Objective <p>This study aimed to observe the efficacy of unilateral lower limb exoskeleton robot training and its effect on neuroplasticity in hemiplegic patients with stroke by comparing it with conventional treatment.</p> Methods <p>Twenty-four patients with chronic stroke were randomly assigned to either the robot group (RG) or the control group (CG). The CG was treated with conventional rehabilitation, and the RG was treated with unilateral lower limb exoskeleton robot-assisted walking training based on conventional rehabilitation. The study’s primary outcome measures included gait analysis and plantar pressure testing before and after treatment. Secondary outcome measures included changes in lower limb Fugl-Meyer (FMA), Timed Up and Go Test (TUG), and Modified Barthel Index (MBI). In addition, we used functional near - infrared spectroscopy (fNIRS) to measure neural activity before and after the intervention.</p> Results <p>The robot group had significantly greater improvements in walking speed and stride length compared to the control group. The robot group showed greater improvements in FMA scores and reductions in TUG duration compared to the control group. Changes in plantar pressure and oxyhemoglobin (HbO) concentrations were observed only in the robot group.</p> Conclusion <p>Both conventional rehabilitation therapy and robot-assisted gait training improve walking function in patients with chronic stroke, but robot-assisted intervention shows more favorable outcomes.</p>