An impairment-specific hip exoskeleton assistance for gait training in subjects with acquired brain injury: a feasibility study

Abstract

This study was designed to investigate the feasibility and the potential effects on walking performance of a short gait training with a novel impairment-specific hip assistance (iHA) through a bilateral active pelvis orthosis (APO) in patients with acquired brain injury (ABI). Fourteen subjects capable of independent gait and exhibiting mild-to-moderate gait deficits, due to an ABI, were enrolled. Subjects presenting deficit in hip flexion and/or extension were included and divided into two groups based on the presence (group A, n = 6) or absence (group B, n = 8) of knee hyperextension during stance phase of walking. Two iHA-based profiles were developed for the groups. The protocol included two overground gait training sessions using APO, and two evaluation sessions, pre and post training. Primary outcomes were pre vs. post-training walking distance and steady-state speed in the 6-min walking test. Secondary outcomes were self-selected speed, joint kinematics and kinetics, gait symmetry and forward propulsion, assessed through 3D gait analysis. Following the training, study participants significantly increased the walked distance and average steady-state speed in the 6-min walking tests, both when walking with and without the APO. The increased walked distance surpassed the minimal clinically important difference for groups A and B, (respectively, 42 and 57 m > 34 m). In group A, five out of six subjects had decreased knee hyperextension at the post-training session (on average the peak of the knee extension angle was reduced by 36%). Knee flexion during swing phase increased, by 16% and 31%, for A and B groups respectively. Two-day gait training with APO providing iHA was effective and safe in improving walking performance and knee kinematics in ABI survivors. These preliminary findings suggest that this strategy may be viable for subject-specific post-ABI gait rehabilitation.

Discovering individual-specific gait signatures from data-driven models of neuromechanical dynamics

“…To compare gait signatures within and between individuals, we phase averaged each trial's signatures across strides. Rather than linearly interpolating the data between foot contact events before averaging, as is common in gait analysis [122,[125][126][127] we computed a continuous phase using the first 3 gait signature modes for each trial using Von Mises interpolation [128]. Compared to averaging across linearly interpolated strides, phase averaging is expected to reduce the variance in the data at any point in the stride [66,90].…”

Inertial sensors for gait monitoring and design of adaptive controllers for exoskeletons after stroke: a feasibility study

“…The estimation of overground gait speed during the 10MWT (MAE = 0.07 m/s) was good enough to detect minimal clinically important differences (0.14 m/s) for post-stroke gait analysis ( Livolsi et al, 2022 ; Shin et al, 2022 ). Our results were slightly better than the ones reported in other studies that estimated the same metrics with shank-worn ( r = 0.94 vs. r = 0.93; MAE = 0.07 m/s vs. MAE = 0.09 m/s) ( Yang et al, 2013 ; Hendriks et al, 2022 ) and foot-worn (MAE = 0.07 m/s vs. MAE = 0.1 m/s) ( Feuvrier et al, 2020 ) IMUs.…”

Current State, Needs, and Opportunities for Wearable Robots in Military Medical Rehabilitation and Force Protection

“…Upper-extremity exoskeletons may offer benefits such as reducing spasticity and restoring dexterity through controlled reaching movements [53]. Lower-extremity exoskeletons may offer significant health benefits such as improving standing and walking function, gait patterns, walking speed, cardiovascular capacity, and the efficiency of oxygen consumption [54][55][56][57][58][59][60][61]. Early interventions using wearable assistive devices have shown improved rehabilitation outcomes [60].…”