Ankle Exoskeleton Assistance Can Improve Over-Ground Walking Economy in Individuals With Cerebral Palsy
Ankle Exoskeleton Assistance Can Improve Over-Ground Walking Economy in Individuals With Cerebral Palsy
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DOI：
10.1109/tnsre.2020.2965029
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发表时间：
2020-02-01
影响因子：
4.9
通讯作者：
Lerner, Zachary F.
中科院分区：
文献类型：
--
作者：
Orekhov, Greg;Fang, Ying;Lerner, Zachary F.
由于脑瘫等疾病而导致神经肌肉损伤的人，由于灵活性和独立性的下降，面临着生活质量下降的问题。腿部外骨骼具有帮助行动能力的潜力，但很少有研究调查它们在地面行走中的用途--这项运动可能有助于我们理解自由生活环境中的潜在好处。这项研究的目的是确定非系索踝关节外骨骼的适应性足底屈肌辅助的潜力，以改善地面行走的经济性和速度。六名脑瘫患者每天完成三次连续的地面训练，以适应和调整援助。在最后一次评估访问中，收集了基线、无动力、低训练调整和高辅助条件下的代谢成本、步行速度和比目鱼肌肌电图。与每个参与者的基线状态相比，我们观察到步行速度增加了3.9%/-1.9%(p=0.050)，比目鱼肌活动减少了22.0+/-4.5%(p=0.002)；运输的代谢成本没有变化(p=0.130)。高辅助使运输的代谢成本降低了8.5%+/-4.0%(p=0.042)，步行速度增加了6.3%/-2.6%(p=0.029)，比目鱼肌活动量减少了25.0%/-4.0%(p<；0.001)。外骨骼辅助步行经济性的改善与训练前的基线步行速度有关(R2=0.94p=0.001)；训练速度越慢和损伤越严重的参与者改善得最多。对于速度较快和损伤较少的参与者来说，能量成本和首选步行速度基本保持不变。这些发现表明，动力脚踝外骨骼有可能改善一些脑瘫患者与活动相关的结果。
Individuals with neuromuscular impairment from conditions like cerebral palsy face reduced quality of life due to diminishing mobility and independence. Lower-limb exoskeletons have potential to aid mobility, yet few studies have investigated their use during over-ground walking - an exercise that may contribute to our understanding of potential benefit in free-living settings. The goal of this study was to determine the potential for adaptive plantar-flexor assistance from an untethered ankle exoskeleton to improve over-ground walking economy and speed. Six individuals with cerebral palsy completed three consecutive daily over-ground training sessions to acclimate to, and tune, assistance. During a final assessment visit, metabolic cost, walking speed, and soleus electromyography were collected for baseline, unpowered, low, training-tuned, and high assistance conditions. Compared to each participant's baseline condition, we observed a 3.9 +/- 1.9% (p = 0.050) increase in walking speed and a 22.0 +/- 4.5% (p = 0.002) reduction in soleus activity with training-tuned assistance; metabolic cost of transport was unchanged (p = 0.130). High assistance resulted in an 8.5 +/- 4.0% (p = 0.042) reduction in metabolic cost of transport, a 6.3 +/- 2.6% (p = 0.029) increase in walking speed, and a 25.0 +/- 4.0% (p < 0.001) reduction in soleus activity. Improvement in exoskeleton-assisted walking economy was related to pre-training baseline walking speed (R-2 = 0.94, p = 0.001); the slower and more impaired participants improved the most. Energy cost and preferred walking speed remained generally unchanged for the faster and less impaired participants. These findings demonstrate that powered ankle exoskeletons have the potential to improve mobility-related outcomes for some people with cerebral palsy.