Effect of robotic exoskeleton gait training during acute stroke on functional ambulation

Abstract

BACKGROUND: Stroke is a leading cause of disability resulting in long-term functional ambulation deficits. Conventional therapy can improve ambulation, but may not be able to provide consistent, high dose repetition of movement, resulting in variable recovery with residual gait deviations. OBJECTIVE: The objective of this preliminary prospective investigation is to evaluate the ability of a robotic exoskeleton (RE) to provide high dose gait training, and measure the resulting therapeutic effect on functional ambulation in adults with acute stroke. METHODS: Participants (n = 14) received standard of care (SOC) and RE overground gait training during their scheduled physical therapy (PT) sessions at the same inpatient rehabilitation facility. The outcome measures included distance walked during their PT training sessions (RE and SOC), and functional ambulation measures (10-meter walk test (10MWT), 6-minute walk test (6 MWT), and timed up and go (TUG)). RESULTS: The average total distance walked during RE and the average distance per RE session was significantly higher than SOC sessions. Total walking distance during PT (RE+SOC) showed a strong positive correlation to the total number of steps during RE sessions and number of RE sessions. All functional ambulation measures showed significant improvement at follow-up compared to baseline. The improvement in functional ambulation measures showed a positive correlation with the increase in number of RE gait training sessions. CONCLUSION: The RE can be utilized for inpatient rehabilitation in conjunction with SOC gait training sessions and may result in improved functional ambulation in adults with acute stroke. This preliminary research provides information on the ability of the robotic exoskeleton to provide high dose therapy and its therapeutic effect on functional ambulation in adults with acute stroke during inpatient rehabilitation.

Comparison of the dynamics of exoskeletal-assisted and unassisted locomotion in an FDA-approved lower extremity device: Controlled experiments and development of a subject-specific virtual simulator

“…The ReWalk (ReWalk Robotics, Yoknaem, Israel) was the first lower extremity device to receive Food and Drug Administration (FDA) approval in 2014, followed by the Ekso (Ekso Bionics, Richmond, CA) and Indego (Parker Hannifin, Cleveland, OH) in 2016, and the Keeogo (B-temia Inc., Quebec City, Canada) in 2020. Prior studies have demonstrated the ability of individuals with neurological disorders who have partial impairments to those who are completely non-ambulatory to walk independently in robotic exoskeletons [8][9][10][11][12][13][14][15][16][17][18][19]. Exoskeletal-assisted locomotion (EAL) has been shown to improve functional and motor recovery [8], mobility [9,10,15,16], chronic pain [20], muscle spasticity [20][21][22], cardiovascular health [13,23], bowel function [24], bladder function [21,22], and quality of life [21].…”

Comparison of the dynamics of exoskeletal-assisted and unassisted locomotion in an FDA-approved lower extremity device: Controlled experiments and development of a subject-specific virtual simulator

“…The ReWalk (ReWalk Robotics, Yoknaem, Israel) was the first lower extremity device to receive Food and Drug Administration (FDA) approval in 2014, followed by the Ekso (Ekso Bionics, Richmond, CA) and Indego (Parker Hannifin, Cleveland, OH) in 2016, and the Keeogo (B-temia Inc., Quebec City, Canada) in 2020. Prior studies have demonstrated the ability of individuals with neurological disorders who have partial impairments to those who are completely non-ambulatory to walk independently in robotic exoskeletons [8][9][10][11][12][13][14][15][16][17][18][19]. Exoskeletal-assisted locomotion (EAL) has been shown to improve functional and motor recovery [8], mobility [9,10,15,16], chronic pain [20], muscle spasticity [20][21][22], cardiovascular health [13,23], bowel function [24], bladder function [21,22], and quality of life [21].…”

“…Prior studies have demonstrated the ability of individuals with neurological disorders who have partial impairments to those who are completely non-ambulatory to walk independently in robotic exoskeletons [8][9][10][11][12][13][14][15][16][17][18][19]. Exoskeletal-assisted locomotion (EAL) has been shown to improve functional and motor recovery [8], mobility [9,10,15,16], chronic pain [20], muscle spasticity [20][21][22], cardiovascular health [13,23], bowel function [24], bladder function [21,22], and quality of life [21]. These studies highlight the growing demand for wearable robotic exoskeletons to improve physical and psychological health, employment opportunities, and community integration in persons with neurological disorders.…”

Dynamic analysis and design of a multipurpose lower limb exoskeleton for rehabilitation

“…It has been proved that exoskeleton has a good effect on the rehabilitation of lower limbs for stroke patients. 2 In recent years, many major breakthroughs on exoskeleton have been obtained. [3][4][5][6][7] An exoskeleton driven by wire rope is proposed in 2019 8 which is used to assist people with hemiplegic.…”

“…It has been proved that exoskeleton has a good effect on the rehabilitation of lower limbs for stroke patients. 2 In recent years, many major breakthroughs on exoskeleton have been obtained. 3 –7…”