Ankle-targeted exosuit resistance increases paretic propulsion in people post-stroke

Journal of NeuroEngineering and Rehabilitation

Research

Sungwoo Park¹  Harini Kannan¹  Conor J. Walsh¹  Julien Erard¹  Krithika Swaminathan¹  Franchino Porciuncula²  Terry D. Ellis³  Louis N. Awad³  Nicholas Wendel³  Teresa Baker³ 

[1] John A. Paulson School of Engineering and Applied Sciences, Harvard University, 02134, Boston, MA, USA;John A. Paulson School of Engineering and Applied Sciences, Harvard University, 02134, Boston, MA, USA;Sargent College of Health and Rehabilitation Sciences, Boston University, 02215, Boston, MA, USA;Sargent College of Health and Rehabilitation Sciences, Boston University, 02215, Boston, MA, USA;

关键词: Resistive training;    Gait biomechanics;    Soft exosuit;    Locomotor adaptation;    Post-stroke rehabilitation;   

DOI  :  10.1186/s12984-023-01204-w

 received in 2023-04-03, accepted in 2023-06-15,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundIndividualized, targeted, and intense training is the hallmark of successful gait rehabilitation in people post-stroke. Specifically, increasing use of the impaired ankle to increase propulsion during the stance phase of gait has been linked to higher walking speeds and symmetry. Conventional progressive resistance training is one method used for individualized and intense rehabilitation, but often fails to target paretic ankle plantarflexion during walking. Wearable assistive robots have successfully assisted ankle-specific mechanisms to increase paretic propulsion in people post-stroke, suggesting their potential to provide targeted resistance to increase propulsion, but this application remains underexamined in this population. This work investigates the effects of targeted stance-phase plantarflexion resistance training with a soft ankle exosuit on propulsion mechanics in people post-stroke.MethodsWe conducted this study in nine individuals with chronic stroke and tested the effects of three resistive force magnitudes on peak paretic propulsion, ankle torque, and ankle power while participants walked on a treadmill at their comfortable walking speeds. For each force magnitude, participants walked for 1 min while the exosuit was inactive, 2 min with active resistance, and 1 min with the exosuit inactive, in sequence. We evaluated changes in gait biomechanics during the active resistance and post-resistance sections relative to the initial inactive section.ResultsWalking with active resistance increased paretic propulsion by more than the minimal detectable change of 0.8 %body weight at all tested force magnitudes, with an average increase of 1.29 ± 0.37 %body weight at the highest force magnitude. This improvement corresponded to changes of 0.13 ± 0.03 N m kg− 1 in peak biological ankle torque and 0.26 ± 0.04 W kg− 1 in peak biological ankle power. Upon removal of resistance, propulsion changes persisted for 30 seconds with an improvement of 1.49 ± 0.58 %body weight after the highest resistance level and without compensatory involvement of the unresisted joints or limb.ConclusionsTargeted exosuit-applied functional resistance of paretic ankle plantarflexors can elicit the latent propulsion reserve in people post-stroke. After-effects observed in propulsion highlight the potential for learning and restoration of propulsion mechanics. Thus, this exosuit-based resistive approach may offer new opportunities for individualized and progressive gait rehabilitation.

【 授权许可】

CC BY   
© The Author(s) 2023

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