Biomechanical differences between able-bodied and spinal cord injured individuals walking in an overground robotic exoskeleton

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Hayes, SC ORCID: https://orcid.org/0000-0003-0767-3657, White, M, Wilcox, CRJ, White, HSF and Vanicek, N, 2022. Biomechanical differences between able-bodied and spinal cord injured individuals walking in an overground robotic exoskeleton. PLOS ONE, 17 (1): e0262915. ISSN 1932-6203

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Official URL: https://doi.org/10.1371/journal.pone.0262915

Abstract

Background: Robotic assisted gait training (RAGT) uses a powered exoskeleton to support an individual’s body and move their limbs, with the aim of activating latent, pre-existing movement patterns stored in the lower spinal cord called central pattern generators (CPGs) to facilitate stepping. The parameters that directly stimulate the stepping CPGs (hip extension and ipsilateral foot unloading) should be targeted to maximise the rehabilitation benefits of these devices.

Aim: To compare the biomechanical profiles of individuals with a spinal cord injury (SCI) and able-bodied individuals inside the ReWalkTM powered exoskeleton and to contrast the users’ profiles with the exoskeleton.

Methods: Eight able-bodied and four SCI individuals donned a ReWalkTM and walked along a 12-meter walkway, using elbow crutches. Whole-body kinematics of the users and the ReWalkTM were captured, along with GRF and temporal-spatial characteristics. Discreet kinematic values were analysed using a Kruskall-Wallis H and Dunn’s post-hoc analysis. Upper-body differences, GRF and temporal-spatial characteristics were analysed using a Mann-Whitney U test (P < 0.05).

Results: Walking speed ranged from 0.32–0.39m/s. Hip abduction, peak knee flexion and ankle dorsiflexion for both the SCI and able-bodied groups presented with significant differences to the ReWalkTM. The able-bodied group presented significant differences to the ReWalkTM for all kinematic variables except frontal plane hip ROM (P = 0.093,δ = -0.56). Sagittal plane pelvic and trunk ROM were significantly greater in the SCI vs. able-bodied (P = 0.004,δ = -1; P = 0.008,δ = -0.94, respectively). Posterior braking force was significantly greater in the SCI group (P = 0.004, δ = -1).

Discussion: The different trunk movements used by the SCI group and the capacity for the users’ joint angles to exceed those of the device suggest that biomechanical profiles varied according to the user group. However, upright stepping with the ReWalkTM device delivered the appropriate afferent stimulus to activate CPGs as there were no differences in key biomechanical parameters between the two user groups.

Item Type:	Journal article
Publication Title:	PLOS ONE
Creators:	Hayes, S.C., White, M., Wilcox, C.R.J., White, H.S.F. and Vanicek, N.
Publisher:	Public Library of Science (PLoS)
Date:	27 January 2022
Volume:	17
Number:	1
ISSN:	1932-6203
Identifiers:	Number Type 10.1371/journal.pone.0262915 DOI 1512293 Other
Rights:	© 2022 Hayes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Divisions:	Schools > School of Science and Technology
Record created by:	Laura Ward
Date Added:	28 Jan 2022 14:14
Last Modified:	28 Jan 2022 14:14
URI:	https://irep.ntu.ac.uk/id/eprint/45439