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OBJECTIVE: Many individuals with cerebral palsy (CP) experience gait deficits resulting in metabolically-inefficient ambulation that is exacerbated by graded walking terrains. The primary goal of this study was to clinically-validate the accuracy and efficacy of adaptive ankle exoskeleton assistance during steady-state incline walking and stair ascent in individuals with CP. Exploratory goals were to assess safety and feasibility of using adaptive ankle exoskeleton assistance in real-world mixed-terrain settings. METHODS: We used a novel battery-powered ankle exoskeleton to provide adaptive ankle plantar-flexor assistance during stance phase. Seven ambulatory individuals with CP completed the study. RESULTS: Adaptive controller accuracy was 85% for incline walking and 81% for stair-stepping relative to the biological ankle moment. Assistance improved energy cost of steady-state incline walking by 14% (p = 0.004) and stair ascent by 21% (p = 0.001) compared to walking without the device. Assistance reduced the muscular demand for the soleus and vastus lateralis during both activities. All participants were able to safely complete the real-world mixed-terrain route, with adaptive ankle assistance resulting in improved outcomes compared to walking with the device providing zero-torque; no group-level differences were found compared to walking without the device, yet individuals with more impairment exhibited a marked improvement. CONCLUSION: Adaptive ankle exoskeleton assistance can improve the energy cost of steady-state incline walking and stair ascent in individuals with CP. SIGNIFICANCE: As the first study to demonstrate safety and performance benefits of ankle assistance on graded terrains in CP, these findings encourage further investigation in free-living settings.

Objective: To determine the effects of providing battery-powered ankle dorsiflexor and plantar flexor exoskeleton assistance on six-minute walk test performance and efficiency in children and young adults with cerebral palsy by comparing distance walked under exoskeleton assisted (Assisted) and no device (Shod) walking conditions, and explore the acclimation rate to maximal walking with ankle exoskeleton assistance. Results: Six-minute walk test performance significantly improved under the final Assisted condition test compared to the Shod condition (42 ± 27 m, p = 0.02), surpassing the minimum clinically important difference range for children and young adults with CP. There was no difference in walking efficiency (-0.06 ± 0.1, p = 0.3). Participants had an average acclimation rate of 19.6 m per session. Conclusions: Powered ankle assistance can significantly improve six-minute walk test performance in individuals with mild-to-moderate gait impairment from CP, supporting the use of this intervention to improve functional mobility and walking capacity in this patient population.

People with lower-limb hemiparesis have impaired function on one side of the body that affects their walking ability. Wearable robotic assistance has been investigated to treat hemiparetic gait by applying assistance to the paretic limb. In this exploratory case series, we sought to compare the effects of bilateral vs. paretic-limb-only ankle exoskeleton assistance on walking performance in a case series of three heterogeneous presentations of lower-limb hemiparesis. A secondary goal was to validate the use of a real-time ankle-moment-adaptive exoskeleton control system for effectively assisting hemiparetic gait; the ankle moment controller accuracy ranged from 72 - 90% across all conditions and participants. Compared to walking without the device, both paretic-limb-only and bilateral assistance resulted in greater average total ankle power (up to 72%), improved treadmill walking efficiency (up to 28%), and increased over-ground walking distance (up to 41%). All participants achieved a more symmetrical, efficient gait pattern with bilateral assistance, indicating that assisting both limbs may be more beneficial than assisting only the paretic side in people with hemiparetic gait. The results of this case series are intended to inform future clinical studies and exoskeleton designs in a wide range of patient populations.