A Propulsion Neuroprosthesis Improves Overground Walking in Community-Dwelling Individuals After Stroke.

Autor:	Choe DK; John A. Paulson School of Engineering and Applied SciencesHarvard University Cambridge MA 02138 USA., Aiello AJ; Sargent College of Health and Rehabilitation SciencesBoston University Boston MA 02215 USA., Spangler JE; Sargent College of Health and Rehabilitation SciencesBoston University Boston MA 02215 USA., Walsh CJ; John A. Paulson School of Engineering and Applied SciencesHarvard University Cambridge MA 02138 USA., Awad LN; Sargent College of Health and Rehabilitation SciencesBoston University Boston MA 02215 USA.
Jazyk:	angličtina
Zdroj:	IEEE open journal of engineering in medicine and biology [IEEE Open J Eng Med Biol] 2024 Jul 04; Vol. 5, pp. 563-572. Date of Electronic Publication: 2024 Jul 04 (Print Publication: 2024).
DOI:	10.1109/OJEMB.2024.3416028
Abstrakt:	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. Competing Interests: The authors declare that they have no competing interests. (© 2024 The Authors.)
Databáze:	MEDLINE
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