This post is part of our Stroke Series during the month of August in which we share recent studies and perspectives on the use of motion analysis technology for the rehabilitation of stroke patients.
Powered exoskeleton technology paired with the FREEEMG has allowed non-ambulatory stroke patients to walk over the ground. In a study last year from the Villa Beretta Rehabilitation Center in Italy, researchers focused on hemiparesis and difficulty with coordination for upper and lower joints in stroke patients. Hemiparesis is weakness in one side of the body which affects walking ability and often the daily function and ability of a patient. The study included 23 stroke patients some of which recently sustained a stroke, others having suffered a stroke over 180 days previous (sub-acute and chronic patients, respectively).
A rehabilitation method using a powered exoskeleton was administrated and analyzed for effectiveness. The Ekso™ is a wearable bionic suit which is intended to overcome the limitations of treadmill rehabilitation while the system works to simulate over-ground walking in daily life. It is designed for both non-ambulatory and ambulatory patients who have experienced stroke in addition to patients suffering from spinal cord injury and traumatic brain injury. Ekso™ provides customizable and progressive support for gait which promotes proper kinematic pattern. The system has varying levels of support for patients who are non-weight bearing to full weight bearing patients needing to improve their gait patterns.
In this study, the system was used to provide full support for patients. Patients were first evaluated with surface electromyography to determine kinematic parameters for individualized treatment based on muscle activation and recruitment. The patients were assessed before the intervention, half way through the 12-session regimen, and after the completion of the regimen. The evaluation was implemented focusing on body function, disability, muscle spasticity, strength, trunk control, motor skills, aerobic capacity, and walking ability.
The results showed that sub-acute patients demonstrated significant improvement in strength at the hip, knee and ankle joints. Furthermore, this group demonstrated improvements in trunk control and motor skills in addition to improvements in the walking tests and walking velocities. In the group of chronic patients, improvements were observed in strength of the hip joints as well as the motor skills and walking velocity. These results indicate that for non-ambulatory and ambulatory stroke patients, it is possible to use surface electromyography for the personalization of rehabilitation through a powered exoskeleton for the improvement in gait and walking ability.
Another research group from the IRCCS Centro Neurolesi “Bonino-Pulejo” in Italy administered a study to compare this intervention for stroke patients to conventional over ground gait training. This larger scale study included 40 chronic stroke patients; half received conventional over ground gait training and the other half experienced gait training with the Ekso™ system. Gait performance, gait temporal parameters and muscle activity were assessed with the G-WALK and FREEEMG from BTS Bioengineering. This system allowed for researchers to evaluate the muscle recruitment and the gait phases of each patient wirelessly. Additionally, frontoparietal effective connectivity through EEG and other signals from the central nervous system.
The outcome of the rehabilitation was evaluated with a walking test, Rivermead Mobility Index and timed-up-and-go-test. It was found that the Ekso™ trained group showed improvement in overall gait quality, sensory-motor integration and activation of the hip and knee muscles. The conventional gait training group demonstrated improvement as well. However, the Ekso™ treatment group demonstrated greater changes and all patients achieved minimal clinical importance difference.
The results of these two studies demonstrate the potential for alternative gait training through powered exoskeletons which can be individualized using the FREEEMG system. Rehabilitation which utilizes powered exoskeletons for progressive therapy of stroke patients has proven to help mobility and thus promote significant improvements in many patient’s lives.
For more information on the Villa Beretta Rehabilitation Center, please visit their BTS Motion Society profile.
This post was based on the following two articles, referenced:
Calabrò, R. S., Naro, A., Russo, M., Bramanti, P., Carioti, L., Balletta, T., & … Bramanti, A. (2018). Shaping neuroplasticity by using powered exoskeletons in patients with stroke: a randomized clinical trial. Journal Of Neuroengineering & Rehabilitation (JNER), 15(1), N.PAG.
Molteni F, Gasperini G, Gaffuri M, Colombo M, Giovanzana C, Lorenzon C, et al. Wearable robotic exoskeleton for overground gait training in sub-acute and chronic hemiparetic stroke patients: preliminary results. Eur J Phys Rehabil Med 2017;53:676-84. DOI: 10.23736/S1973-9087.17.04591-9