Exoskeleton-assisted Gait Training Research Articles

Effects of Training with a Powered Exoskeleton on Cortical Activity Modulation in Hemiparetic Chronic Stroke Patients: A Randomized Controlled Pilot Trial

ObjectivesTo investigate the effects of exoskeleton-assisted gait training in stroke patients. DesignProspective randomized controlled trial. SettingRehabilitation department in a single tertiary hospital. ParticipantsThirty (N=30) chronic stroke patients with Functional Ambulatory Category scale (FAC) between 2 and 4. InterventionPatients were randomly assigned to 1 of 2 groups: training with Healbot G, a wearable powered exoskeleton (Healbot G group; n=15), or treadmill training (control group; n=15). All participants received 30 minutes of training, 10 times per week, for 4 weeks. Outcome MeasurementsThe primary outcome was oxyhemoglobin level changes, representing cortical activity in both motor cortices using functional near-infrared spectroscopy. The secondary outcomes included FAC, Berg Balance Scale, Motricity Index for the lower extremities (MI-Lower), 10-meter walk test, and gait symmetry ratio (spatial step and temporal symmetry ratio). ResultsCompared to the control group, during the entire training session, the pre-training and post-training mean cortical activity, and the amount of increment between pre- and post-training were significantly higher in the Healbot G group (∆mean ± SD; pre-training, 0.245±0.119, post-training, 0.697±0.429, between pre- and post-training, 0.471±0.401μmol, P<.001). There was no significant difference in cortical activity between affected- and unaffected hemispheres after Healbot G training. FAC (∆mean ± SD; 0.35 ± 0.50, P=.012), MI-Lower (∆mean ± SD; 7.01 ± 0.14, P=.001), and spatial step gait symmetry ratio (∆mean ± SD; -0.32 ± 0.25, P=.049) were improved significantly in the Healbot G group. ConclusionExoskeleton-assisted gait training induces cortical modulation effect in both motor cortices, a balanced cortical activation pattern with improvements in spatial step symmetry ratio, walking ability, and voluntary strength.

Exoskeleton-Assisted Gait Training for Subacute Stroke Patients: Feasibility Study and Preliminary Results

Exoskeleton-Assisted Gait Training for Subacute Stroke Patients: Feasibility Study and Preliminary Results

Exoskeleton-assisted Gait Training in Spinal Disease With Gait Disturbance.

Gait impairment reduces a patient's quality of life. Exoskeletons and wearable robotics enable patients with gait disturbance to stand up and walk. An exoskeleton was developed for use in patients with stroke and spinal cord injuries. This study aimed to evaluate the effectiveness of overground exoskeleton-assisted gait training (OEGT) in spine diseases with gait disturbance. This was a single-group preliminary study. Five participants with gait disorders because of root dysfunction accompanying spinal stenosis were included in this study. All participants underwent surgical treatment and an exoskeleton training protocol scheduled for 2 or 3 days per week for 4 weeks. Each session was 60 minutes. Clinical tests were performed before (T1) and at the end of the training (T2). One patient dropped out of the study because of medical issues that were not associated with the exoskeleton. Exoskeleton-assisted rehabilitation was feasible for all participants. All participants showed positive changes in gait performance, balance, proximal muscle strength, psychological state, and satisfaction with the rehabilitation. However, there was no significant improvement in neurological deficits. OEGT is a feasible rehabilitation method for patients with gait disorders caused by degenerative spinal disease.

Effects of an exoskeleton-assisted gait training on post-stroke lower-limb muscle coordination

Objective. Powered exoskeletons have been used to help persons with gait impairment regain some walking ability. However, little is known about its impact on neuromuscular coordination in persons with stroke. The objective of this study is to investigate how a powered exoskeleton could affect the neuromuscular coordination of persons with post-stroke hemiparesis. Approach. Eleven able-bodied subjects and ten stroke subjects participated in a single-visit treadmill walking assessment, in which their motion and lower-limb muscle activities were captured. By comparing spatiotemporal parameters, kinematics, and muscle synergy pattern between two groups, we characterized the normal gait pattern and the post-stroke motor deficits. Five eligible stroke subjects received exoskeleton-assisted gait trainings and walking assessments were conducted pre-intervention (Pre) and post-intervention (Post), without (WO) and with (WT) the exoskeleton. We compared their gait performance between (a) Pre and Post to investigate the effect of exoskeleton-assisted gait training and, (b) WO and WT the exoskeleton to investigate the effect of exoskeleton wearing on stroke subjects. Main results. While four distinct motor modules were needed to describe lower-extremity activities during stead-speed walking among able-bodied subjects, three modules were sufficient for the paretic leg from the stroke subjects. Muscle coordination complexity, module composition and activation timing were preserved after the training, indicating the intervention did not significantly change the neuromuscular coordination. In contrast, walking WT the exoskeleton altered the stroke subjects’ synergy pattern, especially on the paretic side. The changes were dominated by the activation profile modulation towards the normal pattern observed from the able-bodied group. Significance. This study gave us some critical insight into how a powered exoskeleton affects the stroke subjects’ neuromuscular coordination during gait and demonstrated the potential to use muscle synergy as a method to evaluate the effect of the exoskeleton training.This study was registered at ClinicalTrials.gov (identifier: NCT03057652).

Effects of Robotic Exoskeleton-Aided Gait Training in the Strength, Body Balance, and Walking Speed in Individuals With Multiple Sclerosis: A Single-Group Preliminary Study

ObjectiveTo assess effects of 15 exoskeleton-assisted gait training sessions, reflected by the muscle strength of the lower limbs and by walking speed immediately after the training sessions and at the 6-week follow-up. DesignSingle-group longitudinal preliminary study. SettingIndividuals with multiple sclerosis (MS) at a hospital neurology ward. ParticipantsParticipants (N=14) included women and men aged from 36-61 years, with Expanded Disability Status Scale scores from 5.0-6.5. InterventionsExoskeleton-assisted walk training. Main Outcome MeasuresPrimary outcomes included dynamometric knee extensor and flexor strength (Biodex Pro4), postural balance, and center of pressure displacements (Zebris FMD-S). Secondary outcomes included walking speed measured with the timed 25-foot walk test and fatigue (Fatigue Severity Scale). Assessments were performed 4 times, that is, prior to the start of the program (T0), at the end of the physiotherapy without an exoskeleton (T1), at the end of the exoskeleton-assisted training (T2), and at 6-week follow-up (T3). ResultsAt the end of exoskeleton-assisted gait training there was a statistically significant improvement in peak torque of knee extensor muscles compared with the period of exercise without an exoskeleton. No statistically significant change was identified in the value of peak torque of knee flexors at T1. Likewise, the assessment at T2 showed the change in peak torque of knee flexors was not significant. The participants presented significantly faster walking speed after exoskeleton-assisted gait training compared with T0 and T1. No improvement was found in body balance. The subjects reported lower fatigue after exoskeleton-assisted gait training; however, the differences between the assessments at T1 and T0 as well as at T2 and T1 were statistically insignificant. ConclusionsIndividuals with MS and severe gait impairment participating in exoskeleton-assisted gait training achieved significant improvement in lower-limb muscle strength and increase in walking speed, yet the effect was not long-lasting.

Recent Trends and its Effect in Incomplete Spinal Cord Injury Loco-Motor Rehabilitation andndash; A Review

Objective: The purpose of this study is to find out the current trends and its effects in locomotor rehabilitation of individuals with incomplete spinal cord. Methods: Articles were searched through PubMed and Google scholar (year 2016-2020) written in English literature was performed regarding recent advances in the rehabilitation technologies of incomplete SCI patients. Results: Results of this research were according to the based on the clinical findings: Exoskeleton-assisted Gait Training (EGT), Virtual Reality (VR), Robot-Assisted Locomotor Training (RALT), Home based Virtual Reality, Dynamic weight shifting into treadmill, are currently being used. Conclusion: As per the study, there has been advancement in rehabilitation technologies and a significant improvement was noticed in incomplete spinal cord injury patients. More clinical trials and further study is needed for better improvement.

Wearable Biofeedback Improves Human-Robot Compliance during Ankle-Foot Exoskeleton-Assisted Gait Training: A Pre-Post Controlled Study in Healthy Participants.

The adjunctive use of biofeedback systems with exoskeletons may accelerate post-stroke gait rehabilitation. Wearable patient-oriented human-robot interaction-based biofeedback is proposed to improve patient-exoskeleton compliance regarding the interaction torque’s direction (joint motion strategy) and magnitude (user participation strategy) through auditory and vibrotactile cues during assisted gait training, respectively. Parallel physiotherapist-oriented strategies are also proposed such that physiotherapists can follow in real-time a patient’s motor performance towards effective involvement during training. A preliminary pre-post controlled study was conducted with eight healthy participants to conclude about the biofeedback’s efficacy during gait training driven by an ankle-foot exoskeleton and guided by a technical person. For the study group, performance related to the interaction torque’s direction increased during (p-value = 0.07) and after (p-value = 0.07) joint motion training. Further, the performance regarding the interaction torque’s magnitude significantly increased during (p-value = 0.03) and after (p-value = 68.59 × 10−3) user participation training. The experimental group and a technical person reported promising usability of the biofeedback and highlighted the importance of the timely cues from physiotherapist-oriented strategies. Less significant improvements in patient–exoskeleton compliance were observed in the control group. The overall findings suggest that the proposed biofeedback was able to improve the participant-exoskeleton compliance by enhancing human-robot interaction; thus, it may be a powerful tool to accelerate post-stroke ankle-foot deformity recovery.

Effects of Exoskeleton Gait Training on Balance, Load Distribution, and Functional Status in Stroke: A Randomized Controlled Trial.

Background: As a result of stroke, patients have problems with locomotion and transfers, which lead to frequent falls. Recovery after stroke is a major goal of rehabilitation, but it is difficult to choose which treatment method is most beneficial for stroke survivors. Recently, powered robotic exoskeletons are used in treatment to maximize the neural recovery of patients after stroke, but there are no studies evaluating the changes in balance among patients rehabilitated with an exoskeleton.Purpose: The aim of this study was to evaluate the effects of Ekso GT exoskeleton-assisted gait training on balance, load distribution, and functional status of patients after ischemic stroke.Methods: The outcomes are based on 44 patients aged 55–85 years after ischemic stroke who were previously randomly assigned into two groups: experimental (with Ekso GT rehabilitation) and control (with classical rehabilitation). At baseline and after 4 weeks of treatment, the patients were evaluated on balance, load distribution, and functional status using, respectively a stabilometric platform, the Barthel Index, and the Rivermead Mobility Index.Results: In the experimental group, balance improved regarding the variables describing sway area as ellipse major and minor axes. In the control group, improvement was noted in sway velocity. After the therapy, total load distribution on feet in both groups showed a small and insignificant tendency toward reduction in the amount of uninvolved limb loading. In the control group, significant load transfer from the backfoot to the forefoot was noted. Both forms of rehabilitation caused significant changes in functional status.Conclusions: Both training with the use of the Ekso GT exoskeleton and classical physiotherapy lead to functional improvement of patients after ischemic stroke. However, in the experimental group, improvement was observed in a larger number of categories, which may suggest potentially greater impact of treatment with the exoskeleton on functional status. Also, both forms of rehabilitation caused significant changes in balance, but we have noted some trends indicating that treatment with exoskeleton may be more beneficial for some patients. The load transfer from the backfoot to the forefoot observed in the control group was an unfavorable phenomenon. We suggest that the Ekso GT exoskeleton may be a promising tool in the rehabilitation of patients after stroke.Trial registration: Trial ID ACTRN12616000148471

Exoskeleton-assisted Gait Training in Persons With Multiple Sclerosis: A Single-Group Pilot Study

ObjectiveTo investigate the feasibility of conducting exoskeleton-assisted gait training (EGT) and the effects of EGT on gait, metabolic expenditure, and physical function in persons with multiple sclerosis (MS). DesignSingle-group pilot study. SettingResearch laboratory in a rehabilitation hospital. ParticipantsIndividuals with MS (N=10; mean age, 54.3±12.4y) and Expanded Disability Status Scale 6.0-7.5. InterventionsAll participants completed up to 15 sessions of EGT. Main Outcome MeasuresTimed 25-foot walk test at self-selected and fast speed, 6-minute walk test, metabolic expenditure of walking and timed Up and Go test were assessed during walking without the exoskeleton at baseline and immediate post training. ResultsAll participants tolerated the training intensity and completed training without adverse events. After training, gait speed was improved and metabolic expenditure was reduced significantly during the timed 25-foot walk test at self-selected speed. ConclusionsEGT is not only feasible but may also improve gait efficiency for persons with MS. Our observed improvement in gait speed was associated with reduced metabolic expenditure, which was likely because of improved neuromotor coordination. Further studies are required to investigate the effectiveness and integration of EGT in the continuum of MS rehabilitation.

Effects of Exoskeleton-Assisted Gait Training on Functional Rehabilitation Outcomes in Patients With Stroke

Effects of Exoskeleton-Assisted Gait Training on Functional Rehabilitation Outcomes in Patients With Stroke

Exoskeleton-Assisted Gait Training Improves Walking Speed in Chronic Stroke

Improving walking ability is a key goal of rehabilitation therapy after stroke. Better integration of technology has enabled development of powered

Overground wearable powered exoskeleton for gait training in subacute stroke subjects: clinical and gait assessments.

Wearable powered exoskeletons provide intensive overground gait training with patient's active participation: these features promote a successful active motor relearning of ambulation in stroke survivors. The aim of this study was to investigate the feasibility and the clinical effects of an overground exoskeleton-assisted gait training (OEAGT) in subacute stroke patients. Prospective, pilot pre-post, open label, non-randomized experimental study. Four Italian neurological rehabilitation centers. Forty-eight subacute stroke patients were enrolled. Two patients dropped out because of medical problems. Data analysis was conducted on 46 subjects (56.84±14.29 years; 27 male; 29 ischemic; 24 left hemiparesis). Patients underwent 15±2 sessions (60 min/session, 3-5 times/week) of OEAGT. Clinical and gait assessments were performed at the beginning (T1) and at the end (T2) of the training period: modified Barthel Index (BI), modified Ashworth Scale at Hip (MAS-H), Knee (MAS-K), and Ankle (MAS-A) level, Motricity Index (MI), Trunk Control Test (TCT), Functional Ambulation Classification (FAC), Walking Handicap Scale (WHS), 10-Meter Walking Test (10MWT), 6-Minute Walking Test (6mWT), Timed Up-and-Go test (TUG). The Technology Acceptance Model (TAM) questionnaire evaluated the acceptance of OEAGT by patients. Data stratification was performed using the time post the acute event and the onset of rehabilitation treatment, and the MI at T1. Wilcoxon's test (P<0.05) was used. All clinical scales significantly improved at T2; no statistically significant changes were reported for MAS-H, MAS-K, MAS-A. The 69.57% patients were able to walk at T1; 17.39% were not able to walk at T1 but regained ambulation at T2; and 13.04% were not able to walk at either T1 or T2. The ambulant patients showed a statistical improvement in speed measured during the 10MWT and in the distance covered over a time of 6 minutes (6mWT). The results from the TAM questionnaire showed that all subjects perceived the OEAGT positively. The data stratification analysis suggests that the OEAGT does not have any restriction of use. The OEAGT improved the clinical and gait outcomes in subacute patients. Randomized studies on larger samples are needed to confirm these data and to assess the efficacy of OEAGT. Introduce innovative rehabilitation strategies based on customized OEAGT.

Design Advancements toward a Wearable Pediatric Robotic Knee Exoskeleton for Overground Gait Rehabilitation.

Exoskeleton assisted gait training in children with cerebral palsy (CP) offers the potential to increase therapy dosage and intensity compared to current approaches. Here, we report the design and characterization of a pediatric knee exoskeleton for gait training outside of a clinical environment. A multi-layered closed loop control system and a microcontroller based data acquisition system were implemented to provide individualized control approaches and achieve device portability for home use. Step response tests show the averaged 90% rise time was 45 ms for 5 Nm, 35 ms for 10 Nm, 40 ms for 15 Nm. The gain-limited closed-loop torque bandwidth was about 9 Hz with a 9 Nm amplitude chirp in knee flexion and extension. The actuator has low output impedance (<0.5 Nm) at low frequencies expected during use. Future work will investigate the long term effects of providing children with CP knee extension assistance during daily walking on gait biomechanics with, and without, the device.

Effects of Electromechanical Exoskeleton-Assisted Gait Training on Walking Ability of Stroke Patients: A Randomized Controlled Trial

ObjectiveTo assess the efficacy of electromechanical exoskeleton-assisted gait training on walking ability of stroke patients based on ambulatory function, muscle strength, balance, gait speed, and capacity. DesignRandomized controlled trial. SettingUniversity rehabilitation hospital. ParticipantsIndividuals (N=40) with stroke who could stand alone. InterventionsPatients were randomly assigned to control and experimental groups. The control group underwent physical therapist-assisted gait training by conventional method. The experimental group underwent electromechanical gait training assisted by an exoskeleton device. Both types of gait training were performed for 30 minutes each day. The therapeutic interventions were provided for 5 days a week for a period of 4 weeks in both groups. Main Outcome MeasuresFunctional ambulatory category (FAC) before and after gait training. Changes in FAC were the primary outcomes to evaluate the efficacy of electromechanical exoskeleton-assisted gait training. Changes in mobility, walking speed, walking capacity, leg muscle strength, daily activity, and balance were secondary outcomes. ResultsFAC in the control group was 2.44±1.55 in the pretraining and 2.75±1.53 in the post-training. FAC in the experimental group was 3.22±1.31 in the pretraining and 3.78±1.44 in the post-training. Although FAC between pre- and post-training sessions improved in both groups, the changes in FAC were statistically significant in the experimental group alone. Most secondary outcomes in both groups also showed improvement after gait training. However, the differential outcomes were not varied between the 2 groups after adjusting the data for age and stroke duration. We did not exclude patients based on time since stroke onset. The average stroke duration was 530.11±389.21 days in the experimental group. The changes in FAC of the experimental group were negatively correlated with stroke duration. No adverse events were noticed during gait training in either group. ConclusionsElectromechanical exoskeleton-assisted gait training is as effective as conventional gait training by a physical therapist when administered by a gait trainer. As an overground walking system without harness, electromechanical exoskeleton replaced a physical therapist in assisted gait training for patients who stand alone. Because the ambulatory function of stroke patients was affected negatively by stroke duration, the effect of electromechanical-assisted gait training might decline with increased stroke duration.

Exoskeleton-assisted gait training to improve gait in individuals with spinal cord injury: a pilot randomized study

BackgroundRobotic wearable exoskeletons have been utilized as a gait training device in persons with spinal cord injury. This pilot study investigated the feasibility of offering exoskeleton-assisted gait training (EGT) on gait in individuals with incomplete spinal cord injury (iSCI) in preparation for a phase III RCT. The objective was to assess treatment reliability and potential efficacy of EGT and conventional physical therapy (CPT).MethodsForty-four individuals were screened, and 13 were eligible to participate in the study. Nine participants consented and were randomly assigned to receive either EGT or CPT with focus on gait. Subjects received EGT or CPT, five sessions a week (1 h/session daily) for 3 weeks. American Spinal Injury Association (ASIA) Lower Extremity Motor Score (LEMS), 10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), Timed Up and Go (TUG) test, and gait characteristics including stride and step length, cadence and stance, and swing phase durations were assessed at the pre- and immediate post- training. Mean difference estimates with 95% confidence intervals were used to analyze the differences.ResultsAfter training, improvement was observed in the 6MWT for the EGT group. The CPT group showed significant improvement in the TUG test. Both the EGT and the CPT groups showed significant increase in the right step length. EGT group also showed improvement in the stride length.ConclusionEGT could be applied to individuals with iSCI to facilitate gait recovery. The subjects were able to tolerate the treatment; however, exoskeleton size range may be a limiting factor in recruiting larger cohort of patients. Future studies with larger sample size are needed to investigate the effectiveness and efficacy of exoskeleton-assisted gait training as single gait training and combined with other gait training strategies.Trial registrationClinicaltrials.org, NCT03011099, retrospectively registered on January 3, 2017.