Shaping neuroplasticity by using powered exoskeletons in patients with stroke: a randomized clinical trial

Useless, NO protocols are available from this. Damned lazy researchers.
https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-018-0377-8

• Rocco Salvatore CalabròEmail author,
• Antonino Naro,
• Margherita Russo,
• Placido Bramanti,
• Luigi Carioti,
• Tina Balletta,
• Antonio Buda,
• Alfredo Manuli,
• Serena Filoni and
• Alessia Bramanti

Journal of NeuroEngineering and Rehabilitation201815:35

https://doi.org/10.1186/s12984-018-0377-8

©  The Author(s). 2018

Received: 27 December 2017

Accepted: 17 April 2018

Published: 25 April 2018

Abstract

Background

The use of neurorobotic devices may improve gait recovery by entraining specific brain plasticity mechanisms, which may be a key issue for successful rehabilitation using such approach. We assessed whether the wearable exoskeleton, Ekso™, could get higher gait performance than conventional overground gait training (OGT) in patients with hemiparesis due to stroke in a chronic phase, and foster the recovery of specific brain plasticity mechanisms.

Methods

We enrolled forty patients in a prospective, pre-post, randomized clinical study. Twenty patients underwent Ekso™ gait training (EGT) (45-min/session, five times/week), in addition to overground gait therapy, whilst 20 patients practiced an OGT of the same duration. All individuals were evaluated about gait performance (10 m walking test), gait cycle, muscle activation pattern (by recording surface electromyography from lower limb muscles), frontoparietal effective connectivity (FPEC) by using EEG, cortico-spinal excitability (CSE), and sensory-motor integration (SMI) from both primary motor areas by using Transcranial Magnetic Stimulation paradigm before and after the gait training.

Results

A significant effect size was found in the EGT-induced improvement in the 10 m walking test (d = 0.9, p < 0.001), CSE in the affected side (d = 0.7, p = 0.001), SMI in the affected side (d = 0.5, p = 0.03), overall gait quality (d = 0.8, p = 0.001), hip and knee muscle activation (d = 0.8, p = 0.001), and FPEC (d = 0.8, p = 0.001). The strengthening of FPEC (r = 0.601, p lt; 0.001), the increase of SMI in the affected side (r = 0.554, p < 0.001), and the decrease of SMI in the unaffected side (r = − 0.540, p < 0.001) were the most important factors correlated with the clinical improvement.

Conclusions

Ekso™ gait training seems promising in gait rehabilitation for post-stroke patients, besides OGT. Our study proposes a putative neurophysiological basis supporting Ekso™ after-effects. This knowledge may be useful to plan highly patient-tailored gait rehabilitation protocols.

Trial registration

ClinicalTrials.gov, NCT03162263.

Motor modules during adaptation to walking in a powered ankle exoskeleton

Pretty much useless to us since healthy subjects were used. Once again followup research will be needed.
https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-017-0343-x

• Daniel A. JacobsEmail authorView ORCID ID profile,
• Jeffrey R. Koller,
• Katherine M. Steele and
• Daniel P. Ferris

Journal of NeuroEngineering and Rehabilitation201815:2

https://doi.org/10.1186/s12984-017-0343-x

©  The Author(s) 2018

Received: 16 May 2017

Accepted: 13 December 2017

Published: 3 January 2018

Abstract

Background

Modules of muscle recruitment can be extracted from electromyography (EMG) during motions, such as walking, running, and swimming, to identify key features of muscle coordination. These features may provide insight into gait adaptation as a result of powered assistance. The aim of this study was to investigate the changes (module size, module timing and weighting patterns) of surface EMG data during assisted and unassisted walking in an powered, myoelectric, ankle-foot orthosis (ankle exoskeleton).

Methods

Eight healthy subjects wore bilateral ankle exoskeletons and walked at 1.2 m/s on a treadmill. In three training sessions, subjects walked for 40 min in two conditions: unpowered (10 min) and powered (30 min). During each session, we extracted modules of muscle recruitment via nonnegative matrix factorization (NNMF) from the surface EMG signals of ten muscles in the lower limb. We evaluated reconstruction quality for each muscle individually using R² and normalized root mean squared error (NRMSE). We hypothesized that the number of modules needed to reconstruct muscle data would be the same between conditions and that there would be greater similarity in module timings than weightings.

Results

Across subjects, we found that six modules were sufficient to reconstruct the muscle data for both conditions, suggesting that the number of modules was preserved. The similarity of module timings and weightings between conditions was greater then random chance, indicating that muscle coordination was also preserved. Motor adaptation during walking in the exoskeleton was dominated by changes in the module timings rather than module weightings. The segment number and the session number were significant fixed effects in a linear mixed-effect model for the increase in R² with time.

Conclusions

Our results show that subjects walking in a exoskeleton preserved the number of modules and the coordination of muscles within the modules across conditions. Training (motor adaptation within the session and motor skill consolidation across sessions) led to improved consistency of the muscle patterns. Subjects adapted primarily by changing the timing of their muscle patterns rather than the weightings of muscles in the modules. The results of this study give new insight into strategies for muscle recruitment during adaptation to a powered ankle exoskeleton.

Powered robotic exoskeletons in post-stroke rehabilitation of gait: a scoping review

Your doctor and hospital shouldn't need a review article like this because they are already following and have evaluated all the ones already on the market. But I lie, there will be no stroke hospital in the world that has done such analysis.
How many of these does your doctor even know about?

New Exoskeleton Suit from UC Berkeley Helps Paraplegics Walk

 

The H2 robotic exoskeleton for gait rehabilitation after stroke: early findings from a clinical study

 

Keeogo™, a Powered Assistive Walking Device

 

Unplugged Powered Suit supports human movement

 

Soft walking Exoskeletons Tested by Army

  

Wearable modular device to facilitate walking rehabilitation

 I've written 73 posts on exosketons and 376 posts on walking. Your doctor should know the intersection of those sets and be able to defend which ones are chosen in their clinic.

 

UK Clinical Trials Testing Robotic Legs That Might Allow Patients to Walk Hands-Free

The latest one here:

Powered robotic exoskeletons in post-stroke rehabilitation of gait: a scoping review

• Dennis R. Louie and
• Janice J. EngEmail author

Journal of NeuroEngineering and Rehabilitation201613:53

DOI: 10.1186/s12984-016-0162-5

©  The Author(s). 2016

Received: 16 March 2016

Accepted: 3 June 2016

Published: 8 June 2016

Abstract

Powered robotic exoskeletons are a potential intervention for gait rehabilitation in stroke to enable repetitive walking practice to maximize neural recovery. As this is a relatively new technology for stroke, a scoping review can help guide current research and propose recommendations for advancing the research development. The aim of this scoping review was to map the current literature surrounding the use of robotic exoskeletons for gait rehabilitation in adults post-stroke. Five databases (Pubmed, OVID MEDLINE, CINAHL, Embase, Cochrane Central Register of Clinical Trials) were searched for articles from inception to October 2015. Reference lists of included articles were reviewed to identify additional studies. Articles were included if they utilized a robotic exoskeleton as a gait training intervention for adult stroke survivors and reported walking outcome measures. Of 441 records identified, 11 studies, all published within the last five years, involving 216 participants met the inclusion criteria. The study designs ranged from pre-post clinical studies (n = 7) to controlled trials (n  = 4); five of the studies utilized a robotic exoskeleton device unilaterally, while six used a bilateral design. Participants ranged from sub-acute (<7 weeks) to chronic (>6 months) stroke. Training periods ranged from single-session to 8-week interventions. Main walking outcome measures were gait speed, Timed Up and Go, 6-min Walk Test, and the Functional Ambulation Category. Meaningful improvement with exoskeleton-based gait training was more apparent in sub-acute stroke compared to chronic stroke. Two of the four controlled trials showed no greater improvement in any walking outcomes compared to a control group in chronic stroke. In conclusion, clinical trials demonstrate that powered robotic exoskeletons can be used safely as a gait training intervention for stroke. Preliminary findings suggest that exoskeletal gait training is equivalent to traditional therapy for chronic stroke patients, while sub-acute patients may experience added benefit from exoskeletal gait training. Efforts should be invested in designing rigorous, appropriately powered controlled trials before powered exoskeletons can be translated into a clinical tool for gait rehabilitation post-stroke.