Exoskeleton-assisted gait in chronic stroke: An EMG and functional near-infrared spectroscopy study of muscle activation patterns and prefrontal cortex activity |
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| Institution: | 1. Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy;2. Villa Beretta Rehabilitation Center, Valduce Hospital, Via N. Sauro 17 23845 Costa Masnaga, Lecco, Italy;3. IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy;4. Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy;5. Rehabilitation Units, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy;6. Neurorehabilitation Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168 Rome, Italy;1. School of Rehabilitation, Université de Montréal, Montreal, QC, Canada;2. Pathokinesiology Laboratory, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire sur la réadaptation en déficience physique de Montréal, CIUSSS Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada;1. Psychological Sciences, University of California, Merced, CA, United States;2. Departments of Engineering Technology and Electrical and Computer Engineering, University of Houston, TX, United States;3. Cognitive & Information Sciences, University of California, Merced, CA, United States;1. Advanced Vehicle System, Malaysia Japan International Institute of Technology, Universiti Teknologi Malaysia, Jalan Sultan Yahya Petra, 54100 Kuala Lumpur, Malaysia;2. Department of Bio-Science and Engineering, College of Systems Engineering and Science, Shibaura Institute of Technology, Fukasaku 307, Saitama-City 337-8570, Japan;3. Malaysian Research Institute on Ageing, Universiti Putra Malaysia, 43400 Serdang, Malaysia;1. Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center (VA), 1600 SW Archer Rd, Gainesville, FL, 32608, USA;2. Department of Biomedical Engineering (BME), NEB Building, University of Florida, Gainesville, FL, 32608, USA;3. Dept of Chemical Engineering, NEB Building, UF, Gainesville, FL, 32608, USA;4. Dept of Neurology, College of Medicine, UF, Gainesville, FL, 32608, USA;1. Willy Taillard Laboratory of Kinesiology, Geneva University Hospitals and Geneva University, Switzerland;2. HES-SO University of Applied Sciences and Arts Western Switzerland, School of Health Sciences, Geneva, Switzerland;3. Univ Lyon, Université Lyon 1, IFSTTAR, LBMC UMR_T9406, F69622, Lyon, France;4. Pediatric Orthopaedic Service, Department of Child and Adolescent, Geneva University Hospitals and Geneva University, Geneva, Switzerland;1. Centre de Recherches sur la Cognition et l’Apprentissage (UMR7295) Université de Poitiers and Université François-Rabelais de Tours, 5 rue Théodore Lefebvre TSA 21103, 86073 Poitiers Cedex 9, France;2. Laboratoire Sciences de la Cognition, Technologie, Ergonomie (SCoTE), Université de Toulouse, INU Champollion, Albi, France |
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| Abstract: | ObjectivesGait impairment dramatically affects stroke patients’ functional independence. The Ekso™ is a wearable powered exoskeleton able to improve over-ground gait abilities, but the relationship between the cortical gait control mechanisms and lower limbs kinematics is still unclear. Our aims are: to assess whether the Ekso™ induces an attention-demanding process with prefrontal cortex activation during a gait task; to describe the relationship between the gait-induced muscle activation pattern and the prefrontal cortex activity.MethodsWe enrolled 22 chronic stroke patients and 15 matched controls. We registered prefrontal cortex (PFC) activity with functional Near-Infrared Spectroscopy (fNIRS) and muscle activation with surface-electromyography (sEMG) during an over-ground gait task, performed with and without the Ekso™.ResultsWe observed prefrontal cortex activation during normal gait and a higher activation during Ekso-assisted walking among stroke patients. Furthermore, we found that muscle hypo-activation and co-activation of non-paretic limb are associated to a high prefrontal metabolism.ConclusionsAmong stroke patients, over-ground gait is an attention-demanding task. Prefrontal activity is modulated both by Ekso-assisted tasks and muscle activation patterns of non-paretic lower limb. Further studies are needed to elucidate if other Ekso™ settings induce different cortical and peripheral effects.SignificanceThis is the first study exploring the relationship between central and peripheral mechanisms during an Ekso-assisted gait task. |
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| Keywords: | Exoskeleton device Stroke Prefrontal cortex Gait Lower extremity Personalized medicine |
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