A Propulsion Neuroprosthesis Improves Overground Walking in Community-Dwelling Individuals After Stroke
Functional electrical stimulation (FES) is a common neuromotor intervention whereby electrically evoked dorsiflexor muscle contractions assist foot clearance during walking. Plantarflexor neurostimulation has recently emerged to assist and retrain gait propulsion; however, safe and effective coordin...
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IEEE
2024-01-01
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| author | Dabin K. Choe Ashlyn J. Aiello Johanna E. Spangler Conor J. Walsh Louis N. Awad |
| author_facet | Dabin K. Choe Ashlyn J. Aiello Johanna E. Spangler Conor J. Walsh Louis N. Awad |
| author_sort | Dabin K. Choe |
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| description | Functional electrical stimulation (FES) is a common neuromotor intervention whereby electrically evoked dorsiflexor muscle contractions assist foot clearance during walking. Plantarflexor neurostimulation has recently emerged to assist and retrain gait propulsion; however, safe and effective coordination of dorsiflexor and plantarflexor neurostimulation during overground walking has been elusive, restricting propulsion neuroprostheses to harnessed treadmill walking. We present an overground propulsion neuroprosthesis that adaptively coordinates, on a step-by-step basis, neurostimulation to the dorsiflexors and plantarflexors. In 10 individuals post-stroke, we evaluate the immediate effects of plantarflexor neurostimulation delivered with different onset timings, and retention to unassisted walking (NCT06459401). Preferred onset timing differed across individuals. Individualized tuning resulted in a significant 10% increase in paretic propulsion peak (Δ: 1.41 ± 1.52%BW) and an 8% increase in paretic plantarflexor power (Δ: 0.27 ± 0.23 W/kg), compared to unassisted walking. Post-session unassisted walking speed, paretic propulsion peak, and propulsion symmetry all significantly improved by 9% (0.14 ± 0.09 m/s), 28% (2.24 ± 3.00%BW), and 12% (4.5 ± 6.0%), respectively, compared to pre-session measurements. Here we show that an overground propulsion neuroprosthesis can improve overground walking speed and propulsion symmetry in the chronic phase of stroke recovery. Future studies should include a control group to examine the efficacy of gait training augmented by the propulsion neuroprosthesis compared to gait training alone. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2024-01-01 |
| publisher | IEEE |
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| series | IEEE Open Journal of Engineering in Medicine and Biology |
| spelling | doaj-art-1d2ea661cd7e435cafa1c0c786ba864c2025-01-30T00:03:50ZengIEEEIEEE Open Journal of Engineering in Medicine and Biology2644-12762024-01-01556357210.1109/OJEMB.2024.341602810586842A Propulsion Neuroprosthesis Improves Overground Walking in Community-Dwelling Individuals After StrokeDabin K. Choe0Ashlyn J. Aiello1https://orcid.org/0000-0002-9472-7336Johanna E. Spangler2Conor J. Walsh3https://orcid.org/0000-0002-2744-917XLouis N. Awad4https://orcid.org/0000-0002-0159-8011John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USASargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USASargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USAJohn A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USASargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USAFunctional electrical stimulation (FES) is a common neuromotor intervention whereby electrically evoked dorsiflexor muscle contractions assist foot clearance during walking. Plantarflexor neurostimulation has recently emerged to assist and retrain gait propulsion; however, safe and effective coordination of dorsiflexor and plantarflexor neurostimulation during overground walking has been elusive, restricting propulsion neuroprostheses to harnessed treadmill walking. We present an overground propulsion neuroprosthesis that adaptively coordinates, on a step-by-step basis, neurostimulation to the dorsiflexors and plantarflexors. In 10 individuals post-stroke, we evaluate the immediate effects of plantarflexor neurostimulation delivered with different onset timings, and retention to unassisted walking (NCT06459401). Preferred onset timing differed across individuals. Individualized tuning resulted in a significant 10% increase in paretic propulsion peak (Δ: 1.41 ± 1.52%BW) and an 8% increase in paretic plantarflexor power (Δ: 0.27 ± 0.23 W/kg), compared to unassisted walking. Post-session unassisted walking speed, paretic propulsion peak, and propulsion symmetry all significantly improved by 9% (0.14 ± 0.09 m/s), 28% (2.24 ± 3.00%BW), and 12% (4.5 ± 6.0%), respectively, compared to pre-session measurements. Here we show that an overground propulsion neuroprosthesis can improve overground walking speed and propulsion symmetry in the chronic phase of stroke recovery. Future studies should include a control group to examine the efficacy of gait training augmented by the propulsion neuroprosthesis compared to gait training alone.https://ieeexplore.ieee.org/document/10586842/Neuroprosthesisfunctional electrical stimulationpropulsionchronic strokeoverground walking |
| spellingShingle | Dabin K. Choe Ashlyn J. Aiello Johanna E. Spangler Conor J. Walsh Louis N. Awad A Propulsion Neuroprosthesis Improves Overground Walking in Community-Dwelling Individuals After Stroke IEEE Open Journal of Engineering in Medicine and Biology Neuroprosthesis functional electrical stimulation propulsion chronic stroke overground walking |
| title | A Propulsion Neuroprosthesis Improves Overground Walking in Community-Dwelling Individuals After Stroke |
| title_full | A Propulsion Neuroprosthesis Improves Overground Walking in Community-Dwelling Individuals After Stroke |
| title_fullStr | A Propulsion Neuroprosthesis Improves Overground Walking in Community-Dwelling Individuals After Stroke |
| title_full_unstemmed | A Propulsion Neuroprosthesis Improves Overground Walking in Community-Dwelling Individuals After Stroke |
| title_short | A Propulsion Neuroprosthesis Improves Overground Walking in Community-Dwelling Individuals After Stroke |
| title_sort | propulsion neuroprosthesis improves overground walking in community dwelling individuals after stroke |
| topic | Neuroprosthesis functional electrical stimulation propulsion chronic stroke overground walking |
| url | https://ieeexplore.ieee.org/document/10586842/ |
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