Adaptive Ankle Resistance from a Wearable Robotic Device to Improve Muscle Recruitment in Cerebral Palsy

Conner, Benjamin C.; Luque, Jason; Lerner, Zachary F.

doi:10.1007/s10439-020-02454-8

Cited by 47 publications

(48 citation statements)

References 42 publications

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“…In children with CP, ankle power is significantly reduced [37], potentially due to ineffective muscle activation profiles in which agonist activity is partially negated by antagonist activity. In our prior validation study of the resistance controller, we observed a significant decrease in ankle co-contraction when individuals walked with resistance [20]. The present study found that there was a carry-over of this desirable reduction in co-contraction to walking without the device following exo-therapy.…”

Section: Discussionsupporting

confidence: 60%

“…The torque sensors were used for low-level proportional-derivative motor control. Detection of gait events and real-time estimates of ankle moment from the embedded force sensors allowed the device to provide proportional resistance to ankle plantar flexion [20]. An onboard microcontroller with Bluetooth input allowed for remote control via a custom MATLAB graphical user interface and visualization of the estimated ankle movement and exoskeleton torque.…”

Section: B Wearable Resistance Platformmentioning

confidence: 99%

“…This allowed the research team to assess, in real-time, user performance with the device so that active engagement could be maximized. Additional details on the device can be found in earlier work [20].…”

Section: B Wearable Resistance Platformmentioning

confidence: 99%

“…The primary goal of this pilot clinical trial was to develop and evaluate a task-specific gait re-training intervention to improve neuromuscular control and walking efficiency in adolescents with CP. This work builds on our previous validation of an adaptive ankle resistance control scheme implemented on a light-weight wearable exoskeleton to foster increased volitional engagement of the ankle plantar flexor muscles [20]. We hypothesized that repeated neuromuscular gait re-training with adaptive ankle resistance that responds directly to user input would improve the ankle plantar flexor muscle activation profile and decrease co-contraction across the ankle joint.…”

Section: Introductionmentioning

confidence: 99%

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Wearable Robotic Ankle Resistance Training Improves Neuromuscular Control and Walking Efficiency in Cerebral Palsy

Conner

Schwartz

Lerner

2020

Preprint

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Cerebral palsy (CP) is characterized by deficits in motor function due to reduced neuromuscular control. We leveraged the guiding principles of motor learning theory to design a wearable robotic intervention intended to improve neuromuscular control of the ankle. The goal of this pilot clinical trial was to determine the response to four weeks of exoskeleton ankle resistance therapy (exo-therapy) in children with CP. Five children with CP (12-17 years, GMFCS I-II, four males and one female) were recruited for ten, 20-minute sessions of exo-therapy. Surface electromyography, three-dimensional kinematics, and metabolic data were collected at baseline and after training was complete. Changes in neural complexity (via muscle synergy analysis) and metabolic cost were compared to retrospective age- and GMFCS-matched controls who had undergone either single event multi-level orthopedic surgery (SEMLS) or selective dorsal rhizotomies (SDR). Participants displayed decreased co-contraction at the ankle (−29 ± 11%, p = 0.02) and a more typical plantar flexor activation profile (33 ± 13%, p = 0.01), and improvements in neuromuscular control led to a more mechanically-efficient gait pattern (58 ± 34%, p < 0.05) with a reduced metabolic cost of transport (−29 ± 15%, p = 0.02). There were significant increases in neural complexity (5 ± 3%, p = 0.03), where were significantly greater than those seen with SEMLS and SDR (p < 0.01 for both). Ankle exoskeleton resistance therapy shows promise for rapidly improving neuromuscular control for children with CP, and may serve as a meaningful rehabilitative complement to common surgical procedures.

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Section: Discussionsupporting

confidence: 60%

Section: B Wearable Resistance Platformmentioning

confidence: 99%

Section: B Wearable Resistance Platformmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Wearable Robotic Ankle Resistance Training Improves Neuromuscular Control and Walking Efficiency in Cerebral Palsy

Conner

Schwartz

Lerner

2020

Preprint

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“…There is a vital need for an effective and widely-available intervention capable of increasing the dose of task-specific gait therapy for children with CP. To meet this need, a wearable robotic device was recently developed to address deficits in Technology muscle recruitment and reinforce neuromuscular control patterns that may produce lasting improvements in locomotor function [14]. Utilizing onboard sensors and a closed-loop control strategy that responds immediately to user input, this novel training modality provides perfectly synchronized resistance to re-train ankle plantar flexor muscle function during the stance phase of walking.…”

Section: Introductionmentioning

confidence: 99%

Wearable Adaptive Resistance Training Improves Ankle Strength, Walking Efficiency and Mobility in Cerebral Palsy: A Pilot Clinical Trial

Conner

Remec

Orum

et al. 2020

IEEE Open J. Eng. Med. Biol.

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To determine the efficacy of wearable adaptive resistance training for rapidly improving walking ability in children with cerebral palsy (CP). Methods: Six children with spastic CP (five males, one female; mean age 14y 11mo; three hemiplegic, three diplegic; Gross Motor Function Classification System [GMFCS] levels I and II) underwent ten, 20-minute training sessions over four weeks with a wearable adaptive resistance device. Strength, speed, walking efficiency, timed up and go (TUG), and six-minute walk test (6MWT) were used to measure training outcomes. Results: Participants showed increased average plantar flexor strength (17 ± 8%, p = 0.02), increased preferred walking speed on the treadmill (39 ± 25%, p = 0.04), improved metabolic cost of transport (33 ± 9%, p = 0.03), and enhanced performance on the timed up and go (11 ± 9%, p = 0.04) and six-minute walk test (13 ± 9%, p = 0.04). Conclusions: The observed increase in preferred walking speed, reduction in metabolic cost of transport, and improved performance on clinical tests of mobility highlights the potentially transformative nature of this novel therapy; the rate at which this intervention elicited improved function was 3 -6 times greater than what has been reported previously.

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Introduction to Healthy and Post-Stroke Gait and Robotic Gait Assistance

Lora Millán

2024

Springer Theses

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Adaptive Ankle Resistance from a Wearable Robotic Device to Improve Muscle Recruitment in Cerebral Palsy

Cited by 47 publications

References 42 publications

Wearable Robotic Ankle Resistance Training Improves Neuromuscular Control and Walking Efficiency in Cerebral Palsy

Wearable Robotic Ankle Resistance Training Improves Neuromuscular Control and Walking Efficiency in Cerebral Palsy

Wearable Adaptive Resistance Training Improves Ankle Strength, Walking Efficiency and Mobility in Cerebral Palsy: A Pilot Clinical Trial

Introduction to Healthy and Post-Stroke Gait and Robotic Gait Assistance

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