Wearable Ankle Robots in Post-stroke Rehabilitation of Gait: A Systematic Review

Shi, Bin; Chen, Xiaofeng; Zan, Yue; Yin, Shuai; Weng, Qipeng; Zhang, Xue; Wang, Jing; Wen, Weina

doi:10.3389/fnbot.2019.00063

Cited by 58 publications

(42 citation statements)

References 106 publications

(201 reference statements)

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“…Our ndings showed chronic stroke subjects had signi cant improvement in gait independency and enhanced gait con dence at heel strike after 20-session gait training wearing this robot for stair and over-ground gait training [18]. Similar ankle rehabilitation robotics have also shown their potential to be an alternative gait rehabilitation for stroke [19][20][21][22][23], examples are Anklebot [8] and ReStore (ReWalk Robotics, USA) [24]. Nevertheless, few existing researches investigated into the potential of ankle robotics in facilitating stair training.…”

Section: Introductionmentioning

confidence: 69%

“…Recent development of ReStore exo-suit (ReWalk Robotics, USA) featured a soft garment-like design driven by Bowden cable, could offer potential solution to reduce device weight and bulkiness of robot at ankle joint [24]. However, few studies investigated how impaired subjects would response to these rehabilitation robots immediately during walking on stairs, and only few studies reported the therapeutic effects of these devices in multi-center RCT setting [21][22][23]. Our results demonstrated feasibility of intensive stair training using ankle robotics for stroke rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, few existing researches investigated into the potential of ankle robotics in facilitating stair training. Evidencebased RCT studies are needed to evaluate the therapeutic effects of wearing these devices for gait improvement [4,22,23]. Our exoskeleton ankle robot could provide active assistive torque to facilitate paretic ankle dorsi exion for stair clearance and assist plantar exion for loading response (powerassisted mode); alternatively, the motor could also lock the ankle joint at neutral position for foot clearance during swing phase, and release the lock for free ankle movement in stance phase (swingcontrolled mode).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of Wearable Ankle Robotics for Stair and Over-ground Training on Sub-acute Stroke: A Randomized Controlled Trial

Yeung

Lau

Lai

et al. 2020

Preprint

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Background: Wearable ankle robotics could potentially facilitate intensive repetitive task-specific gait training on stair environment for stroke rehabilitation. A lightweight (0.5kg) and portable exoskeleton ankle robot was designed to facilitate over-ground and stair training either providing active assistance to move paretic ankle augmenting residual motor function (power-assisted ankle robot, PAAR), or passively support dropped foot by lock/release ankle joint for foot clearance in swing phase (swing-controlled ankle robot, SCAR).In this two-center randomized controlled trial, we hypothesized that robot-assisted gait training using either PAAR or SCAR in stair environment are more effective to enhance gait recovery and promote independency in early stroke, than conventional training.Methods: Sub-acute stroke survivors (within two months after stroke onset) received hospital usual care plus 20-session robot-assisted training (at least twice weekly, 30-minute per session) on over-ground and stair environments, wearing PAAR (n=14) or SCAR (n=16), as compared to control group receiving conventional training only (CT, n=17). PAAR provided 2.5Nm-4.2Nm torque which was calibratedin each training session to adjust for any progression of functional changes throughout the intervention. Clinical assessments were performed before and after the 20-session intervention, including functional ambulatory categoryas primary outcome measure, along with Berg balance scale and timed 10-metre walk test.Results: After the 20-session interventions, all three groups showed statistically significant and clinically meaningful within-group functional improvement in all outcome measures (p<0.005). Between-group comparison showed SCAR had greater improvement in functional ambulatory category(mean difference +0.6, medium effect size 0.610) with more than 56% independent walkers after training, as compared to only 29% for CT. Analysis of covariance results showed PAAR had greater improvement in walking speed than SCAR (mean difference +0.15m/s, large effect size 0.752), which was in line with the higher cadence and speed when wearing the robot during the 20-session robot-assisted training over-ground and on stairs.Conclusions: Robot-assisted stair training would lead to greater functional improvement in gait independency and walking speed than conventional training in usual care. The active powered ankle assistance might facilitate users to walk more and faster with their paretic leg during stair and over-ground walking.Trial Registration:ClinicalTrials.gov NCT03184259. Registered on 12 June 2017.

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Section: Introductionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of Wearable Ankle Robotics for Stair and Over-ground Training on Sub-acute Stroke: A Randomized Controlled Trial

Yeung

Lau

Lai

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…In recent years, robotic ankle-foot orthosis (RAFO) has been developed to assist ankle movements during gait rehabilitation, including dorsi exion in the swing phase [8]. One example is the soft exosuit, which provides ankle assistance in walking with a cable-driven mechanism [9].…”

Section: Introductionmentioning

confidence: 99%

“…To assist early gait rehabilitation, a light-weighted device that provides high torque for passive ankle dorsi exion movement is required. Due to the weights of electric motors and hardware prototypes, the abovementioned related RAFOs were either above 1 kg for waist or lower-limb parts [8][9][10][11]. Extra load, especially on a stroke hemiplegic patient's paralyzed lower limb, might affect their gait pattern during rehabilitation [12].…”

Section: Introductionmentioning

confidence: 99%

Development of a High-dorsiflexion Assistive System for Subacute Stroke Patients: Intervention Experiment on Healthy Subjects With Dorsiflexion Movement Restriction

Hong

Cheng

Ohashi

et al. 2020

Preprint

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A number of robotic ankle-foot orthoses with practical application for stroke patients have been developed in recent years. However, targets are mainly patients in the chronic phase. In this paper, we present development of a high-dorsiflexion assistive system aiming to support passive dorsiflexion movement in the swing phase for subacute patients in the early phase of gait rehabilitation. By applying a McKibben-type artificial muscle, output of high dorsiflexion torque with a low-weighted prototype was realized. This is expected to minimize loading burden on subacute stroke patients. An experiment on six healthy participants was conducted, and different extents of compensatory movements were applied when their dorsiflexion movements were restricted. The results of processed surface electromyography data significantly decreased when dorsiflexion movement was assisted with our system. Meanwhile, the results of spatial parameters also showed significant improvement of compensatory movement inclination with sufficient assistance. These indicate the potential of realizing assistance of passive ankle movements for patients with very low dorsiflexion abilities, which shows the potential for our future planning of practical pilot studies.

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Soft Wearable Rehabilitation Robots with Artificial Muscles based on Smart Materials: A Review

Gonzalez-Vazquez

Garcia

Kilby

et al. 2023

Advanced Intelligent Systems

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During the past decade, wearable devices such as exoskeletons have gained popularity [1] in different fields, such as the military, [2] industry, [3] and rehabilitation. [4] In the latter, rehabilitation exoskeletons are used to restore or maintain the functionality and mobility of people with physical disabilities. [5] These are receiving greater attention as the number of people with disabilities affecting physical performance will increase in the following decades as the population ages and individuals live longer with noncommunicable conditions (e.g., cerebral palsy, stroke, acquired brain injuries, and muscular dystrophies). [6][7][8] Most current exoskeletons use electric motors and rigid links to realize actuation and often have heavy and bulky designs that are difficult to safely wear outside clinical facilities. [9] Hence, researchers in this area are working to develop soft wearable rehabilitation robots (SWRRs), featuring soft actuators that are agreeable to the users as they have increased compliance, adaptability, comfort, safety, and less weight. [10][11][12] Currently, SWRR relies mainly upon two soft robotic technologies, cable-driven and fluidic actuators. For a cable-driven system, the wire is embedded into clothes or tubes and attached to an anchor point. The other side of the wire is connected to an electric motor to generate the desired movement and force by pulling the cable [13,14] (Figure 1a). Alternatively, in fluidic actuation (Hydraulic/Pneumatic), a pressurized fluid is inserted into a chamber made of highly deformable material to generate a displacement [11,15,16] (Figure 1b). However, these require large and heavy external pumps and valves to compress the fluid. [17] Unfortunately, cable-driven and fluidic actuation need cumbersome components (e.g., electric motors, pumps, and valves) to work, compromising the portability of the systems when used in daily life. [18] Therefore, in recent years, research has been committed to developing new actuator technologies that can overcome the drawbacks of the current actuators used in SWRR. These technologies include artificial muscles based on smart materials (AMSMs). AMSMs are soft actuators composed primarily of material with a low Young's modulus similar to that of soft biological materials (10 ^4-10 ^9 Pa) that can sense and directly convert physical stimulus (e.g., light, electrical, heat) into physical displacement. [19][20][21][22][23] Some examples of smart materials are shape-memory alloy (SMA), [24] dielectric elastomer actuators (DEAs), [25] ionic polymer-metal composites (IPMC), [26] shapememory polymers (SMPs), [27] and twisted and coiled polymer actuators (TCPs). [28] Due to their inherent properties and manufacturing processes, AMSM can be fabricated in various shapes, allowing them to be embedded into flexible and deformable wearable devices. [29][30][31][32] Furthermore, it is possible to fabricate robots with a relatively small weight and volume as they present a power density comparable to the skeletal muscles. [33] Neverthe...

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Wearable Ankle Robots in Post-stroke Rehabilitation of Gait: A Systematic Review

Cited by 58 publications

References 106 publications

Effects of Wearable Ankle Robotics for Stair and Over-ground Training on Sub-acute Stroke: A Randomized Controlled Trial

Effects of Wearable Ankle Robotics for Stair and Over-ground Training on Sub-acute Stroke: A Randomized Controlled Trial

Development of a High-dorsiflexion Assistive System for Subacute Stroke Patients: Intervention Experiment on Healthy Subjects With Dorsiflexion Movement Restriction

Soft Wearable Rehabilitation Robots with Artificial Muscles based on Smart Materials: A Review

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