The objective of this study is to evaluate clinical training strategies that use robotic exoskeletons in individuals who have experienced severe stroke.
Stroke is the leading cause of adult-onset disability, with more than 6.4 million non-institutionalized stroke survivors in the United States
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.
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.
This project will 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.
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.
Deems-Dluhy S & Jayaraman A, Functional mobility with the micro-processor controlled KAFO: tools to measure outcomes in research and your clinical practice. General Sessions; Midwest Chapter of American Academy of Orthotists & Prosthetists, May 27th 2015.
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.
Hoppe-Ludwig S, Deems-Dluhy S, Jayaraman A. The Micro-Processor Controlled Orthosis: What is the Impact to the User, Versus the Stance Control Orthosis and Conventional Locked KAFO? Podium. AOPA World Congress. Las Vegas, NV, September 2017.
This contents of this webpage were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RE5014-02-00). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this webpage do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.