Targeting Paretic Propulsion and Walking Speed With a Soft Robotic Exosuit: A Consideration-of-Concept Trial

Franchino Porciuncula, Teresa C Baker, Dheepak Arumukhom Revi, Jaehyun Bae, Regina Sloutsky, Terry D Ellis, Conor J Walsh, Louis N Awad, Franchino Porciuncula, Teresa C Baker, Dheepak Arumukhom Revi, Jaehyun Bae, Regina Sloutsky, Terry D Ellis, Conor J Walsh, Louis N Awad

Abstract

Background: Soft robotic exosuits can facilitate immediate increases in short- and long-distance walking speeds in people with post-stroke hemiparesis. We sought to assess the feasibility and rehabilitative potential of applying propulsion-augmenting exosuits as part of an individualized and progressive training program to retrain faster walking and the underlying propulsive strategy. Methods: A 54-yr old male with chronic hemiparesis completed five daily sessions of Robotic Exosuit Augmented Locomotion (REAL) gait training. REAL training consists of high-intensity, task-specific, and progressively challenging walking practice augmented by a soft robotic exosuit and is designed to facilitate faster walking by way of increased paretic propulsion. Repeated baseline assessments of comfortable walking speed over a 2-year period provided a stable baseline from which the effects of REAL training could be elucidated. Additional outcomes included paretic propulsion, maximum walking speed, and 6-minute walk test distance. Results: Comfortable walking speed was stable at 0.96 m/s prior to training and increased by 0.30 m/s after training. Clinically meaningful increases in maximum walking speed (Δ: 0.30 m/s) and 6-minute walk test distance (Δ: 59 m) were similarly observed. Improvements in paretic peak propulsion (Δ: 2.80 %BW), propulsive power (Δ: 0.41 W/kg), and trailing limb angle (Δ: 6.2 degrees) were observed at comfortable walking speed (p's < 0.05). Likewise, improvements in paretic peak propulsion (Δ: 4.63 %BW) and trailing limb angle (Δ: 4.30 degrees) were observed at maximum walking speed (p's < 0.05). Conclusions: The REAL training program is feasible to implement after stroke and capable of facilitating rapid and meaningful improvements in paretic propulsion, walking speed, and walking distance.

Keywords: exosuit; gait training; neurorehabilitation; propulsion; soft robotics; stroke; walking; wearable robots.

Conflict of interest statement

JB is currently an employee of Apple Inc. Apple Inc. did not play a role in this study. Patents describing the exosuit components documented in this article have been filed with the U.S. Patent Office. CJW and JB are inventors of at least one of the following patent/patent applications: U.S. 9,351,900, U.S. 14/660,704, U.S. 15/097,744, U.S. 14/893,934, PCT/US2014/068462, PCT/US2015/051107, and PCT/US2017/042286, U.S. 10,434,030, U.S. 10,843,332, U.S. 10,427,293 filed by Harvard University. CJW is a paid consultant to ReWalk Robotics. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Porciuncula, Baker, Arumukhom Revi, Bae, Sloutsky, Ellis, Walsh and Awad.

Figures

Figure 1
Figure 1
Progression of our stroke exosuits program from device development to development of the Robotic Exosuit Augmented Locomotion (REAL) gait training program. a, Awad et al. (2017a); b, Bae et al. (2015); c, Awad et al. (2017b); d, Bae et al. (2018b); e, Awad et al. (2020a); f, Bae et al. (2018a); g, Siviy et al. (2020). *Single-session comparisons of exosuit powered vs. unpowered (or not worn); **Multi-session evaluations of pre-to-post training effects of REAL gait training.
Figure 2
Figure 2
(A) Schematic of soft robotic exosuit with representative force profiles for dorsiflexion and plantarflexion assistance. (B) Laboratory setup for biomechanical evaluation of overground walking. (C) Illustration of Robotic Exosuit Augmented Locomotion (REAL) training, administered by a physical therapist on the treadmill and overground. DF, Dorsiflexion; PF, Plantarflexion; AP-GRF, Anterior-posterior ground reaction force; %bw, Percent body weight; IMU, Inertial measurement unit. (A) Green shoe refers to paretic foot, and red shoe refers to non-paretic foot.
Figure 3
Figure 3
Effects of Robotic Exosuit Augmented Locomotion (REAL) training on 10-m walk test speeds and 6-minute walk test distance. (A) Five comfortable walking speed measurements repeatedly assessed over 2 years prior to the onset of REAL training (four historical timepoints and one pre-training evaluation conducted immediately before the training period), post-training evaluation comfortable walking speed, and pre-to-post maximum walking speeds. (B) Pre-to-post comparisons of 6-minute walk test distance. (C) Time series of anteroposterior ground reaction forces (AP-GRF) of each speed condition; (D) Peak propulsion of each speed condition. CWS, Comfortable walking speed; MWS, Maximum walking speed; MDC, Minimum detectable change; MCID, Minimal clinically importance difference; *: (p < 0.05).

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