Robotic Walking Device to Improve Mobility in Parkinson's Disease
Condition: Parkinson Disease
MeSH terms: Parkinson Disease
Study type: Interventional

Summary: 
      This Phase II randomized controlled trial proposes to examine the impact of long-term use of
      a novel light-weight and wearable assistive robotic device, called the Honda Walking Assist
      (HWA) device, to improve mobility in the home and community in individuals with mild to
      moderate Parkinson's disease (PD). Specific aims of the project are to: 1) determine the
      short-term impact of mechanical gait assistance on efficiency and ease of walking in
      individuals with PD, and 2) determine the effect of long-term HWA device usage on the ease
      and ability to walk unassisted in the home and community in individuals with PD.
    

Detailed description: 
      Difficulties with walking in people with Parkinson's disease contribute to injurious falls
      and decreased quality of life. The Honda Walking Assist (HWA) robotic device is designed to
      assist individuals with gait impairments to take longer strides and walk faster. This study
      will investigate the impact of HWA usage on mobility in the home and community in individuals
      with PD. It will also examine feasibility and safety of HWA usage in the PD population.
      Specific Aim 1: Determine the short-term impact of mechanical gait assistance on efficiency
      and ease of walking in individuals with PD. With disease progression, individuals with PD
      develop gait impairments (e.g., slower gait velocity, shorter step lengths, increased
      step-to-step variability, and freezing of gait), that interfere with their abilities to
      perform daily living tasks and participate in work, home, and social activities and
      predispose them to falls. The investigators hypothesize that wearing the HWA device will
      improve gait efficiency, gait parameters, and perceived ease of walking in individuals with
      PD compared to unassisted walking over a one session period. Specific Aim 2: Determine the
      effect of long-term HWA device usage on the ease and ability to walk unassisted in the home
      and community in individuals with PD. Angular sensors embedded in the HWA monitor the
      cadence, angular velocity, and degree of hip extension and flexion of the device user. When
      the user initiates walking, the HWA automatically adjusts leg movements to reach target walk
      ratios (step length/cadence) by increasing the amount of hip flexion and/or extension using
      power supplied by the device. Thus, the HWA applies continuous, step-by-step cueing to
      individuals with PD to take bigger and more symmetrical steps, thereby producing a faster and
      more efficient walking pattern. By wearing the HWA device over an extended period of time,
      individuals with PD will repetitively practice walking with a more "normal" gait pattern,
      possibly driving neuroplastic changes that will translate to improve unassisted walking. The
      investigators hypothesize that an 8-week intervention of HWA device usage will improve gait
      efficiency, gait parameters, perceived ease of walking, self-confidence, and daily physical
      activity in the home and community in individuals with PD with and without the use of the
      device.
    

Intervention name(s): Training with HWA device; Usual Care
Intervention type(s): Device; Other
Intervention description(s): Gait assessments will be conducted on participants randomized to the Trained group first during unassisted walking followed by HWA-assisted walking. Participants randomized to the Trained group will receive physical therapist supervised home and community-based walking training wearing the HWA device 2 times per week for 45-60 minutes for 8 weeks. Training will consist of walking in and outside of the home while encouraging larger and more symmetrical steps with practice of activities that challenge the person's balance and motor control. Rest breaks will be allowed as needed. If the therapist is unable to adjust the HWA to provide a safe gait pattern, the session will be ended and the device removed.; The Untrained group will continue their usual daily activities including any exercise regimen that they typically perform. However, they will be asked not to start any new exercise program during the study period.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Parkinson; Exoskeleton; Honda; Walking Assist; Walking; Gait; Mobility; Rehabilitation; Physical Therapy