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

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