Post Stroke Walking Kinematics Using the Honda Walking Assist Robotic Exoskeleton

Study Overview
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Brief Summary
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To investigate the effect of a robotic exoskeleton on kinematics, muscle activity, ground reaction forces and spatiotemporal characteristics during walking in persons post stroke.

Detailed Description
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Following stroke walking dysfunction is prevalent. Traditional rehabilitation methods fall short of achieving desirable walking outcomes for most people who experience stroke. Robotic methods to assist walking, such as the Honda Walking Assist Device (HWA) Robot from Honda R & D Americas Inc., are being explored as a means of improving the recovery of walking post stroke. Prior to examining the effectiveness of exoskeletal robots for walking recovery it is important to understand their effect on kinematic and muscle responses during walking. Kinematic and muscle responses at the hip during walking with the HWA were recently described. The purpose of this study is to quantify the effect of walking with the HWA on body segments remote from the hip. These segments include knee, ankle, trunk and arm. The non-invasive measures used will include: walking kinematics (measurement of joint angles using cameras), muscle activity (Electromyography), ground reaction forces (detected by a force plate in the floor) and spatiotemporal characteristics (such as walking speed). Measures will be collected under three conditions: 1) walking at self-selected pace (control), 2) walking at self-selected pace with the HWA (4 Newton-meter assist mode for hip flexion and extension), 3) walking immediately following HWA use (aftereffect).

Official Title
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Post Stroke Walking Kinematics Using the Honda Walking Assist Robotic Exoskeleton

Conditions
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Stroke

Intervention / Treatment
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* Device: Robotic exoskeleton for walking assist


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ≥12 weeks but <1 year post stroke at time of study participation Age: 18-85 years Ability to walk a minimum of 10 meters with standby assistance with or without orthosis or assistive device (Functional Ambulation categories 3, 4 or 5) Able to follow three step commands Express the ability to understand study tasks and purpose Able and willing to provide written informed consent Living in the community with the ability to travel to maurices Community Clinic for testing Willingness to wear the StepWatch pedometer for a period of 3 days in their home (If applicable) ≥ 90 days post major orthopedic surgery (such as a joint replacement) (If applicable) ≥ 6 months post cardiac surgery Exclusion Criteria: Serious cardiac conditions (hospitalized for myocardial infarction or heart surgery within 3 months, congestive heart failure, unstable cardiac arrhythmias, hypertrophic cardiomyopathy, severe aortic stenosis, angina or dyspnea at rest or during activities of daily living) Severe arthritis or orthopedic conditions that limit lower extremity range of motion (> 10° or < 90° knee flexion, lacking > 25° hip extension, >15° from neutral plantar flexion.) Preexisting neurologic disorders such as Dementia, Multiple Sclerosis, Amyotrophic Lateral Sclerosis, Parkinson's Disease or Ataxia. History of lower limb amputation, non-healing ulcers, legal blindness or severe visual impairment

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Intervention Model: Single Group Assignment
Interventional Model Description: Within-subject design
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Device: Robotic exoskeleton for walking assist|Participants will have two testing sessions in this within-subject design experiment. The conditions under which walking will be evaluated are control (normal) walking, walking with the exoskeleton assistance and walking immediately following exoskeleton walking. The conditions under which stair walking (ascending and descending) will be evaluated include control (normal) stairs and exoskeleton assisted stairs. Assistance is provided by The Honda Walking Assist (HWA) System is a robotic device developed by Honda R&D Corporation ®, Japan. The devices computer-activated motors use hip angle information to guide assistance delivered through the thigh straps to the legs in time with the walking cycle. The maximum torque delivered is 4 Newton-meters.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Gait Kinematics | Difference in affected leg maximum knee flexion angle (initial swing to midswing) between conditions Kinematic Analysis of Gait will be obtained using a Qualisys 8-camera motion capture system. Sample rate 120 Hz. A modified Istituti Ortopedici Rizzoli (IOR) gait marker set ( 40 markers) applied bilaterally. | Gait kinematics were measured in each of 4 conditions during one 2-hour session for each participant. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lower Limb Electromyography (EMG) | Average max EMG of affected tibialis anterior muscle measured during swing phase for walking conditions using Delsys Tringo EMG sensors. Sample rate 2000Hz. | Measured during swing phase of gait during each of 4 walking conditions during a single data collection session. | 
| Ground Reaction Force at Terminal Stance | 2 Force platforms were used to quantify ground reaction forces at terminal stance for the affected lower limbs during gait. Sample rate 1200Hz. | Force data will be measured at a single time point (in one 2-hour session) for each participant in each of 4 conditions. | 
| Stair Climbing Ascend/Descend Test | A timed test of the ability to ascend and descend stairs with our without a rail. For this study a flight of 7 stairs will be used. The means of two trials of ascending and descending will be recorded. (Flansbjer et al., 2005) | Stairs will be measured at a single time point (in one 2-hour session) for each participant | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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exoskeleton, gait, kinematics, EMG, stair climbing