Effects of overground gait training assisted by a wearable exoskeleton in patients with Parkinson’s disease

Abstract

BackgroundIn the recent past, wearable devices have been used for gait rehabilitation in patients with Parkinson’s disease. The objective of this paper is to analyze the outcome of a wearable hip orthosis whose assistance adapts in real time to the patient’s gait kinematics via adaptive oscillators. In particular, this study focuses on a metric characterizing natural gait variability, i.e., the level of long-range autocorrelations (LRA) in series of stride durations.MethodsEight patients with Parkinson’s disease (Hoehn and Yahr stages 1-2.5) performed overground gait training three times per week for four consecutive weeks, assisted by a wearable hip orthosis. Gait was assessed based on performance metrics such as the hip range of motion, speed, stride length and duration, and the level of LRA in inter-stride time series assessed using the Adaptive Fractal Analysis. These metrics were measured before, directly after, and 1 month after training.ResultsAfter training, patients increased their hip range of motion, their gait speed and stride length, and decreased their stride duration. These improvements were maintained 1 month after training. Regarding long-range autocorrelations, the population’s behavior was standardized towards a metric closer to the one of healthy individuals after training, but with no retention after 1 month.ConclusionThis study showed that an overground gait training with adaptive robotic assistance has the potential to improve key gait metrics that are typically affected by Parkinson’s disease and that lead to higher prevalence of fall.Trial registration: ClinicalTrials.gov Identifer NCT04314973. Registered on 11 April 2020.