A soft robotic exosuit improves walking in patients after stroke

Stroke-induced hemiparetic gait is characteristically slow and metabolically expensive. Passive assistive devices such as ankle-foot orthoses are often prescribed to increase function and independence after stroke; however, walking remains highly impaired despite-and perhaps because of-their use. We sought to determine whether a soft wearable robot (exosuit) designed to supplement the paretic limb's residual ability to generate both forward propulsion and ground clearance could facilitate more normal walking after stroke. Exosuits transmit mechanical power generated by actuators to a wearer through the interaction of garment-like, functional textile anchors and cable-based transmissions. We evaluated the immediate effects of an exosuit actively assisting the paretic limb of individuals in the chronic phase of stroke recovery during treadmill and overground walking. Using controlled, treadmill-based biomechanical investigation, we demonstrate that exosuits can function in synchrony with a wearer's paretic limb to facilitate an immediate 5.33 +/- 0.91 degrees increase in the paretic ankle's swing phase dorsiflexion and 11 +/- 3% increase in the paretic limb's generation of forward propulsion (P < 0.05). These improvements in paretic limb function contributed to a 20 +/- 4% reduction in forward propulsion interlimb asymmetry and a 10 +/- 3% reduction in the energy cost of walking, which is equivalent to a 32 +/- 9% reduction in the metabolic burden associated with poststroke walking. Relatively low assistance (similar to 12% of biological torques) delivered with a lightweight and nonrestrictive exosuit was sufficient to facilitate more normal walking in ambulatory individuals after stroke. Future work will focus on understanding how exosuit-induced improvements in walking performance may be leveraged to improve mobility after stroke.