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The Effects of Exoskeleton Assisted Knee Extension on Lower-Extremity Gait Kinematics, Kinetics, and Muscle Activity in Children with Cerebral Palsy

Individuals with cerebral palsy often exhibit crouch gait, a debilitating and inefficient walking pattern marked by excessive knee flexion that worsens with age. To address the need for improved treatment, we sought to evaluate if providing external knee extension assistance could reduce the excessi...

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Autores principales: Lerner, Zachary F., Damiano, Diane L., Bulea, Thomas C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647342/
https://www.ncbi.nlm.nih.gov/pubmed/29044202
http://dx.doi.org/10.1038/s41598-017-13554-2
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author Lerner, Zachary F.
Damiano, Diane L.
Bulea, Thomas C.
author_facet Lerner, Zachary F.
Damiano, Diane L.
Bulea, Thomas C.
author_sort Lerner, Zachary F.
collection PubMed
description Individuals with cerebral palsy often exhibit crouch gait, a debilitating and inefficient walking pattern marked by excessive knee flexion that worsens with age. To address the need for improved treatment, we sought to evaluate if providing external knee extension assistance could reduce the excessive burden placed on the knee extensor muscles as measured by knee moments. We evaluated a novel pediatric exoskeleton designed to provide appropriately-timed extensor torque to the knee joint during walking in a multi-week exploratory clinical study. Seven individuals (5–19 years) with mild-moderate crouch gait from cerebral palsy (GMFCS I-II) completed the study. For six participants, powered knee extension assistance favorably reduced the excessive stance-phase knee extensor moment present during crouch gait by a mean of 35% in early stance and 76% in late stance. Peak stance-phase knee and hip extension increased by 12° and 8°, respectively. Knee extensor muscle activity decreased slightly during exoskeleton-assisted walking compared to baseline, while knee flexor activity was elevated in some participants. These findings support the use of wearable exoskeletons for the management of crouch gait and provide insights into their future implementation.
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spelling pubmed-56473422017-10-26 The Effects of Exoskeleton Assisted Knee Extension on Lower-Extremity Gait Kinematics, Kinetics, and Muscle Activity in Children with Cerebral Palsy Lerner, Zachary F. Damiano, Diane L. Bulea, Thomas C. Sci Rep Article Individuals with cerebral palsy often exhibit crouch gait, a debilitating and inefficient walking pattern marked by excessive knee flexion that worsens with age. To address the need for improved treatment, we sought to evaluate if providing external knee extension assistance could reduce the excessive burden placed on the knee extensor muscles as measured by knee moments. We evaluated a novel pediatric exoskeleton designed to provide appropriately-timed extensor torque to the knee joint during walking in a multi-week exploratory clinical study. Seven individuals (5–19 years) with mild-moderate crouch gait from cerebral palsy (GMFCS I-II) completed the study. For six participants, powered knee extension assistance favorably reduced the excessive stance-phase knee extensor moment present during crouch gait by a mean of 35% in early stance and 76% in late stance. Peak stance-phase knee and hip extension increased by 12° and 8°, respectively. Knee extensor muscle activity decreased slightly during exoskeleton-assisted walking compared to baseline, while knee flexor activity was elevated in some participants. These findings support the use of wearable exoskeletons for the management of crouch gait and provide insights into their future implementation. Nature Publishing Group UK 2017-10-18 /pmc/articles/PMC5647342/ /pubmed/29044202 http://dx.doi.org/10.1038/s41598-017-13554-2 Text en © The Author(s) 2017 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Article
Lerner, Zachary F.
Damiano, Diane L.
Bulea, Thomas C.
The Effects of Exoskeleton Assisted Knee Extension on Lower-Extremity Gait Kinematics, Kinetics, and Muscle Activity in Children with Cerebral Palsy
title The Effects of Exoskeleton Assisted Knee Extension on Lower-Extremity Gait Kinematics, Kinetics, and Muscle Activity in Children with Cerebral Palsy
title_full The Effects of Exoskeleton Assisted Knee Extension on Lower-Extremity Gait Kinematics, Kinetics, and Muscle Activity in Children with Cerebral Palsy
title_fullStr The Effects of Exoskeleton Assisted Knee Extension on Lower-Extremity Gait Kinematics, Kinetics, and Muscle Activity in Children with Cerebral Palsy
title_full_unstemmed The Effects of Exoskeleton Assisted Knee Extension on Lower-Extremity Gait Kinematics, Kinetics, and Muscle Activity in Children with Cerebral Palsy
title_short The Effects of Exoskeleton Assisted Knee Extension on Lower-Extremity Gait Kinematics, Kinetics, and Muscle Activity in Children with Cerebral Palsy
title_sort effects of exoskeleton assisted knee extension on lower-extremity gait kinematics, kinetics, and muscle activity in children with cerebral palsy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647342/
https://www.ncbi.nlm.nih.gov/pubmed/29044202
http://dx.doi.org/10.1038/s41598-017-13554-2
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