title: A neuromechanics-based powered ankle exoskeleton to assist walking post-stroke: a feasibility study.
abstract: BACKGROUND
  In persons post-stroke, diminished ankle joint function can contribute to inadequate gait propulsion. To target paretic ankle impairments, we developed a neuromechanics-based powered ankle exoskeleton. Specifically, this exoskeleton supplies plantarflexion assistance that is proportional to the user's paretic soleus electromyography (EMG) amplitude only during a phase of gait when the stance limb is subjected to an anteriorly directed ground reaction force (GRF). The purpose of this feasibility study was to examine the short-term effects of the powered ankle exoskeleton on the mechanics and energetics of gait.
  
  
  METHODS
  Five subjects with stroke walked with a powered ankle exoskeleton on the paretic limb for three 5 minute sessions. We analyzed the peak paretic ankle plantarflexion moment, paretic ankle positive work, symmetry of GRF propulsion impulse, and net metabolic power.
  
  
  RESULTS
  The exoskeleton increased the paretic plantarflexion moment by 16% during the powered walking trials relative to unassisted walking condition (p < .05). Despite this enhanced paretic ankle moment, there was no significant increase in paretic ankle positive work, or changes in any other mechanical variables with the powered assistance. The exoskeleton assistance appeared to reduce the net metabolic power gradually with each 5 minute repetition, though no statistical significance was found. In three of the subjects, the paretic soleus activation during the propulsion phase of stance was reduced during the powered assistance compared to unassisted walking (35% reduction in the integrated EMG amplitude during the third powered session).
  
  
  CONCLUSIONS
  This feasibility study demonstrated that the exoskeleton can enhance paretic ankle moment. Future studies with greater sample size and prolonged sessions are warranted to evaluate the effects of the powered ankle exoskeleton on overall gait outcomes in persons post-stroke.
authors.affiliation: Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, 911 Oval Drive, Campus Box 7115, Raleigh, NC, 27695, USA. ktakaha@ncsu.edu.
authors.forename: Kota Z
authors.initials: KZ
authors.lastname: Takahashi
authors.affiliation: Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Bondurant Hall, 321 South Columbia St, Campus Box 7135, Chapel Hill, NC, 27599, USA. michael_lewek@med.unc.edu.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Lewek
authors.affiliation: Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, 911 Oval Drive, Campus Box 7115, Raleigh, NC, 27695, USA. gsawicki@email.unc.edu.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Sawicki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle; D000843:Ankle Joint; D001186:Artificial Limbs; D001696:Biomechanical Phenomena; D001701:Bionics; D004576:Electromyography; D004734:Energy Metabolism; D005240:Feasibility Studies; D005260:Female; D005528:Foot; D006801:Humans; D008297:Male; D055595:Mechanical Phenomena; D008875:Middle Aged; D010291:Paresis / Q000534:rehabilitation; D011474:Prosthesis Design; D012371:Robotics; D000071939:Stroke Rehabilitation; D016138:Walking