Limb guidance system in robot-assisted gait training for clinical functional improvement in stroke patients: a narrative review

Abstract

Introduction: stroke is a leading cause of motor disability globally. Robot-assisted gait training (RAGT) is increasingly used to support post-stroke gait rehabilitation by providing repetitive, task-specific walking practice. This narrative review examines recent evidence on exoskeleton, end-effector and hybrid limb guidance systems in RAGT and their effects on functional outcomes in patients with stroke. Methods: a structured narrative review of clinical studies published between January 2021 and December 2025 was conducted. PubMed, Scopus and Web of Science were searched on 13 March 2026. Studies were included if they involved adult stroke survivors, investigated exoskeleton, end-effector or hybrid RAGT, included a control or comparison group, and reported at least one functional outcome related to gait, balance, mobility, motor function or activities of daily living. Results: twenty-one studies involving 1,168 participants were included. Fifteen studies evaluated exoskeleton systems only, three evaluated end-effector systems only, two evaluated hybrid systems, and one directly compared exoskeleton and end-effector RAGT with conventional overground gait training. Exoskeleton studies commonly reported improvements in gait speed, walking endurance, balance, lower-limb motor function and functional independence. End-effector studies showed promising findings for gait-related outcomes, but evidence remains limited. Hybrid systems did not consistently show superiority over conventional rehabilitation. Most studies were limited by small sample size, short intervention duration and limited follow-up. Conclusion: current evidence suggests that RAGT may support functional recovery after stroke, particularly when combined with conventional physiotherapy. Larger trials with direct device comparison, standardised outcomes and longer follow-up are needed.