Training for Walking Efficiency With a Wearable Hip-Assist Robot in Patients With Stroke

Abstract

Background and Purpose— The purpose of this study was to investigate the effects of gait training with a newly developed wearable hip-assist robot on locomotor function and efficiency in patients with chronic stroke. Methods— Twenty-eight patients with stroke with hemiparesis were initially enrolled, and 26 patients completed the randomized controlled trial (14 in the experimental and 12 in the control groups). The experimental group participated in a gait training program over a total of 10 sessions, including 5 treadmill sessions and 5 over-ground gait training sessions while wearing a hip-assist robot, the Gait Enhancing and Motivating System (GEMS, Samsung Advanced Institute of Technology, Suwon, Republic of Korea). The control group received gait training without Gait Enhancing and Motivating System. Primary outcome measured locomotor function and cardiopulmonary metabolic energy efficiency. Also, secondary outcome measured motor function and balance parameter. Results— Compared with the control group, the experimental group had significantly greater improvement in spatiotemporal gait parameters and muscle efforts after the training intervention ( P <0.05). The net cardiopulmonary metabolic energy cost (mL·kg −1 ·min − 1 ) was also reduced by 14.71% in the experimental group after the intervention ( P <0.01). Significant group×time interactions were observed for all parameters ( P <0.05). Cardiopulmonary metabolic efficiency was strongly correlated with gait symmetry ratio in the experimental group ( P <0.01). Conclusions— Gait training with Gait Enhancing and Motivating System was effective for improving locomotor function and cardiopulmonary metabolic energy efficiency during walking in patients with stroke. These findings suggest that robotic locomotor training can be adopted for rehabilitation of patients with stroke with gait disorders. Clinical Trial Registration— URL: https://clinicaltrials.gov . Unique identifier: NCT02843828.

Wearable Hip-assist Robot Modulates Cortical Activation during Gait in Stroke Patients: A Functional Near-Infrared Spectroscopy Study

“…Increased activity in SMC and SMA in the late phase during walking without the GEMS-H may indicate a compensatory activation in stroke patients due to impaired brain function and loss of automatism. Our previous study [10] demonstrated that the GEMS-H enhanced symmetricity of gait in stroke patients. Less activation in the SMC and SMA in the late phase during gait with GEMS-H might be a re ection of more symmetric and coordinated gait patterns by assisting rhythmic hip exion and extension movements in gait with the GEMS-H.…”

“…The GEMS-H has a lightweight (2.8 kg), comfortable and slim design that can be adjusted to t the user's body (Figure 1). For more information regarding the strategy of assistive algorithms used for the GEMS-H, please see our previous paper [10].…”

“…The Gait Enhancing and Motivating System-Hip (GEMS-H), developed by Samsung Electronics Co., Ltd. (Suwon, Republic of Korea), is a hip-type robotic exoskeleton. Our previous studies showed that GEMS-H improved gait function, muscle e ciency, and cardiopulmonary metabolic e ciency [7][8][9][10]. However, it is not yet known how GEMS-H assisted gait training modulates cortical activity of stroke patients.…”

Wearable Hip-assist Robot Modulates Cortical Activation during Gait in Stroke Patients: A Functional Near-Infrared Spectroscopy Study

“…The GEMS-H has a lightweight (2.8 kg), comfortable and slim design that can be adjusted to fit the user's body. For more information regarding the strategy of assistive algorithms used for the GEMS-H, please see our previous paper [10].…”

“…The Gait Enhancing and Motivating System-Hip (GEMS-H), developed by Samsung Electronics Co., Ltd. (Suwon, Republic of Korea), is a hip-type robotic exoskeleton. Our previous studies showed that GEMS-H improved gait function, muscle efficiency, and cardiopulmonary metabolic efficiency [7][8][9][10]. However, it is not yet known how GEMS-H assisted gait training modulates cortical activity of stroke patients.…”