Ankle-targeted exosuit resistance increases paretic propulsion in people post-stroke.
Ankle-targeted exosuit resistance increases paretic propulsion in people post-stroke.
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DOI：
10.1186/s12984-023-01204-w
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发表时间：
2023-06-30
影响因子：
5.1
通讯作者：
Walsh, Conor J.
中科院分区：
文献类型：
--
作者：
Swaminathan, Krithika;Porciuncula, Franchino;Park, Sungwoo;Kannan, Harini;Erard, Julien;Wendel, Nicholas;Baker, Teresa;Ellis, Terry D.;Awad, Louis N.;Walsh, Conor J.
个性化、有针对性和高强度的训练是中风后患者成功步态康复的标志。具体而言，在步态的站立阶段增加使用受损的踝关节来增加推进力与更高的步行速度和对称性有关。传统的渐进式阻力训练是一种用于个性化和强化康复的方法，但往往无法在步行过程中针对瘫痪的踝关节跖屈。可穿戴辅助机器人已经成功地辅助踝关节特定机制来增加中风后患者的麻痹推进力，这表明它们有潜力提供有针对性的阻力来增加推进力，但这一应用在这一人群中仍然没有得到充分的研究。本研究旨在探讨使用柔软踝关节外装护具进行有针对性的站立相跖屈阻力训练对中风后人群推进力学的影响。我们在9名慢性中风患者中进行了这项研究，并测试了三种阻力大小对麻痹性推进峰值、踝关节扭矩和踝关节功率的影响，同时参与者以舒适的步行速度在跑步机上行走。对于每个力的大小，参与者步行1分钟，而机器护甲是不活动的，2分钟的主动阻力，1分钟的机器护甲不活动，在顺序。我们评估了步态生物力学的变化，在主动阻力和阻力后的部分相对于初始非活动部分。在所有测试的力大小下，主动阻力行走增加的轻瘫推进力超过0.8%体重的最小可检测变化，在最高力大小下平均增加1.29 ± 0.37%体重。这一改善对应于峰值生物踝关节扭矩变化0.13 ± 0.03 N m kg− 1和峰值生物踝关节功率变化0.26 ± 0.04 W kg− 1。消除阻力后，推进力变化持续30秒，最高阻力水平后体重改善1.49 ± 0.58%，未抵抗关节或肢体无代偿性受累。有针对性的运动服应用于麻痹踝跖屈肌的功能阻力可以引起中风后人群的潜在推进储备。在推进中观察到的后效突出了学习和恢复推进力学的潜力。因此，这种基于机器护甲的阻力方法可以为个性化和渐进式步态康复提供新的机会。在线版本包含补充材料，可通过10.1186/s12984-023-01204-w获得。
Individualized, targeted, and intense training is the hallmark of successful gait rehabilitation in people post-stroke. Specifically, increasing use of the impaired ankle to increase propulsion during the stance phase of gait has been linked to higher walking speeds and symmetry. Conventional progressive resistance training is one method used for individualized and intense rehabilitation, but often fails to target paretic ankle plantarflexion during walking. Wearable assistive robots have successfully assisted ankle-specific mechanisms to increase paretic propulsion in people post-stroke, suggesting their potential to provide targeted resistance to increase propulsion, but this application remains underexamined in this population. This work investigates the effects of targeted stance-phase plantarflexion resistance training with a soft ankle exosuit on propulsion mechanics in people post-stroke. We conducted this study in nine individuals with chronic stroke and tested the effects of three resistive force magnitudes on peak paretic propulsion, ankle torque, and ankle power while participants walked on a treadmill at their comfortable walking speeds. For each force magnitude, participants walked for 1 min while the exosuit was inactive, 2 min with active resistance, and 1 min with the exosuit inactive, in sequence. We evaluated changes in gait biomechanics during the active resistance and post-resistance sections relative to the initial inactive section. Walking with active resistance increased paretic propulsion by more than the minimal detectable change of 0.8 %body weight at all tested force magnitudes, with an average increase of 1.29 ± 0.37 %body weight at the highest force magnitude. This improvement corresponded to changes of 0.13 ± 0.03 N m kg− 1 in peak biological ankle torque and 0.26 ± 0.04 W kg− 1 in peak biological ankle power. Upon removal of resistance, propulsion changes persisted for 30 seconds with an improvement of 1.49 ± 0.58 %body weight after the highest resistance level and without compensatory involvement of the unresisted joints or limb. Targeted exosuit-applied functional resistance of paretic ankle plantarflexors can elicit the latent propulsion reserve in people post-stroke. After-effects observed in propulsion highlight the potential for learning and restoration of propulsion mechanics. Thus, this exosuit-based resistive approach may offer new opportunities for individualized and progressive gait rehabilitation. The online version contains supplementary material available at 10.1186/s12984-023-01204-w.
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影响因子：
4.2
作者：
Bowden, Mark G.;Balasubramanian, Chitralakshmi K.;Kautz, Steven A.
通讯作者：
Kautz, Steven A.
影响因子：
2.5
作者：
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影响因子：
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通讯作者：
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影响因子：
2.8
作者：
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通讯作者：
Walsh, Conor J.
影响因子：
1.4
作者：
Guadagnoli, MA;Lee, TD
通讯作者：
Lee, TD