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

项目总结 中风每年影响大约80万人，导致偏瘫和典型的迟缓， 不对称行走。我们的团队开发并广泛研究了一种新型的软机器人外衣 通过在使用过程中增强瘫痪肢体的功能，改善瘫痪患者的推进能力和行走速度。 这些发现证明了软体机器人外衣作为辅助设备的价值，但它的康复作用 潜在的可能性仍不清楚。 恢复步行速度对临床医生和患者都很重要；然而，改善 步行速度可以通过不同的康复过程来实现，从推进恢复(例如， 推进对称性)到补偿(例如，依赖非偏瘫推进)。地面反力 分析已经被用来区分推进恢复和补偿，但缺乏特异性 在确定行走和行走过程中下肢肌肉的神经肌肉控制方面的损害 通过康复改善控制。为了确定雷亚尔的康复潜力，我们将 神经肌肉控制措施与运动推进和速度的常规措施相结合 以表征其康复过程(即，恢复与补偿)和神经肌肉预测因素。 在这个项目中，我们将研究机器人Exosuit增强重复训练的效果 运动(真实)步态训练，是我们实验室开发的标准化步态再训练方案，以 利用软机器人外衣的步态恢复效果，通过以下方式重新训练中风后更快的步行 改善了偏瘫的推进能力。更具体地说，22名中风后慢性(6个月)参与者将 完成三次真实的步态训练。描述REAL的康复潜力(目标1) 和预测真正的治疗反应(目标2)，在每次访问中，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 已知的神经肌肉控制的不同措施对中风后的步态损害很敏感。一个 神经肌肉控制措施与标准临床相结合的多模式评估方法 生物力学评估提供了最好的机会了解中风后 步行障碍和恢复与真正的训练。 此研究项目为我的发展计划提供了一个与我的 指导团队应用并提高我在测量、分析和理解神经肌肉方面的技能 控制中风后，最终使我做好准备领导一个翻译研究实验室开发和 评估康复设备以改善神经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.