Ankle resistance with a unilateral soft exosuit increases plantarflexor effort during pushoff in unimpaired individuals
Abstract Background

Ankle-targeting resistance training for improving plantarflexion function during walking increases rehabilitation intensity, an important factor for motor recovery after stroke. However, understanding of the effects of resisting plantarflexion during stance on joint kinetics and muscle activity—key outcomes in evaluating its potential value in rehabilitation—remains limited. This initial study uses a unilateral exosuit that resists plantarflexion during mid-late stance in unimpaired individuals to test the hypotheses that when plantarflexion is resisted, individuals would (1) increase plantarflexor ankle torque and muscle activity locally at the resisted ipsilateral ankle, but (2) at higher forces, exhibit a generalized response that also uses the unresisted joints and limb. Further, we expected (3) short-term retention into gait immediately after removal of resistance.

Methods

Ten healthy young adults walked at 1.25 m s−1for four 10-min discrete bouts, each comprising baseline, exposure to active exosuit-applied resistance, and post-active sections. In each bout, a different force magnitude was applied based on individual baseline ankle torques. The peak resistance torque applied by the exosuit was 0.13 ± 0.01, 0.19 ± 0.01, 0.26 ± 0.02, and 0.32 ± 0.02 N m kg−1, in the LOW, MED, HIGH, and MAX bouts, respectively.

Results

(1) Across all bouts, participants increased peak ipsilateral biological ankle torque by 0.13–0.25 N m kg−1(p < 0.001) during exosuit-applied resistance compared to corresponding baselines. Additionally, ipsilateral soleus more »

Conclusions

Targeted resistance of ankle plantarflexion during stance by an exosuit consistently increased local ipsilateral plantarflexor effort during active resistance, but force magnitude will be an important parameter to tune for minimizing the involvement of the unresisted joints and limb during training.

Authors:
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Publication Date:
NSF-PAR ID:
10361139
Journal Name:
Journal of NeuroEngineering and Rehabilitation
Volume:
18
Issue:
1
ISSN:
1743-0003
Publisher:
National Science Foundation
##### More Like this
1. Background:

Quadriceps weakness is common after anterior cruciate ligament (ACL) reconstruction and can alter gait mechanics. Functional resistance training (FRT) is a novel approach to retraining strength after injury, but it is unclear how it alters gait mechanics. Therefore, we tested how 3 different types of FRT devices: a knee brace resisting extension (unidirectional brace), a knee brace resisting extension and flexion (bidirectional brace), and an elastic band pulling backwards on the ankle (elastic band)–acutely alter gait kinetics in this population.

Hypothesis:

The type of FRT device will affect ground-reaction forces (GRFs) during and after the training. Specifically, the uni- and bidirectional braces will increase GRFs when compared with the elastic band.

Study Design:

Crossover study.

Level of Evidence:

Level 2.

Methods:

A total of 15 individuals with ACL reconstruction received FRT with each device over 3 separate randomized sessions. During training, participants walked on a treadmill while performing a tracking task with visual feedback. Sessions contained 5 training trials (180 seconds each) with rest between. Vertical and anterior-posterior GRFs were assessed on the ACL-reconstructed leg before, during, and after training. Changes in GRFs were compared across devices using 1-dimensional statistical parametric mapping.

Results:

Resistance applied via bidirectional brace acutely increased gait kinetics during terminal stance/pre-swing (ie,more »

Conclusion:

FRT after ACL reconstruction can acutely alter gait kinetics during training. Devices can be applied to selectively alter gait kinetics. However, the long-term effects of FRT after ACL reconstruction with these devices are still unknown.

Clinical Relevance:

FRT may be applied to alter gait kinetics of the involved limb after ACL reconstruction, depending on the device used.

2. Background:

Thigh muscle weakness after anterior cruciate ligament reconstruction (ACLR) can persist after returning to activity. While resistance training can improve muscle function, “nonfunctional” training methods are not optimal for inducing transfer of benefits to activities such as walking. Here, we tested the feasibility of a novel functional resistance training (FRT) approach to restore strength and function in an individual with ACLR.

Hypothesis:

FRT would improve knee strength and function after ACLR.

Study Design:

Case report.

Level of Evidence:

Level 5.

Methods:

A 15-year-old male patient volunteered for an 8-week intervention where he performed 30 minutes of treadmill walking, 3 times per week, while wearing a custom-designed knee brace that provided resistance to the thigh muscles of his ACLR leg. Thigh strength, gait mechanics, and corticospinal and spinal excitability were assessed before and immediately after the 8-week intervention. Voluntary muscle activation was evaluated immediately after the intervention.

Results:

Knee extensor and flexor strength increased in the ACLR leg from pre- to posttraining (130 to 225 N·m [+74%] and 44 to 88 N·m [+99%], respectively) and increases in between-limb extensor and flexor strength symmetry (45% to 92% [+74%] and 47% to 72% [+65%], respectively) were also noted. After the intervention, voluntary muscle activation in the ACLR legmore »

Conclusion:

A full 8 weeks of FRT that targeted both quadriceps and hamstring muscles lead to improvements in strength and gait, suggesting that FRT may constitute a promising and practical alternative to traditional methods of resistance training.

Clinical Relevance:

FRT may serve as a viable approach to improve knee strength and function after ACL reconstruction.

3. Objective

This study examined the interaction of gait-synchronized vibrotactile cues with an active ankle exoskeleton that provides plantarflexion assistance.

Background

An exoskeleton that augments gait may support collaboration through feedback to the user about the state of the exoskeleton or characteristics of the task.

Methods

Participants ( N = 16) were provided combinations of torque assistance and vibrotactile cues at pre-specified time points in late swing and early stance while walking on a self-paced treadmill. Participants were either given explicit instructions ( N = 8) or were allowed to freely interpret (N=8) how to coordinate with cues.

Results

For the free interpretation group, the data support an 8% increase in stride length and 14% increase in speed with exoskeleton torque across cue timing, as well as a 5% increase in stride length and 7% increase in speed with only vibrotactile cues. When given explicit instructions, participants modulated speed according to cue timing—increasing speed by 17% at cues in late swing and decreasing speed 11% at cues in early stance compared to no cue when exoskeleton torque was off. When torque was on, participants with explicit instructions had reduced changes in speed.

Conclusion

These findings support that the presence of torque mitigates how cues were usedmore »

Application

Interactions between haptic feedback and exoskeleton use during gait can inform future feedback designs to support coordination between users and exoskeletons.

4. Abstract Background

Electromyography (EMG)-based audiovisual biofeedback systems, developed and tested in research settings to train neuromuscular control in patient populations such as cerebral palsy (CP), have inherent implementation obstacles that may limit their translation to clinical practice. The purpose of this study was to design and validate an alternative, plantar pressure-based biofeedback system for improving ankle plantar flexor recruitment during walking in individuals with CP.

Methods

Eight individuals with CP (11–18 years old) were recruited to test both an EMG-based and a plantar pressure-based biofeedback system while walking. Ankle plantar flexor muscle recruitment, co-contraction at the ankle, and lower limb kinematics were compared between the two systems and relative to baseline walking.

Results

Relative to baseline walking, both biofeedback systems yielded significant increases in mean soleus (43–58%, p < 0.05), and mean (68–70%, p < 0.05) and peak (71–82%, p < 0.05) medial gastrocnemius activation, with no differences between the two systems and strong relationships for all primary outcome variables (R = 0.89–0.94). Ankle co-contraction significantly increased relative to baseline only with the EMG-based system (52%, p = 0.03).

Conclusion

These findings support future research on functional training with this simple, low-cost biofeedback modality.

5. Abstract Background

Improving the prediction ability of a human-machine interface (HMI) is critical to accomplish a bio-inspired or model-based control strategy for rehabilitation interventions, which are of increased interest to assist limb function post neurological injuries. A fundamental role of the HMI is to accurately predict human intent by mapping signals from a mechanical sensor or surface electromyography (sEMG) sensor. These sensors are limited to measuring the resulting limb force or movement or the neural signal evoking the force. As the intermediate mapping in the HMI also depends on muscle contractility, a motivation exists to include architectural features of the muscle as surrogates of dynamic muscle movement, thus further improving the HMI’s prediction accuracy.

Objective

The purpose of this study is to investigate a non-invasive sEMG and ultrasound (US) imaging-driven Hill-type neuromuscular model (HNM) for net ankle joint plantarflexion moment prediction. We hypothesize that the fusion of signals from sEMG and US imaging results in a more accurate net plantarflexion moment prediction than sole sEMG or US imaging.

Methods

Ten young non-disabled participants walked on a treadmill at speeds of 0.50, 0.75, 1.00, 1.25, and 1.50 m/s. The proposed HNM consists of two muscle-tendon units. The muscle activation for each unit was calculatedmore »

Results

On average, the normalized moment prediction root mean square error was reduced by 14.58 % ($$p=0.012$$$p=0.012$) and 36.79 % ($$p<0.001$$$p<0.001$) with the proposed HNM when compared to sEMG-driven and US imaging-driven HNMs, respectively. Also, the calibrated models with data from the inter-speed mode were more robust than those from single-speed modes for the moment prediction.

Conclusions

The proposed sEMG-US imaging-driven HNM can significantly improve the net plantarflexion moment prediction accuracy across multiple walking speeds. The findings imply that the proposed HNM can be potentially used in bio-inspired control strategies for rehabilitative devices due to its superior prediction.