Soft robotic exosuit augmented high intensity gait training on stroke survivors: a pilot study

Sung Yul Shin, Kristen Hohl, Matt Giffhorn, Louis N Awad, Conor J Walsh, Arun Jayaraman, Sung Yul Shin, Kristen Hohl, Matt Giffhorn, Louis N Awad, Conor J Walsh, Arun Jayaraman

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 ([Formula: see text] < 0.05) and endurance ([Formula: see text] < 0.01) together with other traditional gait related outcomes. The gait quality measures including hip ([Formula: see text] < 0.01) and knee ([Formula: see text] < 0.05) flexion/extension exhibited an increase in range of motion in a symmetric manner ([Formula: see text] < 0.05). We also observed an increase in bilateral ankle angular velocities ([Formula: see text] < 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).

Keywords: Clinical outcomes; Exosuit; Gait quality; High intensity gait training; Soft robotics; Stroke.

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
A The ReWalk ReStore™ (ReWalk Robotics, Israel) soft robotic exosuit designed to assist paretic ankle dorsiflexion and plantarflexion of individuals with post-stroke. B Workflow of intervention, including assessment and training of high intensity gait training augmented with soft robotic exosuit. Gait training sessions consist of initial 10MWT to determine baseline self-selected speed followed by five sets of 6-min walking on treadmill or overground. Pre: before training; Mid: after 9 training sessions; Post: after 18 training sessions; 10MWT: 10-Meter Walk Test
Fig. 2
Fig. 2
Clinical outcome measures before training (Pre), after 9 training sessions (Mid), and after 18 training sessions (Post) time points. 10MWT SSV: 10-Meter Walk Test for self-selected walking velocity; 10MWT FV: 10-Meter Walk Test for fast walking velocity; FGA: functional gait assessment; TUG: Timed-Up-and-Go; 6MWT: 6-min walk test; LE Motor FM: lower extremity subscale of the Fugl-Meyer Assessment; 2MWT OG: 2-min walk test overground, 2MWT TM: 2-min walk test treadmill
Fig. 3
Fig. 3
A Selected gait quality measures with significance before training (Pre), after 9 training sessions (Mid), and after 18 training sessions (Post) time points. B Example of ankle angular velocity profiles across a single gait cycle from a representative subject (top panel) and changes in ankle angular velocity at Pre, Mid and Post time points (bottom panel). US unaffected side, AS affected side, FE flexion/extension, AAV ankle angular velocity

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