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Foley SA, Washabaugh EP. Applying elastic resistance bands for gait training: A simulation-based study to determine how band configuration affects gait biomechanics and muscle activation. Gait Posture 2024; 108:320-328. [PMID: 38199091 DOI: 10.1016/j.gaitpost.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 12/20/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Wearable robotic exoskeletons and leg braces are desirable for gait rehabilitation because they can apply loads directly to an affected joint. Yet, they are not widely used in clinics because they are costly and complex to set up. Conversely, tethered devices, such as elastic resistance bands, are widely available in clinics, are low-cost, and are quick to set up. However, resistance bands will affect walking differently based on how they are configured to pull on the leg (e.g., pulling forward or backward). RESEARCH QUESTION How can a resistance band be configured to alter muscle activation and gait biomechanics based on the segment it is attached to and the angle with which it attaches? METHODS We used an open-source musculoskeletal modeling platform to emulate several configurations of an elastic band pulling on the ankle, calf, and thigh at various angles during non-pathological walking. We evaluated gait biomechanics and simulated muscle activation using computed muscle control (CMC) and identified a subset of four configurations with potential applications for gait training. Eight non-pathological participants then walked on a treadmill under these configurations to verify how these configurations altered muscle activation. RESULTS We found that muscle activity greatly varied based on the location where the elastic band is attached and the angle with which the elastic band pulls on the leg. Notably, specific angles can be used to pull on the legs to elicit an increase or decrease in muscle activation. SIGNIFICANCE This study provides insight into how tethered devices can be configured to provide assistance or resistance during gait training. This information can be applied when developing low-cost gait training solutions for addressing individuals' impairments.
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Affiliation(s)
- Sierra A Foley
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Edward P Washabaugh
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA.
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Swaminathan K, Porciuncula F, Park S, Kannan H, Erard J, Wendel N, Baker T, Ellis TD, Awad LN, Walsh CJ. Ankle-targeted exosuit resistance increases paretic propulsion in people post-stroke. J Neuroeng Rehabil 2023; 20:85. [PMID: 37391851 PMCID: PMC10314463 DOI: 10.1186/s12984-023-01204-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/15/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Individualized, targeted, and intense training is the hallmark of successful gait rehabilitation in people post-stroke. Specifically, increasing use of the impaired ankle to increase propulsion during the stance phase of gait has been linked to higher walking speeds and symmetry. Conventional progressive resistance training is one method used for individualized and intense rehabilitation, but often fails to target paretic ankle plantarflexion during walking. Wearable assistive robots have successfully assisted ankle-specific mechanisms to increase paretic propulsion in people post-stroke, suggesting their potential to provide targeted resistance to increase propulsion, but this application remains underexamined in this population. This work investigates the effects of targeted stance-phase plantarflexion resistance training with a soft ankle exosuit on propulsion mechanics in people post-stroke. METHODS We conducted this study in nine individuals with chronic stroke and tested the effects of three resistive force magnitudes on peak paretic propulsion, ankle torque, and ankle power while participants walked on a treadmill at their comfortable walking speeds. For each force magnitude, participants walked for 1 min while the exosuit was inactive, 2 min with active resistance, and 1 min with the exosuit inactive, in sequence. We evaluated changes in gait biomechanics during the active resistance and post-resistance sections relative to the initial inactive section. RESULTS Walking with active resistance increased paretic propulsion by more than the minimal detectable change of 0.8 %body weight at all tested force magnitudes, with an average increase of 1.29 ± 0.37 %body weight at the highest force magnitude. This improvement corresponded to changes of 0.13 ± 0.03 N m kg- 1 in peak biological ankle torque and 0.26 ± 0.04 W kg- 1 in peak biological ankle power. Upon removal of resistance, propulsion changes persisted for 30 seconds with an improvement of 1.49 ± 0.58 %body weight after the highest resistance level and without compensatory involvement of the unresisted joints or limb. CONCLUSIONS Targeted exosuit-applied functional resistance of paretic ankle plantarflexors can elicit the latent propulsion reserve in people post-stroke. After-effects observed in propulsion highlight the potential for learning and restoration of propulsion mechanics. Thus, this exosuit-based resistive approach may offer new opportunities for individualized and progressive gait rehabilitation.
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Affiliation(s)
- Krithika Swaminathan
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, 02134, USA
| | - Franchino Porciuncula
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, 02134, USA
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, 02215, USA
| | - Sungwoo Park
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, 02134, USA
| | - Harini Kannan
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, 02134, USA
| | - Julien Erard
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, 02134, USA
| | - Nicholas Wendel
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, 02215, USA
| | - Teresa Baker
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, 02215, USA
| | - Terry D Ellis
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, 02215, USA
| | - Louis N Awad
- Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, 02215, USA
| | - Conor J Walsh
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, 02134, USA.
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Washabaugh EP, Augenstein TE, Koje M, Krishnan C. Functional Resistance Training With Viscous and Elastic Devices: Does Resistance Type Acutely Affect Knee Function? IEEE Trans Biomed Eng 2023; 70:1274-1285. [PMID: 36240034 PMCID: PMC10170553 DOI: 10.1109/tbme.2022.3214773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Functional resistance training (FRT) during walking is an emerging approach for rehabilitating individuals with neuromuscular or orthopedic injuries. During FRT, wearable exoskeleton/braces can target resistance to a weakened leg joint; however, the resistive properties of the training depend on the type of resistive elements used in the device. Hence, this study was designed to examine how the biomechanical and neural effects of functional resistance training differ with viscous and elastic resistances during both treadmill and overground walking. METHODS Fourteen able-bodied individuals were trained on two separate sessions with two devices that provided resistance to the knee (viscous and elastic) while walking on a treadmill. We measured gait biomechanics and muscle activation during training, as well as kinematic aftereffects and changes in peripheral fatigue and neural excitability after training. RESULTS We found the resistance type differentially altered gait kinetics during training-elastic resistance increased knee extension during stance while viscous resistance primarily affected swing. Also, viscous resistance increased power generation while elastic resistance could increase power absorption. Both devices resulted in significant kinematic and neural aftereffects. However, overground kinematic aftereffects and neural excitability did not differ between devices. CONCLUSION Different resistance types can be used to alter gait biomechanics during training. While there were no resistance-specific changes in acute neural adaptation following training, it is still possible that prolonged and repeated training could produce differential effects. SIGNIFICANCE Resistance type alters the kinetics of functional resistance training. Prolonged and repeated training sessions on patients will be needed to further measure the effects of these devices.
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Affiliation(s)
| | - Thomas E. Augenstein
- Michigan Medicine, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA; University of Michigan, Robotics Institute, Ann Arbor, MI, USA
| | - Mary Koje
- Michigan Medicine, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Michigan Medicine, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA; University of Michigan, Robotics Institute, Ann Arbor, MI, USA
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