Immediate Adaptations to Post-Stroke Walking Performance Using a Wearable Robotic Exoskeleton

Abstract Objective To examine the immediate effects of a hip-assistive wearable robotic exoskeleton on clinical walking performance, walking energetics, gait kinematics, and corticomotor excitability in individuals with stroke. Design Randomized cross-over trial. Setting Research laboratory of a rehabilitation hospital. Participants Twelve individuals (4F/8M, mean age 57.8±7.2) with chronic hemiparetic stroke. Interventions Honda’s Stride Management Assist (SMA) exoskeleton, which provides torque-based flexion and extension assistance at the hip joints during walking. Main Outcome Measures The primary outcome measure was change in self-selected walking speed with the device off vs. with the device on. Secondary outcome measures included changes in clinical endurance, energy expenditure, kinematics, and corticomotor excitability of lower limb muscles. Results In a single session using the device, participants exhibited adaptations over most outcome measures. Self-selected walking speed and peak treadmill speed increased, while oxygen consumption rate decreased during overground and treadmill endurance tests. More symmetric walking patterns were observed during treadmill walking. Changes in corticomotor excitability were highly variable among participants, with a non-significant increase in excitability for the paretic rectus femoris. Conclusions The SMA hip exoskeleton causes immediate positive adaptations in walking performance in individuals with stroke when the device is in use.