Safety & efficacy of a robotic hip exoskeleton on outpatient stroke rehabilitation

 

But you didn't ask or answer the most important question! 

Does this get them recovered enough to not need the orthosis? 

Horrendous research, I'd have you all fired! Survivors don't want compensation, they want RECOVERY!

Safety & efficacy of a robotic hip exoskeleton on outpatient stroke rehabilitation

• Rebecca Macaluso,
• Matt Giffhorn,
• Sara Prokup,
• Brice Cleland,
• Jusuk Lee,
• Bokman Lim,
• Minhyung Lee,
• Hwang-Jae Lee,
• Sangeetha Madhavan &
• Arun Jayaraman 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 127 (2024) Cite this article

• Metrics details

Abstract

Objective

The objective of this study was to analyze the safety and efficacy of using a robotic hip exoskeleton designed by Samsung Electronics Co., Ltd., Korea, called the Gait Enhancing and Motivating System-Hip (GEMS-H), in assistance mode only with the poststroke population in an outpatient-rehabilitation setting.

Methods

Forty-one participants with an average age of 60 and average stroke latency of 6.5 years completed this prospective, single arm, interventional, longitudinal study during the COVID-19 pandemic. Significant modifications to the traditional outpatient clinical environment were made to adhere to organizational physical distancing policies as well as guidelines from the Centers for Disease Control. All participants received gait training with the GEMS-H in assistance mode for 18 training sessions over the course of 6–8 weeks. Performance-based and self-reported clinical outcomes were assessed at four time points: baseline, midpoint (after 9 training sessions), post (after 18 training sessions), and 1-month follow up. Daily step count was also collected throughout the duration of the study using an ankle-worn actigraphy device. Additionally, corticomotor excitability was measured at baseline and post for 4 bilateral lower limb muscles using transcranial magnetic stimulation.

Results

By the end of the training program, the primary outcome, walking speed, improved by 0.13 m/s (p < 0.001). Secondary outcomes of walking endurance, balance, and functional gait also improved as measured by the 6-Minute Walk Test (47 m, p < 0.001), Berg Balance Scale (2.93 points, p < 0.001), and Functional Gait Assessment (1.80 points, p < 0.001). Daily step count significantly improved with and average increase of 1,750 steps per day (p < 0.001). There was a 35% increase in detectable lower limb motor evoked potentials and a significant decrease in the active motor threshold in the medial gastrocnemius (-5.7, p < 0.05) after training with the device.

Conclusions

Gait training with the GEMS-H exoskeleton showed significant improvements in walking speed, walking endurance, and balance in persons with chronic stroke. Day-to-day activity also improved as evidenced by increased daily step count. Additionally, corticomotor excitability changes suggest that training with this device may help correct interhemispheric imbalance typically seen after stroke.

Trial Registration

This study is registered with ClinicalTrials.gov (NCT04285060).

Introduction

Stroke is the leading cause of adult-onset disability in the United States. Up to 80% of stroke survivors experience considerable gait impairments, such as reduced walking speeds, reduced endurance, and asymmetrical walking patterns, resulting in limited capacity for community ambulation [1]. These mobility deficits are the result of a combination of numerous neuromuscular changes post stroke, including: reduced corticospinal drive and control [2], muscle atrophy and weakness [3], impaired balance and postural control [4], and abnormal muscle synergies [5].

The goal of post-stroke rehabilitation is to facilitate return to an individual’s highest level of function for employment and social and community participation [6]. The return of mobility and walking is a crucial part of this return to everyday function [7]. There is strong evidence that individuals who have had a stroke continue to recover years after the original neurological insult [8, 9]. Thus, continuing therapy as part of outpatient care or in home/community settings provides the opportunity for individuals with chronic stroke to continue to recover walking function. One group of technologies that shows promise in seamless integration with the outpatient and community settings are unconstrained, light-weight, modular, robotic exoskeletons. The use of these modular exoskeletons may allow intense gait training to be combined with activities of daily living. Furthermore, these robots can also target specific chronic impairments without sacrificing the functional task practice. However, there are a limited number of studies that investigate the impact of this technology on walking performance in the chronic stroke population in the outpatient, home, and/or community settings [10, 11]. More clinical studies are warranted to help provide evidence to guide this new generation of light-weight, modular robots to become part of everyday rehabilitation strategies.

The primary objective of this study was to analyze the safety and efficacy, as measured by clinical outcomes, daily step count, and corticomotor excitability, of using the Samsung Gait Enhancing and Motivating System-Hip (GEMS-H) in assistance mode with the poststroke population as part of an outpatient-rehabilitation program. The primary hypothesis was that subjects would demonstrate improved clinical outcomes, as well as higher daily step counts and increased corticomotor excitability, after completing 18 training sessions.

Exoskeleton Could Help Stroke Victims Walk Again

 Video at link.

Has your doctor evaluated these earlier ones? NO? I guess you don't have a functioning stroke doctor! I expect my doctor to be competent and up-to-date on all stroke rehab!

• hip exoskeleton (5 posts to May 2020)

Exoskeleton Could Help Stroke Victims Walk Again

Researchers from the University of Massachusetts Amherst (UMass) announced a study that explored how a portable robotic hip exoskeleton could help with stroke rehabilitation. 

Stroke victims often struggle with walking as the distances between their steps can be uneven. However, according to the research team, the exoskeleton could train people to alter this walking asymmetry. 

The proof-of-concept study was inspired by split-belt treadmills. These machines feature a pair of belts that move at different speeds and have helped stroke patients correct uneven walking. Wouter Hoogkamer, an assistant professor at UMass and an author of the study, explained that a human’s nervous system eventually adapts to the treadmill’s different speeds, which leads to a more symmetrical walk when the belts move at the same rate.

However, the benefits of this method are limited to the treadmill and do not fully extend to walking overground. With this in mind, the researchers designed their exoskeleton to apply resistive and assistive forces to hip joints, mimicking training on a split-belt treadmill.

The researchers proved that their exoskeleton can modify walking asymmetry and now plan to test the device overground. The team also plans to measure neural changes related to exoskeleton use and test the new method on stroke victims. 

The development follows an announcement last September that the National Institutes of Health awarded a four-year, $1.14 million grant to a team of UMass researchers to create a way to track body movements. The research will target rehabilitation for stroke victims, with the possibility of additional applications that cover a range of disciplines. 

Robotic hip exoskeleton could be a promising avenue for stroke rehabilitation

 Has your doctor evaluated these earlier ones? NO? I guess you don't have a functioning stroke doctor! I expect my doctor to be competent and up-to-date on all stroke rehab!

• hip exoskeleton (5 posts to May 2020)

Robotic hip exoskeleton could be a promising avenue for stroke rehabilitation

-Reviewed

Mar 4 2024University of Massachusetts Amherst

More than 80% of stroke survivors experience walking difficulty, significantly impacting their daily lives, independence, and overall quality of life. Now, new research from the University of Massachusetts Amherst pushes forward the bounds of stroke recovery with a unique robotic hip exoskeleton, designed as a training tool to improve walking function. This invites the possibility of new therapies that are more accessible and easier to translate from practice to daily life compared to current rehabilitation methods. 

Following stroke, people often experience walking asymmetry, where one step is shorter than the other. The study, published in IEEE Transactions on Neural Systems and Rehabilitation Engineering, reveals that the robotic hip exoskeleton has the potential to effectively train individuals to modify their walking asymmetry, presenting a promising avenue for stroke rehabilitation. 

The approach employed by the robotic exoskeleton is inspired by split-belt treadmills, which are specialized machines with two side-by-side belts moving at different speeds. Prior research has shown that repeated training on a split-belt treadmill can reduce walking asymmetry in stroke patients. 

Wouter Hoogkamer, assistant professor of kinesiology and author on the paper, has spent the last decade studying split-belt treadmills. "Split-belt treadmill training is designed to exaggerate a stroke patient's walking asymmetry by running the belts under each foot at different speeds. Over time, the nervous system adapts, such that when the belts are set to the same speed, they walk more symmetrically." 

Unfortunately, there are limits to the benefits gained from treadmill-based training methods.

What is learned on a treadmill does not completely transfer to overground contexts. This is because walking on a treadmill is not exactly the same as walking overground."

Banu Abdikadirova, mechanical and industrial engineering doctoral candidate and lead study author 

"The ultimate goal of gait rehabilitation is not to improve walking on a treadmill – it is to improve locomotor function overground," says Meghan Huber, assistant professor of mechanical and industrial engineering and senior author on the paper. "With this in mind, our focus is to develop methods of gait rehabilitation that translate to functional improvements in real-world contexts." 

With this motivation, the UMass team sought a novel way to exaggerate walking asymmetry without a treadmill. 

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This proof-of-concept study showed that applying resistive forces about one hip joint and assistive forces about the other with their exoskeleton mimicked the effects of split-belt treadmill training in neurologically intact individuals. 

Now that the research team has proven that the exoskeleton can alter gait asymmetry, they are eager to move their research into overground contexts that are more akin to the real world. 

"Because our exoskeleton is portable, it can be used during overground walking," says Mark Price, a postdoctoral researcher in mechanical and industrial engineering and kinesiology and author on the paper. "We can build upon the successes of split-belt treadmill training with this device to enhance the accessibility of gait training and enhance the transfer of training benefits into everyday walking contexts." 

The researchers also plan to expand their work by measuring the neural changes caused by walking with the exoskeleton and testing this new method on stroke survivors. 

"A portable exoskeleton offers numerous clinical benefits," says Abdikadirova. "Such a device can be seamlessly integrated into the daily lives of chronic stroke survivors, offering an accessible way to increase training time, which is critical for improving walking. It can also be used during early intervention in hospitals for improved functional outcomes." 

The robotic hip exoskeleton is just one of the innovative devices designed to study and enhance gait function developed by the collaborative team of undergraduate students, graduate students, and postdoctoral researchers from the Human Robot Systems Lab, led by Huber, and the Integrative Locomotion Lab, led by Hoogkamer. 

"It is inspiring to witness the innovations that emerge when individuals from diverse backgrounds unite under a shared mission," says Huber. "Only through this type of cross-disciplinary research can we engineer technologies that can have a meaningful impact on people's lives."

Source:

University of Massachusetts Amherst

Journal reference:

Abdikadirova, A., et al. (2024) Gait Adaptation to Asymmetric Hip Stiffness Applied by a Robotic Exoskeleton. IEEE Transactions on Neural Systems and Rehabilitation Engineering. doi.org/10.1109/TNSRE.2024.3354517.