Design and evaluation of an independent 4‐week, exosuit‐assisted, post‐stroke community walking program

Abstract

Chronic impairment in the paretic ankle following stroke often requires that individuals use compensatory patterns such as asymmetric propulsion to achieve effective walking speeds needed for community engagement. Ankle exosuit assistance can provide ankle biomechanical benefit in the lab, but such environments inherently limit the amount of practice available. Community walking studies without exosuits can provide massed practice and benefit walking speed but are limited in their ability to assist proper mechanics. In this study, we combined the positive aspects of community training with those of exosuit assistance. We developed and evaluated a community Robotic Exosuit Augmented Locomotion (cREAL) program. Four participants in the chronic stage of stroke independently used our community ankle exosuit for walking in the community 3–5 days/week for 4 weeks. We performed lab evaluations before and after the 4‐week program. Two participants significantly improved their unassisted paretic propulsion by an average of 27% after the program and walked on average 4001 steps/day more in the week following the program. Despite the small number of participants, this study provides preliminary evidence for the potential of exosuits to augment gait training and rehabilitation in the community.

Implementation of a unilateral hip flexion exosuit to aid paretic limb advancement during inpatient gait retraining for individuals post-stroke: a feasibility study

“…Besides the improved distance and cadence in LB-support sessions and walking speed in B-support sessions, however, the majority of the functional and spatiotemporal outcomes were similar with and without exosuit assistance across all sessions. The positive orthotic effects exhibited in LB- and B-support sessions but not in No-support sessions were consistent with previous studies where individuals with higher functional scores [ 43 , 46 , 72 ] or in later stages of stroke recovery [ 34 , 73 , 74 ] benefited less from assistive devices. That said, the exosuit assistance did not disturb or negatively impact gait performance in individuals who did not necessarily require limb advancement assistance.…”

“…Previous studies have evaluated the effect of exosuit assistance in individuals with chronic stroke. In these studies, exosuits effectively targeted the ankle to provide both immediate (i.e., orthotic effect) [ 43 ] and rehabilitative (i.e., therapeutic effect) [ 44 – 46 ] functional and biomechanical benefits in individuals post-stroke. Recently, a few preliminary studies have demonstrated a positive orthotic effect in biomechanical strategies of exosuits targeting the hip in individuals with chronic stroke [ 47 , 48 , 50 ].…”