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

项目概要 中风每年影响大约 800,000 人，导致偏瘫和典型的缓慢、 不对称行走。我们的团队开发并广泛研究了一种新型软机器人外装， 通过在使用过程中增强瘫痪肢体的功能来提高瘫痪推进力和行走速度。 这些发现证明了软体机器人外装作为辅助设备的价值，但其康复功能 潜力仍不清楚。 步行速度的恢复对于临床医生和患者都很重要；然而，改进 步行速度可以通过不同的康复过程来实现，包括推进力恢复（例如， 推进对称性）到补偿（例如，对非麻痹推进的依赖）。地面反作用力 分析已用于区分推进恢复和补偿，但缺乏特异性 识别步行和行走过程中下肢肌肉神经肌肉控制的损伤 通过康复改善控制。为了确定 REAL 的康复潜力，我们将 将神经肌肉控制措施与运动推进力和速度的常规措施相结合 描述其康复过程（即恢复与补偿）和神经肌肉预测因子。 对于这个项目，我们将研究重复使用增强型机器人外衣的效果 Locomotion (REAL) 步态训练，是我们实验室开发的标准化步态再训练方案，旨在 利用软机器人外装的步态恢复效果，通过以下方式重新训练中风后更快的行走 改善麻痹推进力。更具体地说，22 名长期（> 6 个月）中风后参与者将 完成三期真实步态训练。描述 REAL 的康复潜力（目标 1） 和真实治疗反应的预测因素（目标 2），每次就诊时我们将进行多模式 结合标准生物力学和临床评估（即推进力和速度）的评估 已知对中风后步态障碍敏感的神经肌肉控制的独特措施。一个 将神经肌肉控制措施与标准临床相结合的多模式评估方法 和生物力学评估提供了了解中风后疾病之间联系的最佳机会 通过真正的训练行走障碍和恢复。 该研究项目通过提供与我一起工作的机会来补充我的发展计划 指导团队应用和增强我在测量、分析和理解神经肌肉方面的技能 控制中风后，最终让我准备好领导一个转化研究实验室，开发和 评估康复设备以提高神经系统疾病患者的步行能力。

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.