (cOR\u0026thinsp;=\u0026thinsp;18.4, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.009), Walk 10 Feet (cOR\u0026thinsp;=\u0026thinsp;6.8, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.025), and Walking 50 Feet\u0026thinsp;+\u0026thinsp;2 turns (cOR\u0026thinsp;=\u0026thinsp;7.7, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.011). These cumulative odds ratios from the ordinal logistic regression models represent the odds of being in a higher category of mobility function at discharge relative to all lower categories. For instance, a cOR of 18.4 for Chair-to-Bed Transfer indicates that participants in the Rise\u0026amp;Walk group had 18.4 times greater odds of achieving improved mobility scores at discharge compared to the Standard Care group, after controlling for baseline scores. An alluvial diagram illustrating these improvements stratified by group is presented in \u003cb\u003eFig.\u0026nbsp;1.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAlthough other items did not achieve statistical significance at the α\u0026thinsp;=\u0026thinsp;0.05 level, all remaining effect sizes were relatively large, ranging from cOR\u0026thinsp;=\u0026thinsp;2.4 (12 Steps; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.199) to cOR\u0026thinsp;=\u0026thinsp;13.3 (Sit-to-Stand; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.053). Results of each ordinal regression are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, and summary statistics for each Section GG item are detailed in \u003cb\u003eAdditional File 2\u003c/b\u003e.\u003c/p\u003e\u003cp\u003eWhen summing change scores across all seven Section GG mobility items, the Rise\u0026amp;Walk group achieved an estimated total functional gain of median of 26 points (IQR: 21.5\u0026ndash;27), compared to 16.5 points (11.25\u0026ndash;21) in the Standard Care group (Fig.\u0026nbsp;2). When adjusting for baseline function, the predicted median total improvement from admission to discharge, estimated via mixed-effects quantile regression, was significantly greater in the Rise\u0026amp;Walk group compared to the Standard Care group (median difference\u0026thinsp;=\u0026thinsp;6.5 points, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.01)\u003c/p\u003e\u003cp\u003eIn the Rise\u0026amp;Walk group, 12 of 13 participants (92%) met the \u0026ge;\u0026thinsp;16-point MCID threshold, compared to 17 of 32 participants (53%) in the Standard Care group (Fig.\u0026nbsp;3). This represents a significantly higher rate of clinically meaningful improvement in the Rise\u0026amp;Walk group, with a 39-percentage point difference (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.017).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eOrdinal Regression Results Comparing Mobility Outcomes Between Rise\u0026amp;Walk and Standard Care.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCumulative Odds Ratio\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSignificance\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSit-to-Stand\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.053\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChair-to-Bed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWalk 10 ft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e6.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWalk 50 ft\u0026thinsp;+\u0026thinsp;2 turns\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWalk 150 ft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.082\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4 Steps\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12 Steps\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.199\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eResults are from separate ordinal logistic regression models evaluating mobility outcomes at discharge. The primary effect sizes are reported is the cumulative odds ratio (cOR), which estimates the odds that a participant in the Rise\u0026amp;Walk group will achieve a higher functional mobility category compared to the Standard Care group, adjusting for baseline admission scores. Values greater than 1.0 indicate higher odds of improvement in the Rise\u0026amp;Walk group, while values less than 1.0 indicate higher odds in the Standard Care group.\u003c/p\u003e\u003cp\u003e* p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, *** p\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003cp\u003e\u003cb\u003eSecondary Outcomes - Balance \u0026amp; Gait Speed\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMetrics for balance (BBS) and gait speed (10MWT) were available for only a subset of participants, including 9 in the Standard Care group and 5 in the Rise\u0026amp;Walk group. Inferential analyses were not performed, as the limited sample precludes adequate adjustment for baseline differences, which appeared particularly important for comparisons involving the 10MWT (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOverall, the direction of results favored the Rise\u0026amp;Walk group for both balance and gait speed. Descriptively, the mean change in BBS scores from baseline was 18.3\u0026thinsp;\u0026plusmn;\u0026thinsp;11.4 in the Standard Care group and 24.4\u0026thinsp;\u0026plusmn;\u0026thinsp;14.9 in the Rise\u0026amp;Walk group (mean difference: 6.1 points). For the 10MWT at comfortable speed, mean change was 0.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.25 m/s in the Standard Care group and 0.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.28 m/s in the Rise\u0026amp;Walk group (mean difference: 0.12 m/s). At fast speed, the mean change was 0.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.33 m/s versus 0.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.27 m/s, respectively (mean difference: 0.23 m/s). A summary of these balance and gait speed outcomes is provided in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e and visualized in \u003cb\u003eFig.\u0026nbsp;4.\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMean change from admission scores at discharge for balance and gait speed.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutcome\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStandard Care: Mean Change\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRise\u0026amp;Walk: Mean Change\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMean Difference in Change\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBBS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10MWT (Comfortable speed, m/s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10MWT (Fast speed, m/s)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e10MWT\u0026thinsp;=\u0026thinsp;10-Meter Walk Test; BBS\u0026thinsp;=\u0026thinsp;Berg Balance Scale\u003c/p\u003e\u003cp\u003eNotably, all participants in the Rise\u0026amp;Walk group exceeded the MCID for both the BBS and 10MWT (fast speed), with 4 out of 5 (80%) also exceeding the threshold for the comfortable pace 10MWT, reflecting consistent and substantial functional gains. In contrast, 7 out of 9 (78%) of the Standard Care group met the MCID for BBS, and 6 out of 9 (67%) met the thresholds for both gait speed measures (Fig.\u0026nbsp;4).\u003c/p\u003e\u003cp\u003e\u003cb\u003eLength of Stay\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe mean length of stay was 16.7\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2 days (range: 7\u0026ndash;10) in the Standard Care group and 19.2\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3 days (range: 10\u0026ndash;24) in the Rise\u0026amp;Walk group. Although the Rise\u0026amp;Walk group had a longer average stay by 2.5 days, this difference was not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.154).\u003c/p\u003e\u003cp\u003e\u003cb\u003eAdverse Events\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNo device-related or therapy-related adverse events were reported. All scheduled Section GG assessments were completed; secondary outcome documentation was missing only when therapy time constraints precluded testing.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this pilot study suggest that robotic-assisted gait training with Rise\u0026amp;Walk\u0026reg; may offer meaningful advantages over conventional therapy for improving short-distance mobility and functional transfers in patients with recent stroke. Specifically, the Rise\u0026amp;Walk group demonstrated significantly greater gains in three Section GG mobility items, including Chair to Bed Transfer, Walk 10 ft, and Walk 50 ft plus 2 Turns. Furthermore, the directionality of results consistently favored Rise\u0026amp;Walk-assisted therapy over conventional physical therapy across all individual mobility outcomes. Although the samples were too small to determine any statistically meaningful differences in BBS or 10MWT outcomes, the directionality of results also favored Rise\u0026amp;Walk therapy over conventional physical therapy.\u003c/p\u003e\u003cp\u003eBoth groups exceeded the 16-point threshold for clinically meaningful improvement in Section GG mobility on average [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]; however, a greater proportion of participants in the Rise\u0026amp;Walk group met this threshold (92% vs. 53%), representing a 39-percentage point difference. Additionally, the Rise\u0026amp;Walk group demonstrated a significantly higher predicted median improvement in individual scores. This finding reinforces the potential clinical significance of Rise\u0026amp;Walk integration in promoting more robust inpatient mobility recovery, particularly within typical resource-constrained rehabilitation environments.\u003c/p\u003e\u003cp\u003eThese results align with existing literature supporting the efficacy of robotic-assisted gait training (RAGT) in subacute stroke populations [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], particularly in enhancing walking speed and independence. However, unlike many prior RAGT trials conducted in highly controlled research environments, this study provides preliminary real-world evidence for the feasibility and impact of robotic integration within a typical inpatient rehabilitation setting. Importantly, these improvements were achieved with only 4.2 sessions per length of stay on average, underscoring the potential for scalable integration into clinical workflows without requiring full replacement of conventional therapy.\u003c/p\u003e\u003cp\u003eAdditionally, this study offers preliminary insight into the application of a novel, technology-integrated Rating of Perceived Exertion (RPE) tracking method to guide robotic training dosage. The Rise\u0026amp;Walk software enabled therapists to document and adjust training intensity in real time based on patient-reported exertion, allowing for individualized progression. Although the Modified Borg scale has been validated for monitoring exercise intensity in stroke populations, its application in robotic rehabilitation settings remains an emerging area of study. Previous studies support incorporating intensity thresholds into robotic rehabilitation, highlighting the need for further validation of scalable dosing models.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] This approach represents an important step toward establishing dose-response relationships in robotic gait training, a critical gap in current research.\u003c/p\u003e\u003cp\u003eFrom a clinical implementation perspective, the Rise\u0026amp;Walk device allowed therapists to provide high-repetition, intensive gait training with minimal physical strain, supporting both patient and clinician safety an increasingly important factor given the prevalence of musculoskeletal injuries among rehabilitation professionals.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] The device\u0026rsquo;s ability to accommodate seated, standing, and walking modes further supports flexible use for patients across the functional spectrum, including those who require frequent rest or exhibit limited upright tolerance early in recovery.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSeveral limitations must be acknowledged. The non-randomized, retrospective design introduces potential selection bias, and intervention fidelity (e.g., actual session frequency or duration) varied across patients. There were also small but potentially meaningful baseline imbalances regarding age and sex. Given the small sample size, adequately controlling for these imbalances was not possible; therefore, future work should aim to address this limitation with larger, more balanced samples.\u003c/p\u003e\u003cp\u003eAnother limitation is that, although patients in the Rise\u0026amp;Walk group demonstrated improved Section GG mobility outcomes, this group also had a longer length of stay (albeit non-significant), which could have influenced the results. Furthermore, there was variability in the delivery of Rise\u0026amp;Walk therapy, ranging from 2 to 8 sessions per patient per stay (mean of 4.2 sessions). We lacked adequate data linking session counts to individual patient IDs, so we were unable to model the relationship between the number of sessions and improvement. However, it is reasonable to hypothesize that patients receiving more sessions may have experienced better outcomes, highlighting the need to balance treatment dose and effect in future studies.\u003c/p\u003e\u003cp\u003eThe sample also spanned a wide age range, from 29 to 92 years. Given the small sample size, it was difficult to fully account for disparate improvements by age, and outliers in this distribution may impact modeling results. Future studies should aim to model the effect of age more precisely.\u003c/p\u003e\u003cp\u003eFinally, the small sample size and single-site setting limit the generalizability of the findings. Nonetheless, these limitations are balanced by the study\u0026rsquo;s real-world clinical context and detailed functional outcome data, providing a valuable foundation for future prospective trials.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThese preliminary findings support the integration of robotic-assisted gait training, specifically with the Rise\u0026amp;Walk device, as a feasible and potentially impactful adjunct to conventional stroke rehabilitation. The ability to deliver individualized, intensive, and safe mobility training within the resource constraints of an inpatient setting represents a meaningful advancement for both patients and clinicians. Future research should prioritize adequately powered randomized controlled trials to confirm these findings, optimize dosing strategies, and evaluate long-term outcomes including community ambulation and healthcare utilization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eDisclosure\u003c/h2\u003e\u003cp\u003eThis study was supported in part by an affiliated healthcare organization. The views expressed in this publication are those of the author(s) and do not necessarily reflect the official views of the supporting institution or its affiliates.\u0026rdquo;\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting Interests\u003c/h2\u003e\u003cp\u003eLuke Benda is the CEO and co-founder of Healing InnovationsJulie Hartman is an employee of Healing innovationsJulie \u0026amp; Luke were not involved in data collection or final data analysis\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eHuman Ethics and Consent to Participate Declarations\u003c/h2\u003e\u003cp\u003e This retrospective chart review study was approved by the [Methodist Healthcare Institutional Review Board and Research Operations Committee], which granted a waiver of informed consent due to the use of de-identified data. (IRB Protocol #2313076-1 and 2313076-2).\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eDeclaration\u003c/p\u003e\u003cp\u003eThe authors received no funding for this work.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJ.H: Responsible for study design, wrote manuscript, assisted with data analysis review, manuscript submissionL.B: Assisted with manuscript, assisted with data analysis reviewJ.C.: Assisted with manuscript review, data collection, preliminary data-analysisS.F.: Organized Study team, data collection, reviewed manuscript\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eAcknowledgements The authors acknowledge Superior Medical Experts, Inc. for editorial assistance, statistical support, and contributions to data interpretation and manuscript preparation\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBillinger SA, Arena R, Bernhardt J, et al. Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(8):2532\u0026ndash;53. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1161/STR.0000000000000022\u003c/span\u003e\u003cspan address=\"10.1161/STR.0000000000000022\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMehrholz J, Thomas S, Elsner B. Electromechanical-assisted training for walking after stroke. Cochrane Database Syst Rev. 2020;10(10):CD006185. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/14651858.CD006185.pub5\u003c/span\u003e\u003cspan address=\"10.1002/14651858.CD006185.pub5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCalabr\u0026ograve; RS, Naro A, Russo M, et al. Shaping neuroplasticity by using powered exoskeletons in patients with stroke: a randomized clinical trial. J Neuroeng Rehabil. 2018;15(1):35. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12984-018-0384-2\u003c/span\u003e\u003cspan address=\"10.1186/s12984-018-0384-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBruni MF, Melegari C, De Cola MC, et al. What does best evidence tell us about robotic gait rehabilitation in stroke patients: a systematic review. J Clin Neurosci. 2018;48:11\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jocn.2017.10.073\u003c/span\u003e\u003cspan address=\"10.1016/j.jocn.2017.10.073\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSarı D, \u0026Ccedil;olak TK, Batur EB, Baltacı G. Effects of robotic rehabilitation on walking ability and functional independence in stroke patients: a systematic review. Turk J Phys Med Rehabil. 2021;67(1):1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.5606/tftrd.2021.6546\u003c/span\u003e\u003cspan address=\"10.5606/tftrd.2021.6546\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCenters for Medicare \u0026amp; Medicaid Services. Section GG Functional Abilities and Goals: Quick Tips. CMS.gov. Accessed April 2025. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments\u003c/span\u003e\u003cspan address=\"https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarchal-Crespo L, Reinkensmeyer DJ. Review of control strategies for robotic movement training after neurologic injury. J Neuroeng Rehabil. 2009;6:20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1743-0003-6-20\u003c/span\u003e\u003cspan address=\"10.1186/1743-0003-6-20\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGupta A, Prakash NB, Honavar PR. Gait Training with Robotic Exoskeleton Assisted Rehabilitation System in Patients with Incomplete Traumatic and Non-Traumatic Spinal Cord Injury: A Pilot Study and Review of Literature. Ann Indian Acad Neurol. 2023;26(1):43\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/aian.aian_1003_22\u003c/span\u003e\u003cspan address=\"10.4103/aian.aian_1003_22\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShirley Ryan AbilityLab. (2018, April 16). \u003cem\u003eBorg Rating Scale of Perceived Exertion\u003c/em\u003e. Rehabilitation Measures Database. Retrieved April 28, 2025, from.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShirley Ryan AbilityLab. (2020, June 30). \u003cem\u003eBerg Balance Scale\u003c/em\u003e. Rehabilitation Measures Database. Retrieved April 28, 2025, from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sralab.org/rehabilitation-measures/berg-balance-scale\u003c/span\u003e\u003cspan address=\"https://www.sralab.org/rehabilitation-measures/berg-balance-scale\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAcademy of Neurologic Physical Therapy. (2019). \u003cem\u003e10 Meter Walk Test (10MWT) Pocket Guide\u003c/em\u003e. Retrieved April 28, 2025, from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.neuropt.org/docs/default-source/cpgs/core-outcome-measures/10mwt-pocket-guide-proof8-(2)28db36a5390366a68a96ff00001fc240.pdf​\u003c/span\u003e\u003cspan address=\"https://www.neuropt.org/docs/default-source/cpgs/core-outcome-measures/10mwt-pocket-guide-proof8-(2)28db36a5390366a68a96ff00001fc240.pdf​\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMiddleton A, Graham JE, Ottenbacher KJ. Functional status is associated with 30-day potentially preventable hospital readmissions after inpatient rehabilitation among Medicare beneficiaries with stroke. Med Care. 2018;56(9):739\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MLR.0000000000000955\u003c/span\u003e\u003cspan address=\"10.1097/MLR.0000000000000955\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHeran M, Mongeon D, Thiel A. Robotic-assisted gait training and neuroplasticity in stroke: A systematic review. Brain Res. 2024;1802:148304. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.brainres.2024.148304\u003c/span\u003e\u003cspan address=\"10.1016/j.brainres.2024.148304\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmerican Physical Therapy Association. Safe Patient Handling and Mobility in Physical Therapy. APTA.org. Published 2020. Accessed. April 2025. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.apta.org\u003c/span\u003e\u003cspan address=\"https://www.apta.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"robotic-assisted gait training, stroke rehabilitation, neurological rehabilitation, high intensity gait training, task specific training, gait training","lastPublishedDoi":"10.21203/rs.3.rs-7266083/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7266083/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Robotic-assisted gait training (RAGT) may enhance mobility recovery after stroke, but real-world inpatient data on clinical implementation remain limited.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To evaluate whether integration of the Rise\u0026amp;Walk® end-effector robotic system improves functional mobility outcomes compared to conventional therapy in an inpatient stroke rehabilitation unit.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e This retrospective cohort study reviewed charts of stroke inpatients admitted between June and December 2024 at a regional inpatient rehabilitation facility. Patients who received robotic-assisted therapy with the Rise\u0026amp;Walk system (n = 13) were compared to those who received standard-of-care physical therapy (n = 32), hereafter the Standard Care group. Rise\u0026amp;Walk participants received 2–8 sessions per stay (mean: 4.2). Outcomes included seven Section GG mobility items, the Berg Balance Scale (BBS), and the 10-Meter Walk Test (10MWT) at comfortable and fast speeds. Ordinal logistic regression models adjusted for baseline scores estimated cumulative odds of improvement on GG items. Due to small sample sizes (Rise\u0026amp;Walk: n = 5, Standard Care: n = 9), BBS and 10MWT results are reported descriptively. Summed Section GG gains were compared to a ≥16-point threshold for clinically meaningful improvement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The Rise\u0026amp;Walk group showed greater odds of improvement on all GG mobility items, with statistically significant effects for Chair-to-Bed Transfer (cumulative odds ratio [cOR] = 18.4, \u003cem\u003ep\u003c/em\u003e = .009), Walk 10 Feet (cOR = 6.8, \u003cem\u003ep\u003c/em\u003e = .025), and Walk 50 Feet + 2 Turns (cOR = 7.7, \u003cem\u003ep\u003c/em\u003e = .011). Other items showed large but non-significant effects (e.g., Sit-to-Stand: cOR = 13.3, \u003cem\u003ep\u003c/em\u003e = .053). Clinically meaningful GG gains (≥16 points) occurred in 12 of 13 Rise\u0026amp;Walk participants (92%) versus 17 of 32 in the Standard Care group (53%) (\u003cem\u003ep\u003c/em\u003e = .017). Although underpowered for hypothesis testing, descriptive results for BBS and 10MWT favored Rise\u0026amp;Walk: BBS improvement was 24.4 ± 14.9 vs. 18.3 ± 11.4 points; 10MWT gains were 0.35 vs. 0.23 m/s (comfortable) and 0.54 vs. 0.31 m/s (fast).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Use of the Rise\u0026amp;Walk system was associated with greater mobility gains than standard therapy. These findings support feasibility and potential benefit of robotic gait training in inpatient rehabilitation and warrant confirmation in randomized trials.\u003c/p\u003e","manuscriptTitle":"Functional Mobility Outcomes Following Robotic-Assisted Gait Training with Rise\u0026amp;Walk® in Inpatient Stroke Rehabilitation: A Retrospective Pilot Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-12 12:52:57","doi":"10.21203/rs.3.rs-7266083/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f5fb3621-c264-41e3-8b59-6440420e64ea","owner":[],"postedDate":"August 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-08T10:39:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-12 12:52:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7266083","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7266083","identity":"rs-7266083","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}