The World Health Organization (WHO) defines stroke as “a case of rapidly developed clinical signs of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death, with no apparent cause other than of vascular origin”[1].

Stroke is recognized as the second most common cause of disability worldwide. The incidence of stroke increases with age, with incidences in patients over the age of 65 accounting for approximately 25% of cases in the older population. It significantly affects the activities of daily living (ADL) of older people, thereby greatly impacting the quality of life and independence of individuals and their families[2]. In addition, it not only causes mental and physical problems but also generates substantial social costs, both directly and indirectly. According to statistics, over the past 30 years, the global incidence of stroke has increased by 70%, prevalence by 85%, mortality rate by 43%, and disability-adjusted life years (DALYs) by 32%. The estimated global expenditure on stroke exceeds 891 billion dollars, accounting for more than 1.12% of the worldwide GDP[3,4].

Approximately 50% to 75% of stroke survivors develop residual motor or cognitive impairments that affect their ability to live independently[5]. In most cases, they experience decreased joint mobility and stability, reduced muscle strength and endurance, diminished reflexes, and decreased motor control and walking pattern functions. These issues can lead to problems with weight shifting, maintaining the body's center, balance abilities, and walking capacity. Moreover, 80% of patients exhibit walking disorders immediately after a stroke, which stem from these aforementioned functional abnormalities. Patients are forced to support 60–70% of their weight on the non-paralyzed side while the strength of the paralyzed side gradually weakens, reducing by up to 50%. Consequently, the walking pattern becomes asymmetrical, decreasing their walking speed[6,7]. These patterns increase the likelihood of falls, and changes in walking patterns and muscle weakness raise the risk of secondary injuries due to functional limitations.

In the rehabilitation of stroke patients, a crucial therapeutic goal is the recovery of mobility. This is because the ability to walk independently determines the feasibility of performing daily living activities independently. This factor significantly impacts the patient's return to home or community life, serving as a critical criterion that influences the improvement of quality of life and satisfaction with treatment. Physical therapy is the most influential factor in gait rehabilitation, as highlighted through three key treatments: Firstly, the tilting table, which, when applied to patients living in bedridden conditions, not only prevents orthostatic hypotension but also stimulates various sensory pathways and postural responses, enhances arousal and awareness levels, and through gradual weight bearing, can train stability in an upright position[8]. Secondly, repetitive gait training using a treadmill plays a role in awakening the sensation of walking. It maintains the long swing phase of the paralyzed lower limb during walking in stroke patients, maintains symmetrical posture, and reduces the stiffness in the plantar flexors, aiding in balance ability[9]. Lastly, functional electrical stimulation (FES) involves an attachment to the leg muscles that induces muscle contractions, effectively promoting venous return. This can improve cerebral blood flow and help maintain blood pressure from orthostatic stress. Moreover, muscle contractions can enhance muscle strength and be used in gait training to induce a normal patient walking pattern[10,11].

In modern times, with the advancement of robotics, rehabilitation using robots has garnered attention, among which a multipurpose robotic orthotic exercise device has been developed for patients suffering from gait disorders due to brain diseases, combining the functions of the aforementioned equipment. This device is widely used in clinical settings. The main difference between training with the multipurpose robotic orthotic exercise device and treadmill training is that the gait training process is automated and assisted by robotic protocols. In clinical settings, treadmill training for patients with severe symptoms requires up to three therapists for walking assistance, controlling the paralyzed lower limb, and trunk movement control[12]. In contrast, robotic gait training with partial weight support allows for the repeated practice of a complete gait cycle without errors owing to minimal personnel, thus offering superiority in both efficacy and convenience.

The R-BOT PRO, developed by Cotras in Korea, is a medical device that combines a robotic system enabling individual lower limb movements with a tilting table whose standing angle can be adjusted. It allows for the selective performance of FES exercise assistance in repetitive gait training and incorporates 3D virtual reality monitoring to enhance user immersion. Therefore, this retrospective pilot study aims to examine the effect of robotic-assisted rehabilitation treatment using the R-BOT PRO on the cognitive and physical functions of stroke patients. Physical function will be assessed using variables such as the Manual Muscle Test for upper and lower extremities (MMTUE, MMTLE), the Functional Ambulation Category (FAC), the Berg Balance Scale (BBS), and the Modified Barthel Index (MBI). Cognitive function will be evaluated using the Mini-Mental State Examination (MMSE) and the National Institutes of Health Stroke Scale (NIHSS). By measuring these variables before and after the intervention, we aim to determine the extent to which therapy using the R-BOT PRO can impact cognitive and physical functional recovery in stroke patients.

1. Subjects

This study was conducted in collaboration with the Hospital in Icheon City, Gyeonggi-do, and involved patients diagnosed with stroke through brain imaging techniques such as computed tomography (CT) or magnetic resonance imaging (MRI). Participants who showed signs of hemiplegia on the National Institutes of Health Stroke Scale (NIHSS) test and received 8 weeks of R-BOT rehabilitation treatment, with a pre-treatment motor function of the affected upper or lower limb of grade 1 or higher, were included. Patients who were unable to complete the rehabilitation program due to neurological or medical complications, those with bilateral paralysis, and those with missing follow-up test results were excluded. Data from 6 patients who agreed to participate were used for the final statistics. This research received approval from the Public Institutional Review Board (P01-202407-01-059).

The characteristics of the participants are shown in Table 1.

Table 1

General characteristics of the participants (n = 6)

Variables	Mean ± SD
Age (years)	72.50 ± 12.46
Height (cm)	164.66 ± 9.33
Weight (kg)	68.55 ± 16.85

NOTE: SD; standard deviation

2. Equipment and Methods

In this study, we retrospectively investigated the medical records of participants (age, gender, lesion location, period from onset to start of treatment, etc.). The intervention was applied to the participants involved in therapy using a robotic-assisted orthopedic exercise device, utilizing the Passive Program of the R-BOT PRO developed by Cotras. Participants received 40 therapy sessions over 8 weeks, with 5 sessions per week, each lasting 30 minutes. The tilt angle was adjusted according to the daily condition of the patient. The application of other treatments alongside the R-BOT included occupational therapy, physical therapy (1:1 NDT, CYCLE), and pain management.

1) Intervention device

The therapeutic device used in this study, shown in Fig. 1, is the R-BOT PRO(R-BOT PRO, Cotras, Korea), a robotic-assisted orthopedic exercise device developed by Cotras. The R-BoT Plus is a device designed for the early rehabilitation of patients who have suffered severe central nervous system damage due to stroke or other conditions. It aims to prevent complications arising from prolonged inactivity due to extended bed rest while simultaneously promoting the recovery of gait through intensive sensory stimulation. The device features a Robot-assisted Stepper mounted on an upright tilt table, which adjusts the degree of robotic guidance force based on the patient's condition to facilitate either active or passive lower limb movements. As the tablés tilt angle is gradually increased, the patient receives cyclic leg loading, providing repetitive weight-bearing stimuli to both lower limbs. This process aids in restoring the patient's sensory perception of normal gait patterns in an upright posture. Additionally, the device includes a FES system with surface electrodes. When used in conjunction with the robotic movements, FES delivers electrical stimulation to both lower limbs, further enhancing patient stimulation and contributing to the rehabilitation process.

Fig. 1. Equipment description.
A. Promotional image of the R-BOT PRO. B. Full view of the R-BOT PRO system. C. 3D virtual reality provides visual feedback to enhance rehabilitation engagement.

It is a robot used for rehabilitating and treating gait disorders in patients or disabled individuals, aimed at reconstructing lower limb muscles or recovering joint movements. The device comprises a control unit, a drive unit, and a mounting unit. When a training program is input into the monitor, the control unit governs the drive unit according to stored standard human gait patterns to conduct walking exercises. During this process, the patient, wearing the drive mounting unit, performs walking exercises, thereby receiving gait rehabilitation therapy.

The device operates through a control system facilitated by a touchscreen control capable of commanding a BLDC motor, following the activation of a motor in the standing system to ensure the patient's condition remains as stable as possible. It allows patients to continuously perform lower limb exercises while lying down or maintaining a standing position. Therefore, it can be used for muscle reconstruction, recovery of joint movements, and early walking training through standing and muscle strength composite training for patients with difficulty standing.

Additionally, the device offers various functionalities, such as manual/active joint movements, initial rehabilitation training for symmetric weight loading before walking training, customized walking training for each patient with assistive/passive/resistive functions, including speed/stride/incline adjustments, heart rate measurement, and real-time monitoring, active movement detection through pressure sensors, and improvement of blood circulation through standing training. Moreover, it uses virtual reality (VR) and 3D imaging for visual feedback to motivate patients in their rehabilitation. These diverse functionalities suggest that the R-BOT can be utilized effectively for gait rehabilitation and treatment, offering customized therapy for the patient's condition and needs.

Furthermore, the R-BOT is classified as a medical device by the Ministry of Food and Drug Safety and is designed to meet the common standards for electrical/mechanical safety of medical devices, electromagnetic safety standards for medical devices, and medical device standard specifications, positioning it as an advanced medical device.

2) Measuring tool

(1) Functional Ambulation Category (FAC)

The Functional Ambulation Category (FAC) assesses postural stability during walking in patients with neurological conditions. It categorizes walking ability into 6 levels based on stages, making it widely known as a simple, easy-to-interpret, and efficient assessment scale because it only requires stairs and 15 meters of flat ground for the test. The evaluation consists of 10 items and can be completed within approximately 10 minutes, with each item scored on a scale of 0 to 3, providing a maximum score of 30[13,14].

(2) Manual muscle testing (MMT)

The manual muscle testing (MMT) method was initially developed by Lovett in 1912 and later revised by Wright. It has been extensively used for over a century to the present day. The MMT grading system published by the Medical Research Council (MRC) is the most widely used and is as follows: 0 = no muscle contraction detected, 1 = muscle contraction detected, 2 = full range of motion (ROM) in a gravity-eliminated position, 3 = full ROM against gravity, 4 = full ROM against gravity and some resistance, and 5 = normal muscle strength. In this study, the MRC classification of MMT was followed to measure the muscle strength of the affected upper and lower limbs in participants [15].

(3) Mini-mental state examination (MMSE)

The MMSE, developed by Folstein and McHugh in 1975, is a cognitive assessment scale that is easier to apply than other cognitive scales and can be administered quickly within 5–10 minutes. It also has the advantage of minimal practice effects, allowing for repeated measurements throughout the disease progression to observe changes over time. Scores above 24 indicate 'definitive normal', below 19 indicate 'definitive dementia', and 20–23 points are considered 'suspected dementia'. For illiterate individuals, scores are adjusted by adding 1 point for time orientation, 2 points for attention and calculation, and 1 point for language function, ensuring that the scores do not exceed the maximum possible in each section. The MMSE-K is widely used across various fields as a simple cognitive function screening tool based on its high reliability and validity[16,17].

(4) National Institute of Health Stroke Scale (NIHSS)

The National Institute of Health Stroke Scale (NIHSS), developed by the National Institutes of Health in 1989, serves as an indicator of stroke symptom deterioration, encompassing 11 categories: Level of consciousness, gaze palsy, visual field defects, facial palsy, arm weakness, leg weakness, limb ataxia, sensory loss, language disturbance, dysarthria, and neglect. It quantitatively measures the extent of neurological damage in stroke patients. The scoring ranges from 0 to 42, with higher scores indicating more severe patients. Designed not only for neurologists but also for emergency medicine physicians and nurses, it can be administered in an average time of 6.6 minutes per person, making it relatively simple to perform. Numerous studies have corroborated its reliability and validity. Therefore, it is broadly usable by medical staff beyond neurologists, offering the advantage of quickly and comprehensively evaluating without missing critical parts of neurological examination[18,19].

(5) Modified Barthel Index (MBI)

The modified Barthel Index (MBI) is widely used for assessing the activities of daily living in stroke patients and is reported to have higher sensitivity, simplicity, ease of scoring, and high reliability and validity compared to other tools. The MBI consists of 11 items: Personal hygiene, bathing, eating, toilet use, stair climbing, dressing, bowel control, bladder control, walking, wheelchair use, and transfers between chairs/beds. However, the wheelchair item is only measured as an alternative to walking when walking is not possible, resulting in 10 measurable items. Each item is scored on a 5-point scale, ranging from complete independence to inability to perform the task. The scoring system ranges from 5 to 15 points for each item, with a total score of 100 indicating complete independence in all activities[20].

(6) Berg Balance Scale (BBS)

The Berg Balance Scale (BBS) is an assessment tool developed to measure static and dynamic balance abilities more objectively. This tool measures a patient's ability to maintain balance during various functional movements and consists of 14 functional tasks performed in daily life, used to evaluate the degree of recovery in stroke patients. Furthermore, due to its short evaluation time and simple process, it is used to assess the physical balance abilities of older people and individuals with hemiplegia due to cerebrovascular accidents, children with cerebral palsy, and others with disabilities resulting from central nervous system disorders[21].

3) Data Analysis

In this study, descriptive statistics were utilized to calculate general characteristics, and the mean and standard deviation of each variable were derived. All statistical analyses were conducted using 'IBM SPSS 26.0 Statistical softwaré. Pre-post variables of the exercise program application were analyzed using a paired t-test. The statistical significance level was set at α = .05.

Parametric statistical comparisons were conducted using the mean values of pre- and post-measurements for each factor. Due to the small sample size in this study, non-parametric statistical comparisons were also conducted using the mean values of pre- and post-measurements, similar to parametric statistics. The non-parametric statistical results showed significant effects in all assessment tools except for MMTUE and FAC, which is similar to the parametric statistical comparisons.

No significant difference was observed between pre- and post-measurements for MMTUE (p > .05). In contrast, MMTLE demonstrated a significant difference between pre- and post-measurements (p < .05). Further detailed statistical analysis of MMTLE indicated significant improvements in all areas except the hip joint (p < .05). MMSE also showed a significant difference between pre- and post-measurements (p < .05). NIHSS exhibited a highly significant difference between pre- and post- measurements (p < .05), which was similarly reflected in the MBI results (p < .05). For FAC, a significant difference was detected between pre- and post-measurements (p  < .05), and BBS likewise demonstrated significant improvement (p < .05)(Table 2, Table 3).

Table 2

Comparison of before and after the intervention (n = 6)

	pre	post	t	p
MMTUE	2.31 ± .84	2.43 ± .81	-1.145	.302
MMTLE	1.75 ± .52	2.21 ± .51	-3.041	.018*
FAC	.83 ± .98	1.83 ± .98	-3.361	.041*
MMSE	21.00 ± 9.44	24.83 ± 7.05	-3.845	.022*
NIHSS	8.83 ± 2.86	5.17 ± 2.14	8.000	.000**
MBI	32.17 ± 21.38	63.00 ± 13.21	-7.390	.002*
BBS	13.83 ± 12.64	23.33 ± 14.61	-3.411	.014

NOTE: MMT; Manual muscle testing, UE; Upper Extremity, LE; lower Extremity, MMSE; Mini-mental state examination, NIHSS; National Institute of Health Stroke S cale, MBI; Modified B arthel I ndex, F AC; Functional Ambulation Category, BBS; Berg Balance Scale * p < .05, ** p < .001 mean ± standard deviation.

Table 3

Comparison of before and after the intervention: MMT Lower Extrimity (n = 6)

	pre	post	t	p
hip Flx	2.92 ± .66	3.17 ± .61	-.591	.580
hip Ext	2.75 ± .76	2.92 ± .38	-.395	.709
hip Abd	2.50 ± .84	2.83 ± .52	-.756	.484
hip Add	2.58 ± .80	2.92 ± .38	-.791	.465
hip ER	2.75 ± .76	2.92 ± .86	-.439	.679
hip IR	2.75 ± .76	3.08 ± .74	-.830	.444
knee Flx	3.00 ± .71	3.42 ± .92	-2.712	.042*
knee Ext	3.08 ± .74	3.67 ± .68	-2.150	.084*
ankle PF	1.33 ± 1.51	2.75 ± 1.17	-3.782	.013*
ankle DF with IV	1.67 ± 1.37	2.58 ± 1.20	-3.379	.020*
ankle IV	1.33 ± 1.51	2.58 ± 1.20	-5.000	.004*
ankle EV with DF	1.33 ± 1.51	2.58 ± 1.20	-5.000	.004*

NOTE: Flx; flexion, Ext; extension, Abd; abduction, Add; adduction, ER; external rotation, IR; internal rotation, PF; plantar flexion, DF; dorsi flexion, IV; inversion, EV; eversion

In this study, we applied R-BOT rehabilitation treatment to patients complaining of hemiplegia symptoms due to stroke and investigated the efficacy of this intervention. The intervention was conducted on 6 patients with similar symptoms of hemiplegia, with treatment sessions lasting 30 minutes per day, five days a week for a total of 8 weeks. After the intervention, improvements were observed in the patient's muscle strength, cognition, gait, and balance abilities.

As technology advances, the medical environment changes. Over the past few years, medical devices similar to the R-BOT have been continuously invented. Presently, their efficacy is recognized, and they are being used in clinical settings and changing rehabilitation mechanisms. Examples include the 'Lokomat', a wearable robot based on a treadmill, which has been widely used in clinical settings worldwide since the early 2000s. The effectiveness of Lokomat therapy has been extensively studied in various patient groups, such as stroke, spinal cord injury, and multiple sclerosis , proving its superior effectiveness over traditional rehabilitation[22]. The wearable rehabilitation robot 'curara', with its exoskeleton frame, larger power units, and BES sensors that detect muscle contractions, helps patients who have difficulty standing or walking on their own to move their legs and walk actively. Curara has been proven to significantly affect stride length and walking speed when applied to patients with spinocerebellar ataxia[23]. Similar to R-BOT, the robot-assisted tilting table 'ERIGO' adds robotic footplates to the functions of a traditional tilting table, enabling gait assistance training. Gradual standing, repetitive leg movements, and periodic loading help prevent secondary complications due to immobility. This has also been proven to have better patient satisfaction, leg muscle strength, and cognitive recovery than conventional treatments[24].

R-BOT PRO, similar to the robots mentioned above, is a robotic-assisted orthopedic exercise device that provides a broader range of differentiated treatments compared to existing devices. It combines the functions of a tilting table with gait rehabilitation, and by utilizing a FES system, it enables even more effective gait rehabilitation. Moreover, it has an additional distinguishing feature. R-BOT PRO is integrated with 3D virtual reality monitoring, which helps users engage in neuroplastic rehabilitation exercises through immersive experiences. Additionally, the use of visual feedback through 3D images can motivate patients in their rehabilitation efforts. In this study, the significance of R-BOT PRO was verified, supporting its potential to indicate the future direction for robotic devices in rehabilitation. These distinguishing features suggest the future direction for robotic devices.

This study found clinically significant results in applying R-BOT to stroke patients. Firstly, the intervention resulted in significant improvements in motor ability impairment due to neurological damage in stroke patients, focusing on improvements in muscle strength and balance abilities by comparing MMT and BBS scores before and after the intervention. The R-BOT treatment effectively contributed to the recovery of muscle strength in stroke patients. When comparing the measurements before and after the intervention, MMTUE was showing no significant difference, whereas MMTLE was showing a significant difference. R-BOT is a robotic device intended for lower limb muscle strength and gait training. Therefore, the significant changes in the trained lower limb muscle strength, without changes in upper limb muscle strength, are of great significance. According to a recent study by Lee[25], applying robotic exoskeleton-assisted gait rehabilitation to stroke patients significantly improves lower limb muscle strength, motor performance, walking speed, and quality of life. Moreover, a large-scale systematic review by Calabrò[26], which included 1219 studies and 10 treatment guidelines, reports that lower limb robotic exoskeletons siet gnificantly contribute to the overall recovery of lower limb functions, including walking and leg muscle strength, in stroke patients. These results are consistent with the before-and-after comparison of muscle strength measurements in this study.

Therapy using R-BOT has also effectively contributed to the recovery of balance ability in stroke patients. When comparing the pre- and post-intervention measurements, BBS showed a significant difference. Recent research by Neves compared two different types of robotic-assisted gait training (RAGT) and found significant improvements in the Timed Up and Go test, Dynamic Gait Index, and BBS in both interventions[27]. Furthermore, Loro presented a meta-analysis of 18 randomized clinical trials, showing that RAGT measured higher average differences in BBS and TUG than the control group and was equally effective in improving balance as conventional therapy methods. Both studies confirmed the enhancement of balance and walking ability in stroke patients when applying RAGT, aligning with the results of the pre- and post-comparison of balance ability in this study[28].

Physical exercise benefits motor skills and has a clear advantage for cognitive abilities. According to current research, physical exercise affects neural and vascular aspects, inducing increased neuronal cells, angiogenesis, enhanced synaptic plasticity, and reduced cell damage due to oxidation, thereby improving cognitive functions[29]. Therefore, early physical rehabilitation exercises are applied to patients with neural damage to induce improvements in cognitive functions. Jiang effectively improved the quality of life and promoted cognitive function recovery in patients with post-stroke cognitive impairment by conducting early cognitive training along with aerobic exercise[30]. Gait rehabilitation using R-BOT also significantly contributed to improving cognitive functions and recovery from neurological damage in stroke patients. The results of the MMSE measurements showed a significant difference before and after the intervention. Additionally, the NIHSS showed a very significant difference before and after the intervention.

Ambrose demonstrated that a program combining aerobic exercise and resistance training significantly contributes to improving motor skills and cognitive functions in patients with chronic stroke through a 6-month follow-up study involving 120 participants[31]. This aligns with the findings of this study, suggesting that early physical rehabilitation is essential for recovering neurological motor disorders and cognitive functions in stroke patients. Research by Aprile observed improvements in upper limb motor and cognitive functions in stroke patients when applying robotic movement rehabilitation targeting the upper limbs[32]. An important aspect of this study was implementing a virtual reality rehabilitation program that provided digital content through a monitor interface, simultaneously focusing on upper limb rehabilitation. This study integrated virtual reality into the rehabilitation program, offering patients enjoyable experiences and solid motivation through positive learning experiences. This approach is similar to the virtual reality program used in this study with R-BOT, indicating that robotic movement rehabilitation significantly impacts the motor and cognitive functions of stroke patients, which is consistent with the results of this study.

A total of 40% of acute stroke survivors suffer from persistent ADL impairment even after discharge[33]. ADL refers to everyday tasks, including dressing, bathing, eating, going to the bathroom, and moving(gait)[34]. Within ADL, gait rehabilitation, in particular, should be prioritized because it plays a crucial role in functional independence and community ambulation for stroke survivors[35]. They have motor weakness, a deficit in motor control, proprioceptive loss, and/or ataxia associated with hemiparetic gait patterns. Step and stride length, step width, cadence, and velocity are usually decreased in hemiparetic gaits. Stance and single-leg support durations on the paretic side are decreased; however, the swing phase increases and vice versa on the non-paretic side. This functional failure increases negative experiences, including falls, which may result in social isolation due to community ambulation[36].

The MBI scale is a good measure of ADL across all aspects of life in stroke patients, including walking. In this study, the statistical results of the MBI showed a highly significant difference before and after the intervention. Similarly, for the FAC, which evaluates walking functionally, there was a significant difference before and after the intervention. Thimabut, N. (2020) compared the effects of Welwalk robot therapy and conventional physical therapy on stroke patients with hemiplegia and found significant improvements in the FIM, the 6-minute walk test (6MWT), and the Barthel ADL Index for evaluating ADL[37]. Likewise, in the study by Li, a comparison between the experimental group that received BEAR-H1 walking assistance training after stroke diagnosis and the control group showed significant improvements in the 6-minute walk test, Fugl-Meyer lower extremity assessment, walking speed, cadence, stride, and cycle duration in the experimental group[38]. These results align with the findings in this study, which state that robot-assisted gait therapy provides significant benefits to the walking function and ADL of stroke patients.

Based on these results, robot-assisted gait therapy appears to be an effective intervention that can provide an appropriate recovery experience in the functional aspects of stroke patients. Furthermore, compared with numerous other robot rehabilitation studies, it aligns with the conclusion that the effects are either equivalent or superior to conventional rehabilitation treatments. These robotic rehabilitation devices can offer repetitive and intensive training using preset content without the patient's voluntary effort, reduce therapist intervention for cost-effectiveness, and enhance patient motivation and participation through games and interactive programs, representing a next-generation treatment method[39,40]. Although the development of related technologies is actively ongoing, there is a notable lack of research compared to conventional treatments. However, more research is needed to verify the utility of robot-related therapies and compare them with existing methods to progress into a new era.

This study has several limitations. First, as this is a pilot study with a small sample size and without a control group, it limits the reliability of the outcome measures and makes it difficult to confirm whether the observed functional changes are due to the intervention or to spontaneous recovery. Second, the research is based solely on a pre- and post-comparison of the experimental group, making it impossible to verify the efficacy compared to existing treatments. Third, it is difficult to ascertain the effect of R-BOT treatment alone since occupational therapy, physical therapy, and pain management were also conducted simultaneously. Fourth, although stroke patients are predominantly in older populations, it is challenging to generalize the results across various age groups, including younger stroke patients.

This study aims to verify the impact of robot-assisted rehabilitation therapy using R-BOT on the cognitive and physical abilities of stroke patients, and the results are as follows: The robot-assisted orthotic device, R-BOT, significantly improved the lower limb strength, balance, cognition, activities of daily living, and walking function of stroke patients. This serves as a promising indicator for the utilization of robot therapy in clinical settings and underscores the continuous need for research on robotic therapeutic devices that can replace or supplement existing treatments.

This research was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No.2022R1C1C2007812).