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Gerez L, Micera S, Nuckols R, Proietti T. Assessment of wearable robotics performance in patients with neurological conditions. Curr Opin Neurol 2024:00019052-990000000-00200. [PMID: 39373271 DOI: 10.1097/wco.0000000000001328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
PURPOSE OF REVIEW While wearable robotics is expanding within clinical settings, particularly for neurological rehabilitation, there is still a lack of consensus on how to effectively assess the performance of these devices. This review focuses on the most common metrics, whose selection and design are crucial for optimizing treatment outcomes and potentially improve the standard care. RECENT FINDINGS The literature reveals that while wearable robots are equipped with various embedded sensors, most studies still rely on traditional, nontechnological methods for assessment. Recent studies have shown that, although quantitative data from embedded sensors are available (e.g., kinematics), these are underutilized in favor of qualitative assessments. A trend toward integrating automatic assessments from the devices themselves is emerging, with a few notable studies pioneering this approach. SUMMARY Our analysis suggests a critical need for developing standardized metrics that leverage the data from embedded sensors in wearable robots. This shift could enhance the accuracy of patient assessments and the effectiveness of rehabilitation strategies, ultimately leading to better patient outcomes in neurological rehabilitation.
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Affiliation(s)
- Lucas Gerez
- ARARA Lab, James Watt School of Engineering, University of Glasgow, Glasgow, UK
| | - Silvestro Micera
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa
- Modular Implantable Neuroprostheses (MINE) Laboratory, Università Vita-Salute San Raffaele & Scuola Superiore Sant'Anna, Milan, Italy
- Bertarelli Foundation Chair in Translational Neuroengineering, Centre for Neuroprosthetics and Institute of Bioengineering, School of Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Richard Nuckols
- Department of Mechanical & Industrial Engineering, Francis College of Engineering, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Tommaso Proietti
- The Biorobotics Institute and Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa
- Modular Implantable Neuroprostheses (MINE) Laboratory, Università Vita-Salute San Raffaele & Scuola Superiore Sant'Anna, Milan, Italy
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Chang CK, Lee C, Nuckols RW, Eckert-Erdheim A, Orzel D, Herman M, Traines J, Prokup S, Jayaraman A, Walsh CJ. Implementation of a unilateral hip flexion exosuit to aid paretic limb advancement during inpatient gait retraining for individuals post-stroke: a feasibility study. J Neuroeng Rehabil 2024; 21:121. [PMID: 39026268 PMCID: PMC11256417 DOI: 10.1186/s12984-024-01410-0] [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: 10/03/2023] [Accepted: 06/20/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND During inpatient rehabilitation, physical therapists (PTs) often need to manually advance patients' limbs, adding physical burden to PTs and impacting gait retraining quality. Different electromechanical devices alleviate this burden by assisting a patient's limb advancement and supporting their body weight. However, they are less ideal for neuromuscular engagement when patients no longer need body weight support but continue to require assistance with limb advancement as they recover. The objective of this study was to determine the feasibility of using a hip flexion exosuit to aid paretic limb advancement during inpatient rehabilitation post-stroke. METHODS Fourteen individuals post-stroke received three to seven 1-hour walking sessions with the exosuit over one to two weeks in addition to standard care of inpatient rehabilitation. The exosuit assistance was either triggered by PTs or based on gait events detected by body-worn sensors. We evaluated clinical (distance, speed) and spatiotemporal (cadence, stride length, swing time symmetry) gait measures with and without exosuit assistance during 2-minute and 10-meter walk tests. Sessions were grouped by the assistance required from the PTs (limb advancement and balance support, balance support only, or none) without exosuit assistance. RESULTS PTs successfully operated the exosuit in 97% of sessions, of which 70% assistance timing was PT-triggered to accommodate atypical gait. Exosuit assistance eliminated the need for manual limb advancement from PTs. In sessions with participants requiring limb advancement and balance support, the average distance and cadence during 2-minute walk test increased with exosuit assistance by 2.2 ± 3.1 m and 3.4 ± 1.9 steps/min, respectively (p < 0.017). In sessions with participants requiring balance support only, the average speed during 10-meter walk test increased with exosuit by 0.07 ± 0.12 m/s (p = 0.042). Clinical and spatiotemporal measures of independent ambulators were similar with and without exosuit (p > 0.339). CONCLUSIONS We incorporated a unilateral hip flexion exosuit into inpatient stroke rehabilitation in individuals with varying levels of impairments. The exosuit assistance removed the burden of manual limb advancement from the PTs and resulted in improved gait measures in some conditions. Future work will understand how to optimize controller and assistance profiles for this population.
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Affiliation(s)
- Chih-Kang Chang
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Christina Lee
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Richard W Nuckols
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
- Mechanical and Industrial Engineering, University of Massachusetts Lowell, Lowell, MA, USA
| | - Asa Eckert-Erdheim
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Dorothy Orzel
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | - Maxwell Herman
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | | | | | - Arun Jayaraman
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Conor J Walsh
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA.
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Cotinat M, Celerier M, Arquillière C, Flipo M, Prieur-Blanc N, Viton JM, Bensoussan L. Robotic gait training and botulinum toxin injection improve gait in the chronic post-stroke phase: A randomized controlled trial. Ann Phys Rehabil Med 2024; 67:101785. [PMID: 38118342 DOI: 10.1016/j.rehab.2023.101785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/17/2023] [Accepted: 05/23/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Improving walking ability is one of the main goals of rehabilitation after stroke. When lower limb spasticity increases walking difficulty, botulinum toxin type A (BTx-A) injections can be combined with non-pharmacologic interventions such as intensive rehabilitation using a robotic approach. To the best of our knowledge, no comparisons have been made between the efficacy of robotic gait training and conventional physical therapy in combination with BTx-A injections. OBJECTIVE To conduct a randomized controlled trial to compare the efficacy on gait of robotic gait training versus conventional physiotherapy after BTx-A injection into the spastic triceps surae in people after stroke. METHOD Thirty-three participants in the chronic stroke phase with triceps surae spasticity inducing gait impairment were included. After BTx-A injection, participants were randomized into 2 groups. Group A underwent robotic gait training (Lokomat®) for 2 weeks, followed by conventional physiotherapy for 2 weeks (n = 15) and Group B underwent the same treatment in reverse order (n = 18). The efficacy of these methods was tested using the 6-minute walk test (6MWT), comparing post-test 1 and post-test 2 with the pre-test. RESULTS After the first period, the 6MWT increased significantly more in Group A than in Group B: the mean difference between the interventions was 33 m (95%CI 9; 58 p = 0.007; g = 0.95), in favor of Group A; after the second period, the 6MWT increased in both groups, but the 30 m difference between the groups still remained (95%CI 5; 55 p = 0.019; g = 0.73). CONCLUSION Two weeks of robotic gait training performed 2 weeks after BTx-A injections improved walking performance more than conventional physiotherapy. Large-scale studies are now required on the timing of robotic rehabilitation after BTx-A injection.
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Affiliation(s)
- Maëva Cotinat
- Aix Marseille Université, CNRS, INT UMR 7289, Marseille, France; Department of Physical and Rehabilitation Medicine, Marseille University Hospital, France.
| | - Mathilde Celerier
- Department of Physical and Rehabilitation Medicine, Marseille University Hospital, France
| | - Clelia Arquillière
- Department of Physical and Rehabilitation Medicine, Marseille University Hospital, France
| | - Margot Flipo
- Department of Physical and Rehabilitation Medicine, Marseille University Hospital, France
| | - Nicolas Prieur-Blanc
- Department of Physical and Rehabilitation Medicine, Marseille University Hospital, France
| | - Jean-Michel Viton
- Aix Marseille Université, CNRS, INT UMR 7289, Marseille, France; Department of Physical and Rehabilitation Medicine, Marseille University Hospital, France
| | - Laurent Bensoussan
- Aix Marseille Université, CNRS, INT UMR 7289, Marseille, France; Department of Physical and Rehabilitation Medicine, Marseille University Hospital, France; UGECAM Institut Universitaire de Réadaptation de Valmante Sud
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Porciuncula F, Arumukhom Revi D, Baker TC, Sloutsky R, Walsh CJ, Ellis TD, Awad LN. Effects of high-intensity gait training with and without soft robotic exosuits in people post-stroke: a development-of-concept pilot crossover trial. J Neuroeng Rehabil 2023; 20:148. [PMID: 37936135 PMCID: PMC10629136 DOI: 10.1186/s12984-023-01267-9] [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: 03/14/2023] [Accepted: 10/11/2023] [Indexed: 11/09/2023] Open
Abstract
INTRODUCTION High-intensity gait training is widely recognized as an effective rehabilitation approach after stroke. Soft robotic exosuits that enhance post-stroke gait mechanics have the potential to improve the rehabilitative outcomes achieved by high-intensity gait training. The objective of this development-of-concept pilot crossover study was to evaluate the outcomes achieved by high-intensity gait training with versus without soft robotic exosuits. METHODS In this 2-arm pilot crossover study, four individuals post-stroke completed twelve visits of speed-based, high-intensity gait training: six consecutive visits of Robotic Exosuit Augmented Locomotion (REAL) gait training and six consecutive visits without the exosuit (CONTROL). The intervention arms were counterbalanced across study participants and separated by 6 + weeks of washout. Walking function was evaluated before and after each intervention using 6-minute walk test (6MWT) distance and 10-m walk test (10mWT) speed. Moreover, 10mWT speeds were evaluated before each training visit, with the time-course of change in walking speed computed for each intervention arm. For each participant, changes in each outcome were compared to minimal clinically-important difference (MCID) thresholds. Secondary analyses focused on changes in propulsion mechanics and associated biomechanical metrics. RESULTS Large between-group effects were observed for 6MWT distance (d = 1.41) and 10mWT speed (d = 1.14). REAL gait training resulted in an average pre-post change of 68 ± 27 m (p = 0.015) in 6MWT distance, compared to a pre-post change of 30 ± 16 m (p = 0.035) after CONTROL gait training. Similarly, REAL training resulted in a pre-post change of 0.08 ± 0.03 m/s (p = 0.012) in 10mWT speed, compared to a pre-post change of 0.01 ± 06 m/s (p = 0.76) after CONTROL. For both outcomes, 3 of 4 (75%) study participants surpassed MCIDs after REAL training, whereas 1 of 4 (25%) surpassed MCIDs after CONTROL training. Across the training visits, REAL training resulted in a 1.67 faster rate of improvement in walking speed. Similar patterns of improvement were observed for the secondary gait biomechanical outcomes, with REAL training resulting in significantly improved paretic propulsion for 3 of 4 study participants (p < 0.05) compared to 1 of 4 after CONTROL. CONCLUSION Soft robotic exosuits have the potential to enhance the rehabilitative outcomes produced by high-intensity gait training after stroke. Findings of this development-of-concept pilot crossover trial motivate continued development and study of the REAL gait training program.
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Affiliation(s)
- Franchino Porciuncula
- Department of Physical Therapy, Center for Neurorehabilitation, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
- Department of Physical Therapy, Neuromotor Recovery Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
- Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Dheepak Arumukhom Revi
- Department of Physical Therapy, Neuromotor Recovery Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
- Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
- Department of Mechanical Engineering, Boston University, Boston, MA, USA
| | - Teresa C Baker
- Department of Physical Therapy, Center for Neurorehabilitation, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
- Department of Physical Therapy, Neuromotor Recovery Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Regina Sloutsky
- Department of Physical Therapy, Neuromotor Recovery Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Conor J Walsh
- Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Terry D Ellis
- Department of Physical Therapy, Center for Neurorehabilitation, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA
| | - Louis N Awad
- Department of Physical Therapy, Neuromotor Recovery Lab, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA.
- Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.
- Department of Mechanical Engineering, Boston University, Boston, MA, USA.
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Xie R, Zhang Y, Jin H, Yang F, Feng Y, Pan Y. Effects of soft robotic exoskeleton for gait training on clinical and biomechanical gait outcomes in patients with sub-acute stroke: a randomized controlled pilot study. Front Neurol 2023; 14:1296102. [PMID: 38020601 PMCID: PMC10654217 DOI: 10.3389/fneur.2023.1296102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Ankle function impairment is a critical factor impairing normal walking in survivors of stroke. The soft robotic exoskeleton (SRE) is a novel, portable, lightweight assistive device with promising therapeutic potential for gait recovery during post-stroke rehabilitation. However, whether long-term SRE-assisted walking training influences walking function and gait quality in patients following subacute stroke is unknown. Therefore, the primary objective of this study was to assess the therapeutic effects of SRE-assisted walking training on clinical and biomechanical gait outcomes in the rehabilitation of patients with subacute stroke. Methods A group patients who had experienced subacute stroke received conventional rehabilitation (CR) training combined with 10-session SRE-assisted overground walking training (30 min per session, 5 sessions/week, 2 weeks) (SRE group, n = 15) compared with the control group that received CR training only (CR group, n = 15). Clinical assessments and biomechanical gait quality measures were performed pre-and post-10-session intervention, with the 10-Minute Walk Test (10MWT) and 6-Minute Walk Test (6MWT) used to define the primary clinical outcome measures and the Functional Ambulation Category, Fugl-Meyer Assessment for Lower Extremity (FMA-LE) subscale, and Berg Balance Scale defined the secondary outcome measures. The gait quality outcome measures included spatiotemporal and symmetrical parameters during walking. Results After the 10-session intervention, the SRE and CR groups exhibited significant within-group improvements in all clinical outcome measures (p < 0.05). Between-comparison using covariance analyses demonstrated that the SRE group showed greater improvement in walking speed during the 10MWT (p < 0.01), distance walked during the 6MWT (p < 0.05), and FMA-LE scores (p < 0.05). Gait analyses showed that the SRE group exhibited significantly improved spatiotemporal symmetry (p < 0.001) after 10-session training, with no significant changes observed in the CR group. Conclusion Compared with CR training, SRE-assisted walking training led to greater improvements in walking speed, endurance, and motor recovery. Our findings provide preliminary evidence that SRE may be considered for inclusion in intensive gait training clinical rehabilitation programs to further improve walking function in patients who have experienced stroke.
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Affiliation(s)
- Ruimou Xie
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
- School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yanlin Zhang
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
- School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Hainan Jin
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
- School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Fei Yang
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
- School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yutong Feng
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
- School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yu Pan
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Beijing, China
- School of Clinical Medicine, Tsinghua University, Beijing, China
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Chuang YC, Tsai YL, Lin TTL, Ou-Yang LJ, Lee YC, Cheng YY, Liu CC, Hsu CS. Effects of soft robotic exosuit on ambulation ability in stroke patients: a systematic review. Biomed Eng Online 2023; 22:88. [PMID: 37670316 PMCID: PMC10478336 DOI: 10.1186/s12938-023-01150-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 08/28/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Robot-assisted gait training is incorporated into guidelines for stroke rehabilitation. It is a promising tool combined with conventional therapy for low ambulatory patients. The heavy weight and bulky appearance of a robotic exoskeleton limits its practicality. On the other hand, soft robotic exosuit (SRE) based on its light weight and inconspicuous property, is better tolerated by patients in daily life. The aim of this study is to review the efficacy of the SRE with regard to walking ability and biomechanical properties in stroke patients. METHODS Electronic searches were carried out in PubMed, Embase, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database. Clinical trials that investigated the effectiveness of SREs on ambulation ability in patients with post-stroke hemiparesis were eligible. Qualitative data synthesis was subsequently performed. RESULTS Nine studies were identified as relevant, involving a total of 83 patients. For the assessment of SRE efficacy, outcome measures were walking ability and biomechanical properties. In terms of both immediate effect and training effect, SREs improved the walking speed, walking distance, peak ankle dorsiflexion angle during swing phase, peak paretic propulsion, stride length and compensated gait in stroke patients. CONCLUSIONS SRE improved the ambulation ability of stroke patients in terms of walking ability and biomechanical properties. The small number of studies limits the generalizability of interpretation. More controlled studies with better quality are required to reach a more solid conclusion on this issue.
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Affiliation(s)
- Ya-Chi Chuang
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 407219, Taiwan, ROC
| | - Yu-Lin Tsai
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 407219, Taiwan, ROC
| | - Tony Tung-Liang Lin
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 407219, Taiwan, ROC
| | - Liang-Jun Ou-Yang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333423, Taiwan, ROC
| | - Yu-Chun Lee
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 407219, Taiwan, ROC
- Department of Exercise Health Science, National Taiwan University of Sport, Taichung, 404401, Taiwan, ROC
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, 407224, Taiwan, ROC
| | - Yuan-Yang Cheng
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 407219, Taiwan, ROC
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 402202, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112202, Taiwan
| | - Chuan-Ching Liu
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 407219, Taiwan, ROC.
| | - Chun-Sheng Hsu
- Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Sect. 4, Taichung, 407219, Taiwan, ROC.
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, 402202, Taiwan.
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Sloot LH, Baker LM, Bae J, Porciuncula F, Clément BF, Siviy C, Nuckols RW, Baker T, Sloutsky R, Choe DK, O'Donnell K, Ellis TD, Awad LN, Walsh CJ. Effects of a soft robotic exosuit on the quality and speed of overground walking depends on walking ability after stroke. J Neuroeng Rehabil 2023; 20:113. [PMID: 37658408 PMCID: PMC10474762 DOI: 10.1186/s12984-023-01231-7] [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: 01/18/2023] [Accepted: 08/04/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Soft robotic exosuits can provide partial dorsiflexor and plantarflexor support in parallel with paretic muscles to improve poststroke walking capacity. Previous results indicate that baseline walking ability may impact a user's ability to leverage the exosuit assistance, while the effects on continuous walking, walking stability, and muscle slacking have not been evaluated. Here we evaluated the effects of a portable ankle exosuit during continuous comfortable overground walking in 19 individuals with chronic hemiparesis. We also compared two speed-based subgroups (threshold: 0.93 m/s) to address poststroke heterogeneity. METHODS We refined a previously developed portable lightweight soft exosuit to support continuous overground walking. We compared five minutes of continuous walking in a laboratory with the exosuit to walking without the exosuit in terms of ground clearance, foot landing and propulsion, as well as the energy cost of transport, walking stability and plantarflexor muscle slacking. RESULTS Exosuit assistance was associated with improvements in the targeted gait impairments: 22% increase in ground clearance during swing, 5° increase in foot-to-floor angle at initial contact, and 22% increase in the center-of-mass propulsion during push-off. The improvements in propulsion and foot landing contributed to a 6.7% (0.04 m/s) increase in walking speed (R2 = 0.82). This enhancement in gait function was achieved without deterioration in muscle effort, stability or cost of transport. Subgroup analyses revealed that all individuals profited from ground clearance support, but slower individuals leveraged plantarflexor assistance to improve propulsion by 35% to walk 13% faster, while faster individuals did not change either. CONCLUSIONS The immediate restorative benefits of the exosuit presented here underline its promise for rehabilitative gait training in poststroke individuals.
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Affiliation(s)
- Lizeth H Sloot
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
- ZITI Institute of Computer Engineering, Heidelberg University, Heidelberg, Germany
| | - Lauren M Baker
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
| | - Jaehyun Bae
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
| | - Franchino Porciuncula
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
| | - Blandine F Clément
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
- Institute for Biomedical Engineering, ETH Zürich, Zürich, Schweiz
| | - Christopher Siviy
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
| | - Richard W Nuckols
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
| | - Teresa Baker
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
- Department of Physical Therapy, Boston University, Boston, MA, USA
| | - Regina Sloutsky
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
- Department of Physical Therapy, Boston University, Boston, MA, USA
| | - Dabin K Choe
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
| | - Kathleen O'Donnell
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA
| | - Terry D Ellis
- Department of Physical Therapy, Boston University, Boston, MA, USA
| | - Louis N Awad
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA.
- Department of Physical Therapy, Boston University, Boston, MA, USA.
| | - Conor J Walsh
- Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA.
- Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA.
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De Miguel-Fernández J, Salazar-Del Rio M, Rey-Prieto M, Bayón C, Guirao-Cano L, Font-Llagunes JM, Lobo-Prat J. Inertial sensors for gait monitoring and design of adaptive controllers for exoskeletons after stroke: a feasibility study. Front Bioeng Biotechnol 2023; 11:1208561. [PMID: 37744246 PMCID: PMC10513467 DOI: 10.3389/fbioe.2023.1208561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/11/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction: Tuning the control parameters is one of the main challenges in robotic gait therapy. Control strategies that vary the control parameters based on the user's performance are still scarce and do not exploit the potential of using spatiotemporal metrics. The goal of this study was to validate the feasibility of using shank-worn Inertial Measurement Units (IMUs) for clinical gait analysis after stroke and evaluate their preliminary applicability in designing an automatic and adaptive controller for a knee exoskeleton (ABLE-KS). Methods: First, we estimated the temporal (i.e., stride time, stance, and swing duration) and spatial (i.e., stride length, maximum vertical displacement, foot clearance, and circumduction) metrics in six post-stroke participants while walking on a treadmill and overground and compared these estimates with data from an optical motion tracking system. Next, we analyzed the relationships between the IMU-estimated metrics and an exoskeleton control parameter related to the peak knee flexion torque. Finally, we trained two machine learning algorithms, i.e., linear regression and neural network, to model the relationship between the exoskeleton torque and maximum vertical displacement, which was the metric that showed the strongest correlations with the data from the optical system [r = 0.84; ICC(A,1) = 0.73; ICC(C,1) = 0.81] and peak knee flexion torque (r = 0.957). Results: Offline validation of both neural network and linear regression models showed good predictions (R2 = 0.70-0.80; MAE = 0.48-0.58 Nm) of the peak torque based on the maximum vertical displacement metric for the participants with better gait function, i.e., gait speed > 0.7 m/s. For the participants with worse gait function, both models failed to provide good predictions (R2 = 0.00-0.19; MAE = 1.15-1.29 Nm) of the peak torque despite having a moderate-to-strong correlation between the spatiotemporal metric and control parameter. Discussion: Our preliminary results indicate that the stride-by-stride estimations of shank-worn IMUs show potential to design automatic and adaptive exoskeleton control strategies for people with moderate impairments in gait function due to stroke.
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Affiliation(s)
- Jesús De Miguel-Fernández
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Miguel Salazar-Del Rio
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Marta Rey-Prieto
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Cristina Bayón
- Department of Biomechanical Engineering, University of Twente, Enschede, Netherlands
| | | | - Josep M. Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
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9
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Otlet V, Ronsse R. Adaptive walking assistance does not impact long-range stride-to-stride autocorrelations in healthy people. J Neurophysiol 2023; 130:417-426. [PMID: 37465888 DOI: 10.1152/jn.00181.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/16/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
Many studies have demonstrated in the past that the level of long-range autocorrelations in series of stride durations, characterizing natural gait variability, is impacted by external constraints, such as treadmill or metronome, or by pathologies, such as Parkinson's or Huntington's disease. Nevertheless, no one has analyzed the effects on this metric of a gait constrained by a robot-mediated walking assistance, which intrinsically tends to normalize the gait pattern. This paper focuses on the influence of a wearable active pelvis orthosis on the level of long-range autocorrelations in series of stride durations. Ten healthy participants, aged between 55 and 77 yr, performed four overground walking sessions, wearing this orthosis, and with different assistive parameters. This study showed that the adaptive assistance provided by this device has the potential of improving gait metrics that are typically affected by aging, such as the hip range of motion, walking speed, stride length, and stride duration, without impacting natural gait variability, i.e., the level of long-range autocorrelations in series of stride durations. This combination is virtuous toward the design of an assistive device for people with locomotion disorders resulting in deteriorated levels of long-range autocorrelations, such as patients with Parkinson's disease.NEW & NOTEWORTHY This study is the first that investigates the effects of a wearable active pelvis orthosis using an oscillator-based adaptive assistance on the level of long-range autocorrelations in series of stride durations during overground walking. It is also the first to compare the effects of different assistance settings on spatiotemporal gait metrics.
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Affiliation(s)
- Virginie Otlet
- Institute of Mechanics, Materials, and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
| | - Renaud Ronsse
- Institute of Mechanics, Materials, and Civil Engineering, UCLouvain, Louvain-la-Neuve, Belgium
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
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10
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Siviy C, Baker LM, Quinlivan BT, Porciuncula F, Swaminathan K, Awad LN, Walsh CJ. Opportunities and challenges in the development of exoskeletons for locomotor assistance. Nat Biomed Eng 2022; 7:456-472. [PMID: 36550303 DOI: 10.1038/s41551-022-00984-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
Exoskeletons can augment the performance of unimpaired users and restore movement in individuals with gait impairments. Knowledge of how users interact with wearable devices and of the physiology of locomotion have informed the design of rigid and soft exoskeletons that can specifically target a single joint or a single activity. In this Review, we highlight the main advances of the past two decades in exoskeleton technology and in the development of lower-extremity exoskeletons for locomotor assistance, discuss research needs for such wearable robots and the clinical requirements for exoskeleton-assisted gait rehabilitation, and outline the main clinical challenges and opportunities for exoskeleton technology.
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Affiliation(s)
- Christopher Siviy
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Lauren M Baker
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Brendan T Quinlivan
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Franchino Porciuncula
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.,Department of Physical Therapy, College of Health and Rehabilitation Sciences: Sargent, Boston University, Boston, MA, USA
| | - Krithika Swaminathan
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Louis N Awad
- Department of Physical Therapy, College of Health and Rehabilitation Sciences: Sargent, Boston University, Boston, MA, USA
| | - Conor J Walsh
- John A Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA.
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11
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Shi Y, Dong W, Lin W, Gao Y. Soft Wearable Robots: Development Status and Technical Challenges. SENSORS (BASEL, SWITZERLAND) 2022; 22:7584. [PMID: 36236683 PMCID: PMC9573304 DOI: 10.3390/s22197584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/25/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
In recent years, more and more research has begun to focus on the flexible and lightweight design of wearable robots. During this process, many novel concepts and achievements have been continuously made and shown to the public, while new problems have emerged at the same time, which need to be solved. In this paper, we give an overview of the development status of soft wearable robots for human movement assistance. On the basis of a clear definition, we perform a system classification according to the target assisted joint and attempt to describe the overall prototype design level in related fields. Additionally, it is necessary to sort out the latest research progress of key technologies such as structure, actuation, control and evaluation, thereby analyzing the design ideas and basic characteristics of them. Finally, we discuss the possible application fields, and propose the main challenges of this valuable research direction.
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Affiliation(s)
| | | | | | - Yongzhuo Gao
- State Key Laboratory of Robotics and System, Harbin Institute of Technology (HIT), Harbin 150001, China
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12
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Shin SY, Hohl K, Giffhorn M, Awad LN, Walsh CJ, Jayaraman A. Correction to: Soft robotic exosuit augmented high intensity gait training on stroke survivors: a pilot study. J Neuroeng Rehabil 2022; 19:100. [PMID: 36123744 PMCID: PMC9484065 DOI: 10.1186/s12984-022-01080-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Sung Yul Shin
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, 710 N Lake Shore Dr., Chicago, IL, 60611, USA
| | - Kristen Hohl
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA
| | - Matt Giffhorn
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA
| | - Louis N Awad
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, USA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, USA
| | - Conor J Walsh
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, USA.,Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, USA
| | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, 355 E Erie St., Chicago, IL, 60611, USA. .,Department of Physical Medicine and Rehabilitation, Northwestern University, 710 N Lake Shore Dr., Chicago, IL, 60611, USA.
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