软机器人外骨骼对脑卒中后患者地面行走质量和速度的影响取决于其行走能力。
Effects of a soft robotic exosuit on the quality and speed of overground walking depends on walking ability after stroke.
机构信息
Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, MA, USA.
Wyss Institute for Biologically Inspired Engineering, Boston, MA, USA.
出版信息
J Neuroeng Rehabil. 2023 Sep 1;20(1):113. doi: 10.1186/s12984-023-01231-7.
BACKGROUND
Soft robotic exosuits can provide partial dorsiflexor and plantarflexor support in parallel with paretic muscles to improve poststroke walking capacity. Previous results indicate that baseline walking ability may impact a user's ability to leverage the exosuit assistance, while the effects on continuous walking, walking stability, and muscle slacking have not been evaluated. Here we evaluated the effects of a portable ankle exosuit during continuous comfortable overground walking in 19 individuals with chronic hemiparesis. We also compared two speed-based subgroups (threshold: 0.93 m/s) to address poststroke heterogeneity.
METHODS
We refined a previously developed portable lightweight soft exosuit to support continuous overground walking. We compared five minutes of continuous walking in a laboratory with the exosuit to walking without the exosuit in terms of ground clearance, foot landing and propulsion, as well as the energy cost of transport, walking stability and plantarflexor muscle slacking.
RESULTS
Exosuit assistance was associated with improvements in the targeted gait impairments: 22% increase in ground clearance during swing, 5° increase in foot-to-floor angle at initial contact, and 22% increase in the center-of-mass propulsion during push-off. The improvements in propulsion and foot landing contributed to a 6.7% (0.04 m/s) increase in walking speed (R = 0.82). This enhancement in gait function was achieved without deterioration in muscle effort, stability or cost of transport. Subgroup analyses revealed that all individuals profited from ground clearance support, but slower individuals leveraged plantarflexor assistance to improve propulsion by 35% to walk 13% faster, while faster individuals did not change either.
CONCLUSIONS
The immediate restorative benefits of the exosuit presented here underline its promise for rehabilitative gait training in poststroke individuals.
背景
软机器人外骨骼可以与瘫痪肌肉并行提供部分背屈肌和跖屈肌的支撑，从而提高中风后的步行能力。先前的结果表明，基线步行能力可能会影响用户利用外骨骼辅助的能力，而对连续行走、行走稳定性和肌肉松弛的影响尚未得到评估。在这里，我们评估了便携式踝关节外骨骼在 19 名慢性偏瘫患者连续舒适的地面行走中的作用。我们还比较了两个基于速度的亚组（阈值：0.93 m/s），以解决中风后的异质性问题。
方法
我们改进了以前开发的便携式轻量级软外骨骼，以支持连续的地面行走。我们比较了在实验室中使用外骨骼连续行走五分钟与不使用外骨骼行走的情况，从地面间隙、脚着地和推进、以及运输的能量成本、行走稳定性和跖屈肌松弛等方面进行了比较。
结果
外骨骼辅助与目标步态障碍的改善有关：摆动时的地面间隙增加了 22%，初始接触时的脚到地面的角度增加了 5°，推进时的质心推进力增加了 22%。推进力和脚着地的改善导致步行速度提高了 6.7%（0.04 m/s）（R = 0.82）。在不恶化肌肉用力、稳定性或运输成本的情况下实现了这种步态功能的增强。亚组分析表明，所有个体都受益于地面间隙支撑，但较慢的个体利用跖屈肌辅助将推进力提高了 35%，从而使步行速度提高了 13%，而较快的个体则没有改变。
结论
这里提出的外骨骼的即时恢复效益强调了它在中风后个体康复性步态训练中的前景。
Zotero 插件