Adaptive ankle exoskeleton gait training demonstrates acute neuromuscular and spatiotemporal benefits for individuals with cerebral palsy: A pilot study.
Adaptive ankle exoskeleton gait training demonstrates acute neuromuscular and spatiotemporal benefits for individuals with cerebral palsy: A pilot study.
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DOI：
10.1016/j.gaitpost.2020.11.005
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发表时间：
2022-06
期刊：
影响因子：
2.4
通讯作者：
Lerner ZF
中科院分区：
文献类型：
--
作者：
Fang Y;Orekhov G;Lerner ZF
神经肌肉疾病（如脑瘫）导致的步态异常限制了活动能力，并对生活质量产生负面影响。增加步行速度和步长是治疗CP步态障碍的基本临床目标。使用无系绳踝关节外骨骼提供自适应辅助的地面步态训练如何影响CP患者的运动相关时空结果和下肢肌肉活动？一组不同的CP患者（n = 6，年龄9 - 31，粗大运动功能分类系统I - III级）完成了4次地面训练（98 ± 17分钟的辅助行走），并接受了训练前和训练后评估。在这两次评估中，参与者在有和没有外骨骼的情况下在地面上行走，同时我们记录时空结果和肌肉活动。我们使用双尾配对t检验来比较训练前后以及辅助和无辅助条件之间的所有参数。训练后，在无辅助行走期间，行走速度增加0.24 m/s（p = 0.006），步长增加0.17 m（p = 0.013），而在外骨骼辅助行走期间，行走速度增加0.28 m/s（p = 0.023），步长增加0.15 m（p = 0.002）。外骨骼训练将比目鱼肌和股外侧肌肌肉激活的步幅重复性提高了51%（p ≤ 0.046），而在不同访视和条件下，综合静止期肌肉活动量相似。相对于基线，训练后使用外骨骼行走导致比目鱼肌活动模式与未受损个体的典型模式相似性增加39%（p < 0.001）。这项研究证明了急性时空和神经肌肉的好处，从地面训练与自适应踝关节外骨骼援助，并提供了一个更长的随机对照训练协议完成的理由。
Gait abnormalities from neuromuscular conditions like cerebral palsy (CP) limit mobility and negatively affect quality of life. Increasing walking speed and stride length are essential clinical goals in the treatment of gait disorders from CP. How does over-ground gait training with an untethered ankle exoskeleton providing adaptive assistance affect mobility-related spatiotemporal outcomes and lower-extremity muscle activity in people with CP? A diverse cohort of individuals with CP (n = 6, age 9 – 31, Gross Motor Function Classification System Level I – III) completed four over-ground training sessions (98 ± 17 minutes of assisted walking) and received pre- and post-training assessments. On both assessments, participants walked over-ground with and without the exoskeleton while we recorded spatiotemporal outcomes and muscle activity. We used two-tailed paired t-tests to compare all parameters pre- and post-training, and between assisted and unassisted conditions. Following training, walking speed increased 0.24 m/s (p = 0.006) and stride length increased 0.17 m (p = 0.013) during unassisted walking, while walking speed increased 0.28 m/s (p = 0.023) and stride length increased 0.15 m (p = 0.002) during exoskeleton-assisted walking. Exoskeleton training improved stride-to-stride repeatability of soleus and vastus lateralis muscle activation by up to 51% (p ≤ 0.046), while the amount of integrated stance-phase muscle activity was similar across visits and conditions. Relative to baseline, post-training walking with the exoskeleton resulted in a soleus activity pattern that was 39% more similar to the typical pattern from unimpaired individuals (p < 0.001). This study demonstrates acute spatiotemporal and neuromuscular benefits from over-ground training with adaptive ankle exoskeleton assistance, and provides rationale for completion of a longer randomized controlled training protocol.
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