1
|
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.
Collapse
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.
| |
Collapse
|
2
|
Cataldo AVR, Collimore AN, Spangler J, Ribeirinha-Braga L, Hutchinson K, Wang QM, Thompson L, Awad LN. Enhancing Neuroplasticity in the Chronic Phase After Stroke: Effects of a Soft Robotic Exosuit on Training Intensity and Brain-Derived Neurotrophic Factor. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2023; 4:284-291. [PMID: 38196979 PMCID: PMC10776098 DOI: 10.1109/ojemb.2023.3313396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/21/2023] [Accepted: 09/03/2023] [Indexed: 01/11/2024] Open
Abstract
Objective: High intensity training may enhance neuroplasticity after stroke; however, gait deficits limit the ability to achieve and sustain high walking training intensities. We hypothesize that soft robotic exosuits can facilitate speed-based gait training at higher intensities and longer durations, resulting in a corresponding increase in circulating brain-derived neurotrophic factor (BDNF). Results: Eleven individuals >6-mo post-stroke completed a two-session, pilot randomized crossover trial (NCT05138016). Maximum training speed (Δ: 0.07 ± 0.03 m/s), duration (Δ: 2.07 ± 0.88 min), and intensity (VO2 peak, Δ: 1.75 ± 0.60 ml-O2/kg/min) significantly increased (p < 0.05) during exosuit-augmented training compared to no-exosuit training. Post-session increases in BDNF (Δ: 5.96 ± 2.27 ng/ml, p = 0.03) were observed only after exosuit-augmented training. Biomechanical changes were not observed after exosuit-augmented training; however, a deterioration in gait propulsion symmetry (%Δ: -5 ± 2 %) and an increase in nonparetic propulsion (Δ: 0.9 ± 0.3 %bw) were observed (p < 0.05) after no-exosuit training. Conclusion: Soft robotic exosuits facilitate faster, longer duration, and higher intensity walking training associated with enhanced neuroplasticity.
Collapse
Affiliation(s)
- Anna V. Roto Cataldo
- Boston University, College of Health and Rehabilitation Sciences: SargentBostonMA02215USA
| | - Ashley N. Collimore
- Boston University, College of Health and Rehabilitation Sciences: SargentBostonMA02215USA
| | - Johanna Spangler
- Boston University, College of Health and Rehabilitation Sciences: SargentBostonMA02215USA
| | | | - Karen Hutchinson
- Boston University, College of Health and Rehabilitation Sciences: SargentBostonMA02215USA
| | - Qing Mei Wang
- Spaulding Rehabilitation HospitalCharlestownMA02129USA
| | - LaDora Thompson
- Boston University, College of Health and Rehabilitation Sciences: SargentBostonMA02215USA
| | - Louis N. Awad
- Boston University, College of Health and Rehabilitation Sciences: SargentBostonMA02215USA
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
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.
Collapse
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.
| |
Collapse
|
5
|
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: 20] [Impact Index Per Article: 10.0] [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.
Collapse
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.
| |
Collapse
|
6
|
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] [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.
Collapse
|
7
|
Jategaonkar C, Singh Y, Vashista V. Effect of External Damping on Ankle Motion During the Swing Phase of Walking. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3184781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Chinmay Jategaonkar
- Human-Centered Robotics Laboratory, Indian Institute of Technology Gandhinagar, Gujarat, India
| | - Yogesh Singh
- Human-Centered Robotics Laboratory, Indian Institute of Technology Gandhinagar, Gujarat, India
| | - Vineet Vashista
- Human-Centered Robotics Laboratory, Indian Institute of Technology Gandhinagar, Gujarat, India
| |
Collapse
|
8
|
Shin SY, Hohl K, Giffhorn M, Awad LN, Walsh CJ, Jayaraman A. Soft robotic exosuit augmented high intensity gait training on stroke survivors: a pilot study. J Neuroeng Rehabil 2022; 19:51. [PMID: 35655180 PMCID: PMC9164465 DOI: 10.1186/s12984-022-01034-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/19/2022] [Indexed: 12/01/2022] Open
Abstract
Background Stroke is a leading cause of serious gait impairments and restoring walking ability is a major goal of physical therapy interventions. Soft robotic exosuits are portable, lightweight, and unobtrusive assistive devices designed to improve the mobility of post-stroke individuals through facilitation of more natural paretic limb function during walking training. However, it is unknown whether long-term gait training using soft robotic exosuits will clinically impact gait function and quality of movement post-stroke. Objective The objective of this pilot study was to examine the therapeutic effects of soft robotic exosuit-augmented gait training on clinical and biomechanical gait outcomes in chronic post-stroke individuals. Methods Five post-stroke individuals received high intensity gait training augmented with a soft robotic exosuit, delivered in 18 sessions over 6–8 weeks. Performance based clinical outcomes and biomechanical gait quality parameters were measured at baseline, midpoint, and completion. Results Clinically meaningful improvements were observed in walking speed (\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$p$$\end{document}p < 0.05) and endurance (\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$p$$\end{document}p < 0.01) together with other traditional gait related outcomes. The gait quality measures including hip (\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$p$$\end{document}p < 0.01) and knee (\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$p$$\end{document}p < 0.05) flexion/extension exhibited an increase in range of motion in a symmetric manner (\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$p$$\end{document}p < 0.05). We also observed an increase in bilateral ankle angular velocities (\documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$p$$\end{document}p < 0.05), suggesting biomechanical improvements in walking function. Conclusions The results in this study offer preliminary evidence that a soft robotic exosuit can be a useful tool to augment high intensity gait training in a clinical setting. This study justifies more expanded research on soft exosuit technology with a larger post-stroke population for more reliable generalization. Trial registration This study is registered with ClinicalTrials.gov (ID: NCT04251091)
Collapse
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.
| |
Collapse
|