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Background <p>Robotics has emerged as a promising avenue for gait rehabilitation after stroke. We developed a wearable ankle exoskeleton (AMBLE) for dorsiflexion assist-as-needed training with adaptive control timing to individualize assistance across gait cycle sub-events. This single-armed, non-controlled study investigates effects of 9 weeks x 2 sessions/week robotics training on walking function in persons with chronic stroke and foot drop, and durability 2 months after training ends.</p> Findings <p>Subjects included <i>N</i> = 24 participants (12 male, 12 female) age 57 ± 13 years with mean 10 ± 9 years since stroke. All baseline and post-training outcomes included optical motion capture for 3-D gait biomechanics and were conducted during unassisted (no robot) over-ground walking conditions. AMBLE training improved select gait biomechanics outcomes including maximum toe clearance (mm, pre- 69±28 versus post- 79±30, <i>p</i> &lt; 0.01), ankle peak dorsiflexion angular velocity (°/s, 35±32 versus 47±40, <i>p</i> &lt; 0.01), heel-first foot strikes (%steps, 31±41 versus 44±43, <i>p</i> &lt; 0.01), and paretic step length (cm, 37±16 versus 40±14, <i>p</i> &lt; 0.01. Functional outcomes that improved with training included 10-meter self-selected (m/s, 0.66±0.24 versus 0.70±0.23, <i>p</i> &lt; 0.01) and fastest comfortable velocities (m/s, 0.80±0.31 versus 0.86±0.30, <i>p</i> &lt; 0.01), Dynamic Gait Index (points, 14±5 versus 17±3, <i>p</i> &lt; 0.01), 6-minute walk distance (m, 252±106 versus 280±109, <i>p</i> &lt; 0.01), and Stroke Impact Scale-Mobility (0-100, 280±109 versus 88±10, <i>p</i> &lt; 0.01); all achieving minimal clinically important differences, except walking velocities. Durability testing 2 months after cessation of robotics training showed retention of most biomechanical improvements, including maximum toe clearance (mm, 78.4±26.1, <i>p</i> &lt; 0.01), dorsiflexion angular velocity (°/s, 42.5±37.5, <i>p</i> &lt; 0.01), and heel-first foot strikes (%steps, 46±43, <i>p</i> &lt; 0.01), and most functional outcomes. Notably, durability testing revealed emergence of two new kinematic improvements: increased knee flexion (deg, 33.1±16.5 versus 36.9±17.7, <i>p</i> &lt; 0.01) and hip flexion (deg, 36.8±9.5 versus 39.6±9.2, <i>p</i> &lt; 0.05), while hip abduction and hip hike do not change.</p> Conclusions <p>Nine hours of AMBLE ankle robotics training across 9 weeks durably improves gait biomechanics and functional mobility for persons with chronic stroke and foot drop, even decades post-stroke. Further studies are needed to investigate precision adaptive control robotics for stroke and other mobility disability conditions.</p> <p><i>Trial registration</i>: Clinical trial identifier: NCT04594837.</p>

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Adaptive control ankle robotics training durably improves gait biomechanics in chronic hemiparetic stroke and footdrop

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月29日

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  • Anindo Roy,
  • Bradley Hennessie,
  • Charlene Hafer-Macko,
  • Larry W. Forrester,
  • Kelly Westlake,
  • Richard F. Macko

摘要

Background

Robotics has emerged as a promising avenue for gait rehabilitation after stroke. We developed a wearable ankle exoskeleton (AMBLE) for dorsiflexion assist-as-needed training with adaptive control timing to individualize assistance across gait cycle sub-events. This single-armed, non-controlled study investigates effects of 9 weeks x 2 sessions/week robotics training on walking function in persons with chronic stroke and foot drop, and durability 2 months after training ends.

Findings

Subjects included N = 24 participants (12 male, 12 female) age 57 ± 13 years with mean 10 ± 9 years since stroke. All baseline and post-training outcomes included optical motion capture for 3-D gait biomechanics and were conducted during unassisted (no robot) over-ground walking conditions. AMBLE training improved select gait biomechanics outcomes including maximum toe clearance (mm, pre- 69±28 versus post- 79±30, p < 0.01), ankle peak dorsiflexion angular velocity (°/s, 35±32 versus 47±40, p < 0.01), heel-first foot strikes (%steps, 31±41 versus 44±43, p < 0.01), and paretic step length (cm, 37±16 versus 40±14, p < 0.01. Functional outcomes that improved with training included 10-meter self-selected (m/s, 0.66±0.24 versus 0.70±0.23, p < 0.01) and fastest comfortable velocities (m/s, 0.80±0.31 versus 0.86±0.30, p < 0.01), Dynamic Gait Index (points, 14±5 versus 17±3, p < 0.01), 6-minute walk distance (m, 252±106 versus 280±109, p < 0.01), and Stroke Impact Scale-Mobility (0-100, 280±109 versus 88±10, p < 0.01); all achieving minimal clinically important differences, except walking velocities. Durability testing 2 months after cessation of robotics training showed retention of most biomechanical improvements, including maximum toe clearance (mm, 78.4±26.1, p < 0.01), dorsiflexion angular velocity (°/s, 42.5±37.5, p < 0.01), and heel-first foot strikes (%steps, 46±43, p < 0.01), and most functional outcomes. Notably, durability testing revealed emergence of two new kinematic improvements: increased knee flexion (deg, 33.1±16.5 versus 36.9±17.7, p < 0.01) and hip flexion (deg, 36.8±9.5 versus 39.6±9.2, p < 0.05), while hip abduction and hip hike do not change.

Conclusions

Nine hours of AMBLE ankle robotics training across 9 weeks durably improves gait biomechanics and functional mobility for persons with chronic stroke and foot drop, even decades post-stroke. Further studies are needed to investigate precision adaptive control robotics for stroke and other mobility disability conditions.

Trial registration: Clinical trial identifier: NCT04594837.