Effects of a wearable exoskeleton stride management assist system (SMA®) on spatiotemporal gait characteristics in individuals after stroke: a randomized controlled trial

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Effects of a wearable exoskeleton stride management assist system (SMA®) on spatiotemporal gait characteristics in individuals after stroke: a randomized controlled trial

 Carolyn Buesing
1
†
, Gabriela Fisch
1
†
, Megan O
’
Donnell
1
, Ida Shahidi
1
†
, Lauren Thomas
1
†
,Chaithanya K. Mummidisetty
2
†
, Kenton J. Williams
3
, Hideaki Takahashi
3
, William Zev Rymer
4
and Arun Jayaraman
2*

Abstract

Background:
 Robots offer an alternative, potentially advantageous method of providing repetitive, high-dosage,and high-intensity training to address the gait impairments caused by stroke. In this study, we compared the effects of the Stride Management Assist (SMA®) System, a new wearable robotic device developed by Honda R&D Corporation, Japan, with functional task specific training (FTST) on spatiotemporal gait parameters in stroke survivors.
Methods:
 A single blinded randomized control trial was performed to assess the effect of FTST and task specific walking training with the SMA® device on spatiotemporal gait parameters. Participants (n=50) were randomly assigned to FTST or SMA. Subjects in both groups received training 3 times per week for 6–8 weeks for a maximum of 18 training sessions. The GAITRite® system was used to collect data on subjects’ spatiotemporal gait characteristics before training (baseline), at mid-training, post-training, and at a 3-month follow-up.
Results:
 After training, significant improvements in gait parameters were observed in both training groups compared to baseline, including an increase in velocity and cadence, a decrease in swing time on the impaired side, a decrease in double support time, an increase in stride length on impaired and non-impaired sides, and an increase in step length on impaired and non-impaired sides. No significant differences were observed between training groups; except for SMA group, step length on the impaired side increased significantly during self-selected walking speed trials and spatial asymmetry decreased significantly during fast-velocity walking trials.
Conclusions:
 SMA and FTST interventions provided similar, significant improvements in spatiotemporal gait parameters; however, the SMA group showed additional improvements across more parameters at various time points. These results indicate that the SMA® device could be a useful therapeutic tool to improve spatiotemporal parameters and contribute to improved functional mobility in stroke survivors. Further research is needed to determine the feasibility of using this device in a home setting vs a clinic setting, and whether such home use provides continued benefits.
Trial registration:
 This study is registered under the title
 “
Development of walk assist device to improve community ambulation
”
 and can be located in clinicaltrials.gov with the study identifier: NCT01994395.