Effectiveness of Robot-Assisted Structured Foot-Ankle Sensorimotor Training in Stroke Patients

The inclusion criteria are as follows: 1. Age 40-65 years, 2. Able to understand and follow study instructions, 3. Able to communicate coherently and oriented in time and place, 4. Provided written informed consent, 5. Stroke ≥6 months prior to enrollment (chronic stroke), 6. Ankle plantarflexor spasticity ≤2 on the Modified Ashworth Scale, 7. Ankle dorsiflexor strength ≥ grade 2 on the Medical Research Council (MRC) scale, 8. Passive ankle dorsiflexion to neutral (90°; 0°) without a plantarflexion contracture, 9. Moderate or mild lower-extremity impairment based on the Fugl-Meyer Assessment-Lower Extremity (FMA-LE) score (21-27 moderate; 28-34 mild/good), 10. Able to sit for at least 1 hour, 11. Able to walk at least 10 meters with or without an assistive device, 12. Completed all conventional lower-extremity physical therapy and rehabilitation programs. The exclusion criteria are as follows: 1. Cognitive impairment (Mini-Mental State Test score ≤ 24), 2. Conditions affecting walking or balance (e.g., orthopedic complications, lower extremity amputation, osteoporosis), 3. Insufficient visual acuity to view a screen (e.g., diplopia), 4. Severe visual deficits (e.g., hemianopia) or vestibular disorders34, 5. Sensory deficits such as hemisensory neglect, 6. Acute musculoskeletal or cardiovascular disorders, 7. Intrathecal baclofen pump use or botulinum toxin injections within the past 5 months, 8. Fixed or painful contracture of the paretic ankle, 9. Uncontrolled systemic diseases (e.g., diabetes, hypertension, debilitating or immunosuppressive diseases), 10. history of a non-stroke neurological disease/disorder that may impair comprehension of instructions, 11. Concurrent participation in other lower-extremity physical therapy, robotic rehabilitation, or neurological exercise programs.