Recovery of gait function with a wearable powered exoskeleton in sub-acute stroke patients using SEMG for fine tuning: Preliminary results

Abstract

Gait recovery in post-stroke patients is one of the main goals of post-stroke rehabilitation. Wearable over-ground powered exoskeletons allow individuals with gait dysfunctions to perform an over-ground gait training. Literature lacks of clinical studies on exoskeleton-supported gait rehabilitation in stroke patients and on setting modalities. Ekso is a wearable exoskeleton equipped with 4 motors, which allows the patient to stand up, sit and walk on a flat hard surface. The aim of this study is to investigate the clinical effects of an over-ground walking training with a wearable powered exoskeleton (Ekso), after a sEMG fine tuning, in sub-acute stroke patients. This is a pilot pre-post, open label, non randomized, non controlled experimental study. 47 sub-acute stroke patients underwent a walking rehabilitation training of 15 sessions (60 min/session, 3 times/week) using Ekso. A surface electromyography (sEMG) of rectus femoris, hamstrings, tibialis anterior and soleus of both limbs was collected in order to define the best setting for each patient. Clinical evaluation was performed at the beginning of the training period (t1), and after 15 sessions (t2) using: Barthel Index, Ashworth scale, Motricity Index, Trunk Control Test, Functional Ambulation Scale, 10 meter walking test, 6 minutes walking test, and Walking Handicap Scale. Wilcoxon's tests ( P < 0.05) was used to detect significant changes between data. Significant statistical improvements were found between t0–t2 in Barthel Index, Motricity Index, Trunk Control Test, Functional Ambulation Scale, 10 meter walking test, and 6 minutes walking test. Fifteen sessions of over-ground gait training using a powered wearable robotic exoskeleton, set with sEMG, improve ambulatory functions in sub-acute post-stroke patients. Further studies are needed to better understand the treatment effect.