From post-stroke assistance to rehabilitation: Neuromuscular adaptations to walking with a soft robotic exosuit

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PROJECT SUMMARY Stroke affects approximately 800,000 people annually, resulting in hemiparesis and characteristically slow, asymmetric walking. Our team has developed and extensively studied a novel soft-robotic exosuit that improves paretic propulsion and walking speed by augmenting the function of the paretic limb during use. These findings demonstrate the value of the soft robotic exosuit as an assistive device, but its rehabilitative potential remains unclear. Recovery of walking speed is important for both clinicians and patients; however, improvements in walking speed may be achieved via different rehabilitation processes, ranging from propulsion recovery (e.g., propulsion symmetry) to compensation (e.g., a reliance on nonparetic propulsion). Ground reaction force analyses have been used to differentiate between propulsion recovery and compensation but lack specificity in identifying impairments in the neuromuscular control of the lower limb muscles during walking and improvements in control with rehabilitation. To determine the rehabilitative potential of REAL, we will combine measures of neuromuscular control with conventional measures of locomotor propulsion and speed to characterize its rehabilitation processes (i.e., recovery vs. compensation) and neuromuscular predictors. For this project, we will study the effects of repeated sessions of Robotic Exosuit Augmented Locomotion (REAL) gait training, a standardized gait retraining protocol developed by our laboratory to leverage the gait- restorative effects of soft robotic exosuits to retrain faster walking after stroke by way of improved paretic propulsion. More specifically, 22 chronic (>6 months) post-stroke participants will complete three sessions of REAL gait training. To characterize the rehabilitation potential of REAL (Aim 1) and predictors of a REAL therapeutic response (Aim 2), at each visit we will conduct multi-modal evaluations that combine standard biomechanical and clinical assessments (i.e., propulsion and speed) with distinct measures of neuromuscular control known to be sensitive to post-stroke gait impairments. A multi-modal evaluation approach that combines measures of neuromuscular control with standard clinical and biomechanical evaluations provides the best opportunity to understand the link between post-stroke walking impairment and recovery with REAL training. This research project complements my development plan by providing an opportunity to work with my mentoring team to apply and enhance my skills in measuring, analyzing, and understanding neuromuscular control post-stroke, ultimately preparing me to lead a translational research laboratory developing and evaluating rehabilitation devices to improve walking ability in people with neurological disorders.