Effect of Knee Exoskeleton Assistance and a Real-Time Biofeedback System on Posture and Gait Dynamics in Crouch Gait Subjects
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Kimiavi, Tara Hashemian
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Abstract
Children with crouched gait, a complex gait pattern characterized by knee hyperflexion and reduced knee range of motion, can experience a significant decline in mobility through their adolescence and into early adulthood. Additionally, crouch gait results in hyperflexion of the trunk, excessive lateral trunk lean, and a lack of trunk control, which can increase the metabolic cost of walking and further place stress on the knee joints. Gait rehabilitation using robotic exoskeletons has been proven effective for reducing symptoms of crouch, but rarely ever targets the upper body dynamics as well. The purpose of this study is to investigate the rehabilitative effect of a robotic knee exoskeleton and upper-body visual biofeedback system for facilitating gait training in children with crouched gait. We hypothesize that this combination mechanism would improve kinematic outcomes for children with crouched gait. For up to five visits, two pediatric crouch gait subjects were trained with the device, which used an assist-as-needed control impedance paradigm that incorporated both the kinematics of the knee and the kinematics of the trunk to determine the magnitude of assistance provided at the knee joint. Data analyzed from a single bilateral crouch subject show significant gait improvements on both legs while training with the exoskeleton. The subject’s most affected leg saw a significant increase in peak knee extension during stance (44.21 ± 2.03° to 42.39 ± 1.90°) along with a significant decrease in early stance knee flexion (27.01 ± 4.02° to 42.39 ± 1.90°) and swing flexion (57.78 ± 4.30° to 53.53 ± 3.38°). This study successfully demonstrated kinematic improvements at the trunk, hip, knee, and ankle joints in a child with bilateral crouched gait during and after training with a robotic knee exoskeleton and visual biofeedback assistance paradigm. However, overall kinematic improvements across both the subject’s least and most affected legs were not consistent, leading to a partial hypothesis acceptance. This work demonstrates a potential application of gamified rehabilitation for facilitating gait training in children with crouched gait.
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