Effect of Mobility Training using Robotic Exoskeletons on Functional Recovery in Individuals with Severe Stroke
(Project R2: Mobility)
Arun Jayaraman, PT, PhD
Subject walking, using the Ekso
Stroke is the leading cause of adult-onset disability. Approximately 795,000 people experience a stroke in the U.S. each year resulting in over 6.4 million stroke survivors. A large proportion of survivors (up to 80%) experience considerable gait deficits, including reduced walking speeds and asymmetrical walking patterns, which limit their capacity for community ambulation.
Stroke survivors are currently classified, based on their self-selected walking speeds, as either unable to walk (non-ambulators), limited household ambulators (walking speed <0.4m/s), limited community ambulators (0.4–0.8m/s), or community ambulators (>0.8m/s). However, these walking speeds are significantly lower than those of healthy controls (1.3-1.5 m/s).
Current rehabilitation approaches are most successful in survivors of mild to moderate stroke who are at least limited community ambulators, as a high level of initial function provides a greater potential for progression and recovery to full community ambulation. Compensatory approaches (wheelchair use or admittance to a skilled nursing facility) are unfortunately common strategies for individuals experiencing a severe stroke.
Recent statistics show that 40% of all stroke survivors experience moderate to severe impairments that require special care while an additional 10% are admitted to skilled nursing or long term care facilities and categorized as non-ambulatory (wheelchair-bound) or limited household ambulators. These individuals are unlikely to walk again. There is a compelling need to develop mobility training strategies for survivors of severe stroke.
Various treadmill-based motorized (robotic) devices have been developed to facilitate stepping practice in highly disabled populations. Current devices only allow walking at a constant speed, reduce the muscular and metabolic work required from the participant, and do not impose the balance and postural demands necessary for walking over ground. New generations of robotic exoskeletons may provide the benefits of over-ground stepping practice, including limb loading and balance and posture control, while simultaneously reducing the need for therapist assistance.
The objective of this project is to evaluate a clinical training strategy that uses a robotic exoskeleton in individuals who have experienced severe stroke.
The target population for this study comprises individuals who have experienced a severe stroke and are unable or have a limited ability (i.e., self-selected walking speed <0.4m/s) to walk.