This study is complete and is no longer recruiting subjects.
Up to 80% of stroke survivors experience considerable gait deficits, including reduced walking speeds and asymmetrical walking patterns, which limit their capacity for community ambulation. In addition, almost 40% of 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 or limited household ambulators who are unlikely to walk again. There is a compelling need to develop mobility-training strategies for these survivors of severe stroke.
Although various treadmill-based motorized (robotic) devices have been developed to facilitate stepping practice in mobility-impaired populations, current devices only allow walking at a constant speed, and do not impose the balance and postural demands necessary for walking over ground.
The objective of this study is to test and evaluate a new generation of exoskeletons that 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.
As a first objective, we compared training with the Ekso™ exoskeleton to traditional physical therapy in individuals with chronic stroke. The study involved 26 training sessions (over approximately 10 weeks) of structured, high-dosage exoskeleton training for group 1 (15 individuals), and for group 2 (12 individuals) a similar number of traditional physical therapy sessions.
We are currently organizing and analyzing the data to determine if use of the exoskeleton provided clinically significant gains in walking recovery. Primary outcomes measures will include results from walking distance and speed, in addition to balance-based data.
We are now exploring how training with an exoskeleton with powered-assist for knee extension and flexion (Keeogo™) compares to traditional stair training in the acute stroke population.
Participants were recruited from the Shirley Ryan AbilityLab and randomized into one of two groups; one group (7 individuals) used the exoskeleton device during all training sessions, the other group (7 individuals) received traditional stair training without the device. Gait belts and/or overhead track and harnessing systems were used throughout to ensure participant safety. Primary outcome measures included the 10-meter walk test, 6-minute walk test, the Berg Balance Scale and the Functional Independence Measure.
The information obtained from both studies will provide a greater understanding of the role of robotic exoskeletons in improving mobility after stroke.
Publications & Presentations
Jayaraman A. Exoskeleton-Assisted Walking for Persons with Neurological Conditions; Part I: The State of the Science and Part II: The state of the Art. American Congress of Rehabilitation Medicine (ACRM) meeting, Oct. 7-11 2014; Toronto, Canada.
Jayaraman A. Decentralized Neurorehabilitation – the Next Step for Technology Intervention. International conference on Rehabilitation Robotics (ICOR), August 11-14, 2015, Singapore.
Jayaraman A. Robotic Devices: What we thought, what we can, and what need to International conference on Rehabilitation Robotics (ICOR), August 11-14, 2015, Singapore.
Jayaraman A, Forrest G, Kozlowski A, Evans N, Hartigan C, Spungen A. Exoskeleton-Assisted Walking for Persons with Neurological Conditions: Clinical Application, Health and Fitness, and Personal Mobility. Symposium. ACRM annual Conference, Dallas, Texas, Oct. 28th 2015.
Scanlan K & Jayaraman A. Identifying training strategies for progressing exoskeleton users towards everyday functional ambulation. Special Interest Session; 4th ISCOS and ASIA Joint Scientific Meeting. May 2015, Montreal, Canada.
Winstanley A & Jayaraman A. Effect of Wearable Robotic Device in Outpatient Physical Therapy for Gait Training in Individuals with Stroke. General Sessions; Midwest Chapter of American Academy of Orthotists & Prosthetists, May 27th 2015.
Scanlan K & Jayaraman A. Identifying training strategies for progressing exoskeleton users towards everyday functional ambulation. General Sessions; Midwest Chapter of American Academy of Orthotists & Prosthetists, May 27th 2015.
Wearable Robotics Association, NIST Workshop 4: “Ergonomic issues for Wearable Robotics”; speakers included Arun Jayaraman PT, Ph.D., Rehabilitation Institute of Chicago) and “Design Challenges in Interfacing and Controlling Wearable Robots”; speakers included Tommaso Lenzi, PhD, describing aspects of the lightweight leg (Project D4). Scottsdale AZ., February 12, 2016.
Hohl K, Mummidisetty KC, Jayaraman A. Is a structured exoskeleton over-ground gait training program superior to traditional care in individuals affected by chronic, severe stroke? Presentation at Combined Sections Meeting APTA Feb 2017.
Jayaraman A. Invited Speaker. Workshop: Towards a next generation of wearable robotic devices for human-oriented assistance and therapy. RehabWeek 2017, London, July 2017.
Jayaraman A. Invited Speaker. “The Future of Rehabilitation Robotics: Possibilities & Challenges.” Rehabilitation Technologies Symposium – Hälsostaden, Sweden. October 2017
Jayaraman A. Invited Speaker: “Impact of Wearable Robotics in a Home Environment on Health and Mobility. WeRob 2017 Conference, TIRR Memorial Hospital, Houston, Texas, November 2017
Rymer WZ, Jayaraman A. “Clinical Experience with Wearable Exoskeletons as Therapeutic Rehabilitation Devices following Injury to the CNS: An Evolving Story.” Workshop. ICNR 2018 Conference, Pisa, Italy, October 2018
Jayaraman A. Invited Speaker: “Rehabilitation Robotics: An Overview.” Salesforce HQ, Chicago, January, 2019
Jayaraman A, Lang C, Dewald J, Field-Fote E, Hohl K. Symposium. “Why do We Love and Hate our Robots: Implications for Clinical Practice.” APTA CSM, Washington DC. January 2019
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