Effects of Soft Robotic Exosuit on Exercise Capacity, Biomakers of Neuroplasticity, and Motor Learning After Stroke
Condition: Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      High intensity exercise is known to improve a person's ability to learn new motor skills. The
      goal of this project is to evaluate if a robotic exosuit can help people who have had a
      stroke perform walking rehabilitation at higher intensities than they are able to without the
      exosuit. The investigators will measure exercise training intensity, biomarkers of
      neuroplasticity (e.g., brain-derived neurotrophic factor; BDNF), and motor learning when
      people poststroke exercise with and without the exosuit. For this protocol, exosuits
      developed in collaboration with ReWalk™ Robotics will be used.

      Aim 1: Determine the effects of a soft robotic exosuit on gait training intensity and serum
      BDNF in persons post-stroke completing a single bout of high intensity walking.

      Hypothesis 1: Exosuits will allow individuals post-stroke to (i) walk at higher intensities
      or (ii) walk at a high intensity for longer durations.

      Hypothesis 2: Training at a higher intensity, or training at high intensity for longer
      durations, will result in increased serum BDNF.

      Aim 2: Determine the effects of a soft robotic exosuit on gait biomechanics measured after a
      single bout of high intensity walking with versus without a soft robotic exosuit.

      Hypothesis 3: A single bout of high intensity walking with an exosuit will lead to
      demonstrably better gait biomechanics than a single bout of high intensity exercise without
      an exosuit.
    

Detailed description: 
      Prior studies of the exosuit technology have culminated in strong evidence for the
      gait-restorative effects of soft robotic exosuits for patients post-stroke by means of
      substitution for impaired paretic limb function during walking. The present study builds on
      this work by suggesting that an exosuit's immediate gait-restorative effects can be leveraged
      during high intensity gait training to produce post-training improvements in gait quality.
      Indeed, current rehabilitation efforts are focused on either quality or intensity. They focus
      on gait quality by reducing the training intensity to allow patients to achieve a more normal
      gait. In contrast, efforts focused on training intensity push participants without regard for
      the quality of their movements. The investigators posit that exosuits can uniquely enable
      high intensity gait training that promotes quality of movements.

      Acute bouts of high intensity exercise prior to skilled task practice have been shown to
      enhance motor learning in neurologically intact individuals. However, the impact of high
      intensity exercise on motor learning in clinical populations remains largely unknown. A major
      limitation to studying this relationship in survivors of stroke are challenges in achieving
      and maintaining high intensity exercise levels (>75% max HR) during gait training for
      durations that are comparable to neurologically intact individuals. Exercising at a lower
      intensity or for a shorter duration may result in insufficient neurological "priming" for
      motor learning that typically follows high intensity training-which would be evidenced in
      reduced production of activity-dependent markers of neuroplasticity (e.g., brain-derived
      neurotrophic factor; BDNF). For this study, the investigators will use standardized, maximal
      effort tests to evaluate the ability of a soft robotic exosuit to increase a patient's
      capacity for high intensity gait training. The investigators will also examine the resulting
      effect on BDNF and the relationship between training intensity, BDNF and motor learning
      measures.
    

Intervention name(s): Soft exosuit; No Soft exosuit
Intervention type(s): Device; Behavioral
Intervention description(s): Progressive cardiovascular exercise testing with soft exosuit assistance.; Progressive cardiovascular exercise testing.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: Within-subject design
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: Neuroplasticity; Motor Learning; Exercise; Soft Robotics