Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:

Monday, April 10, 2017

A biologically-inspired multi-joint soft exosuit that can reduce the energy cost of loaded walking

What other soft exosuits is your doctor evaluating?  Walking for stroke survivors is incredibly tiring, help like this would be useful.
  • Fausto A. Panizzolo,
  • Ignacio Galiana,
  • Alan T. Asbeck,
  • Christopher Siviy,
  • Kai Schmidt,
  • Kenneth G. Holt and
  • Conor J. WalshEmail author
Journal of NeuroEngineering and Rehabilitation201613:43
DOI: 10.1186/s12984-016-0150-9
Received: 11 December 2015
Accepted: 17 April 2016
Published: 12 May 2016



Carrying load alters normal walking, imposes additional stress to the musculoskeletal system, and results in an increase in energy consumption and a consequent earlier onset of fatigue. This phenomenon is largely due to increased work requirements in lower extremity joints, in turn requiring higher muscle activation. The aim of this work was to assess the biomechanical and physiological effects of a multi-joint soft exosuit that applies assistive torques to the biological hip and ankle joints during loaded walking.


The exosuit was evaluated under three conditions: powered (EXO_ON), unpowered (EXO_OFF) and unpowered removing the equivalent mass of the device (EXO_OFF_EMR). Seven participants walked on an instrumented split-belt treadmill and carried a load equivalent to 30 % their body mass. We assessed their metabolic cost of walking, kinetics, kinematics, and lower limb muscle activation using a portable gas analysis system, motion capture system, and surface electromyography.


Our results showed that the exosuit could deliver controlled forces to a wearer. Net metabolic power in the EXO_ON condition (7.5 ± 0.6 W kg−1) was 7.3 ± 5.0 % and 14.2 ± 6.1 % lower than in the EXO_OFF_EMR condition (7.9 ± 0.8 W kg−1; p = 0.027) and in the EXO_OFF condition (8.5 ± 0.9 W kg−1; p  = 0.005), respectively. The exosuit also reduced the total joint positive biological work (sum of hip, knee and ankle) when comparing the EXO_ON condition (1.06 ± 0.16 J kg−1) with respect to the EXO_OFF condition (1.28 ± 0.26 J kg−1; p = 0.020) and to the EXO_OFF_EMR condition (1.22 ± 0.21 J kg−1; p = 0.007).


The results of the present work demonstrate for the first time that a soft wearable robot can improve walking economy. These findings pave the way for future assistive devices that may enhance or restore gait in other applications.


Soft exosuit Metabolic power Loaded walking Lower limb exoskeleton


Carrying heavy loads alters the biomechanics of walking, leading to an increased metabolic burden. This negative consequence of load carriage has been reported in soldiers, first responders, and recreational athletes who are required to execute physically demanding tasks during walking [1, 2]. Several studies investigating the locomotion of these populations reported increased lower limb joint work [3, 4], which requires higher muscle activation to both sustain the load and stabilize the joints themselves [5]. Higher muscle activity is associated with an increased metabolic cost [5], leading to an earlier onset of fatigue and an overall reduction of performance [1, 2] while walking. Additionally, prolonged load carriage can result in an increased risk of injury, the most common of which are foot blisters, stress fractures, back strains, metatarsalgia (foot pain), rucksack palsy (shoulder traction injury) and knee pain [6]. Solutions that effectively reduce the burden associated with load carriage during walking are thus warranted.
Lower-limb exoskeletons have been proposed as a means to augment or assist human locomotion for many applications [7]. Some exoskeletons have been designed to make load carriage easier by providing a parallel load path to the ground [8, 9, 10], while others apply torques directly to the wearer’s joints [7, 11, 12, 13, 14]. These systems are composed of rigid frames that allow the transmission of high forces and, although they represent remarkable achievements, their rigid nature presents a number of practical challenges toward the goal of assisting locomotion. The main challenges arise in aligning the exoskeleton and biological joints with each other [15] and reducing system mass and in particular distal mass as this can increase metabolic effort [16].
As an alternative to rigid exoskeletons, we have developed a multi-joint soft exosuit [17, 18, 19, 20, 21, 22] that uses textiles to provide a more compliant means to interface with the human body (Fig. 1a-b). Our exosuit is lightweight, with the majority of mass worn close to the wearer’s center of mass (Additional file 1: Table S1, which compares the weight with other autonomous exoskeletons), minimizing its impact on the energetics of gait [16]. The soft exosuit transmits moments around the biological joint axes through flexible cable-based transmissions and textiles that anchor to the body. Moreover, the exosuit minimally influences the wearer’s natural walking kinematics [17] and is active only when it detects walking. At all other times, the exosuit can be truly transparent when the cables are commanded to go slack. For this study, the exosuit assisted walking by generating assistive torques at the ankle and the hip, since they are the major power contributors to level-ground walking [23], via forces in two load paths (Fig. 1c), each actuated by a proximally-mounted actuation unit (Fig. 1d).
Fig. 1
Soft exosuit components. a and b Back and side view of a participant wearing the soft exosuit. The two actuator units were mounted on an empty backpack and the exosuit was worn from the waist down. c Schematic drawing highlighting the two load paths of the soft exosuit, namely a monoarticular path assisting hip extension (green) and a multiarticular path assisting both hip flexion and ankle plantarflexion (blue). Both load paths share the waist belt (grey). Numbers correspond to the actuation and suit components in (d) and (e). d Mechanics and electronic elements composing the actuator system. Motor (1), battery module (2) and multi-wrap pulley (3). e Textiles elements composing the soft exosuit. Waist belt (5), thigh brace (6) and calf strap (7)
Our research group has demonstrated reductions in metabolic cost during load carriage with a tethered soft exosuit [20, 24]. One study [20], conducted with a lab-based, multi-joint tethered actuation platform (composed of a power supply, linear actuators and motor controllers mounted on a stationary platform next to a treadmill), reported reductions in the metabolic cost of walking for hip extension assistance (4.6 %) and for multi-joint assistance (14.6 %). Multi-joint assistance consisted of hip extension, ankle plantarflexion and hip flexion. Though promising, the tethered actuation platform limits the soft exosuit’s applicability to everyday walking.
Therefore, the aim of this work was to perform the first study with an autonomous (fully portable) multi-joint (assisting hip extension, ankle plantarflexion and hip flexion as in [20]) soft exosuit to evaluate if it could represent an effective solution to reduce the metabolic cost during loaded walking. We evaluated the performance of our soft exosuit on a group of load carriers walking with a load equivalent to 30 % their body weight under three conditions: with the device powered (EXO_ON), with the device unpowered (EXO_OFF) and with the device unpowered with equivalent mass removed (EXO_OFF_EMR). The second condition (EXO_OFF) was evaluated to assess the penalty associated with carrying the additional mass represented by the device itself, an important consideration in the design of such systems. To obtain additional insights on the benefit of wearing the soft exosuit and to extend the knowledge on the biomechanical and physiological effects of this device, we evaluated metabolic cost, muscle activation and joint mechanics which have been shown to be relevant for regulating metabolic energy cost during gait [25].

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