Background: Robotic exoskeleton devices enable individuals with lower extremity weakness to stand up and walk over ground with full weight-bearing and reciprocal gait. Limited information is available on how a robotic exoskeleton affects gait characteristics. Objective: The purpose of this study was to examine whether wearing a robotic exoskeleton affects temporospatial parameters, kinematics, and muscle activity during gait. Methods: The study was completed by 15 healthy adults (mean age 26.2 [SD 8.3] years; 6 males, 9 females). Each participant performed walking under 2 conditions: with and without wearing a robotic exoskeleton (EKSO). A 10-camera motion analysis system synchronized with 6 force plates and a surface electromyography (EMG) system captured temporospatial and kinematic gait parameters and lower extremity muscle activity. For each condition, data for 5 walking trials were collected and included for analysis. Results: Differences were observed between the 2 conditions in temporospatial gait parameters of speed, stride length, and double-limb support time. When wearing EKSO, hip and ankle range of motion (ROM) were reduced and knee ROM increased during the stance phase. However, during the swing phase, knee and ankle ROM were reduced when wearing the exoskeleton bionic suit. When wearing EKSO, EMG activity decreased bilaterally in the stance phase for all muscle groups of the lower extremities and in the swing phase for the distal muscle groups (tibialis anterior and soleus) as well as the left medial hamstrings. Conclusions: Wearing EKSO altered temporospatial gait parameters, lower extremity kinematics, and muscle activity during gait in healthy adults. EKSO appears to promote a type of gait that is disparate from normal gait in first-time users. More research is needed to determine the impact on gait training with EKSO in people with gait impairments.

Neck pain is a widespread medical condition among office workers worldwide. This study aimed to compare physical exercises, including basic body awareness, neck-specific training exercises and ergonomic modifications, and ergonomic modifications alone in the management of chronic non-specific neck pain (NSNP) among office workers. Sixty participants were randomly allocated to an experimental group (physical exercises and ergonomic modifications) or a control group (ergonomic modifications) and received the intervention two times a week for eight weeks. The Numerical Pain Rating Scale, Neck Disability Index, Health and Safety Stress Tool, and Short Form Health Survey-36 were used to measure pain, disability, job stress, and quality of life at baseline, and at weeks 4 and 8 of the study period. A repeated measure ANOVA was used to determine the within-group significant differences and an independent t-test was utilized to compare group differences. The baseline data of the experimental and control groups showed no significant difference (p ≥ 0.05). The 2 × 3 mixed models ANOVA showed a significant difference in pain intensity (p = 0.001, ηp² = 0.042), functional disability (p = 0.001, ηp² = 0.052), work-related stress (p = 0.001, ηp² = 0.036), and QoL (p = 0.012, ηp² = 0.025). Four weeks post-intervention, the experimental group showed significant changes in primary (pain intensity and disability) (1.9; 95% confidence interval 1.65–2.14) and secondary (quality of life and work-related stress) outcomes (p < 0.001). The same gradual improvement in these variables was observed in the 8-week follow-up (p < 0.001). There was a significant improvement in clinical outcomes following the application of physical exercises with ergonomic modifications for chronic NSNP among office workers. This is significant for office workers because it suggests the importance of incorporating physical exercises into their daily routine and making ergonomic changes to their workspaces.

Background: Robotic Exoskeletons (EKSO) are novel technology for retraining common gait dysfunction in people post-stroke. EKSO’s capability to influence gait characteristics post-stroke is unknown. Objectives: To compare temporospatial, kinematic, and muscle activity gait characteristics before and after a single EKSO session and examine kinematic symmetry between involved and uninvolved limbs. Methods: Participants post-stroke walked under two conditions: pre-EKSO, and immediately post-EKSO. A 10-camera motion capture system synchronized with 6 force plates was used to obtain temporospatial and kinematic gait characteristics from 5 walking trials of 9 meters at a self-selected speed. Surface EMG activity was obtained from bilateral gluteus medius, rectus femoris, medial hamstrings, tibialis anterior, and soleus muscles. Wilcoxon Signed Rank tests were used to analyze differences pre- and post-EKSO. Single EKSO session consisted of 22.3±6.8 minutes total time (walk time=7.2±1.5 minutes) with 250±40 steps. Results: Six ambulatory (Functional Ambulation Category, range=4-5) adults (3 female; 44.7±14.6 years) with chronic stroke (4.5±1.9 years post-stroke) participated. No significant differences were observed for temporospatial gait characteristics. Muscle activity was significantly less post-EKSO in the involved leg rectus femoris during swing phase (p=0.028). Ankle dorsiflexion range of motion on the involved leg post-EKSO was significantly less during stance phase (p=0.046). Differences between involved and uninvolved joint range of motion symmetry were found pre-EKSO but not post-EKSO in swing phase hip flexion and stance phase knee flexion and knee extension. Conclusions: EKSO training appears capable of altering gait in people with chronic stroke and a viable intervention to reduce gait dysfunction post-stroke.

Background: Stroke and its associated complications are a major cause of long-term disability worldwide, with spasticity being a common and severe issue. Physical therapy, involving stretching exercises and electrical stimulation, is crucial for managing spasticity. Therefore, this study aimed to evaluate the effects of neuromuscular electrical stimulation (NMES) combined with a conventional rehabilitation program (CRP) on plantarflexor muscle spasticity and walking performance among individuals with chronic stroke. Methods: A pilot randomized clinical trial (RCT) with two groups (active NMES and placebo) was conducted at the physical therapy departments of King Fahad Specialist Hospital, Buraydah, and Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia (November 2020). The assessor and participants were blinded for the group assignment. The active NMES group received exercise and stimulation at the dorsiflexor muscles on the paretic leg for 30 min for 12 sessions. The placebo group received exercise and sham stimulation at the same position and duration as the active group. Of interest were the outcomes for plantarflexor muscle spasticity measured by the modified Ashworth scale (MAS), gait speed measured by 10 m walk test (10-MWT), and functional mobility measured by functional ambulatory category (FAC). Results: Nineteen participants were randomized into active NMES (n = 10) and sham NMES (n = 9) groups, with no significant baseline differences. Within the active NMES group, significant improvements were observed in MAS (p = 0.008), 10-MWT (p = 0.028), and FAC (p = 0.046), while only 10-MWT time improved significantly in the sham NMES group (p = 0.011). Between-group analysis showed that only MAS was significantly lower in the active NMES group (p = 0.006). Percent change analysis indicated a significantly higher increase in percent change for MAS in the active NMES group compared to the sham NMES group (p = 0.035), with no significant differences in other outcome measures. Conclusions: This study showed that NMES in the active group led to significant improvements in spasticity, walking performance, and functional ambulation. Further research is needed to determine the ideal parameters, protocols, and patient selection criteria for NMES interventions in stroke rehabilitation.

Background: Lower body positive pressure (LBPP) emerges for rehabilitation practice tool for athletic and orthopedic conditions. However, LBPP may provide an opportunity therapeutic intervention for gait training in neurological conditions. Objectives: To assess the effectiveness of LBPP gait training on ambulation ability, gait speed, walking endurance, dynamic and static balance, and quality of life in individuals with chronic stroke. Methods: Participants performed LBPP gait training three days a week for six weeks. The main outcome measures were functional ambulation categories (FAC), 10-meter walk test (10-MWT), 6 minutes walking test (6MWT), timed up and go (TUG), functional reach test (FRT), and short-form (SF-36) health survey. Results: Nine chronic stroke (one female, eight males) aged 57 ± 15.4 years with stroke since 4.8 ± 3.9 years participated in LBPP gait training. participants showed significant improvement in FAC (pre, 4 ± 2; post, 5 ± 1; P = 0.034); 10-MWT (pre, 16.35 ± 9.34 s; post, 13.25 ± 7.57 s; P = 0.021) and 6 MWT (pre, 166.22 ± 94.15; post, 206.66 ± 103.64; P = 0.048). No significant differences were observed in the other outcomes. Conclusions: Six weeks of LBPP gait training may potentially improve ambulation ability, gait speed, and walking endurance in individuals with chronic stroke.

Background: Among various body weight-supported locomotor training methods for neurological patients, some studies have recognized the lower body positive pressure (LBPP) treadmill as superior for gait training in neurological patients. The aim of this study is to explore the clinical use and efficacy of LBPP treadmill gait training in neurological patients. Methods: A systematic review was performed following PRISMA guidelines. The inclusion criteria were studies published in English using LBPP with neurological patients were included from the database's inception to March 2023 to avoid misinterpretation of translation. The search was conducted in multiple databases, including Google Scholar, PubMed, Scopus, PEDro, and the Cochrane Database. To improve accuracy and comprehensiveness, studies mentioned in the main articles were also evaluated. Results: The search identified 16 articles that use LBPP with neurological patients. Only a few randomized control studies on the use of LBPP after stroke have been reported. For neurological rehabilitation, LBPP treadmill gait training is safe and feasible. Current research suggests that using the LBPP treadmill in conjunction with traditional rehabilitation treatment has a successively beneficial impact on motor function, particularly in patients with subacute to chronic stroke and Parkinson’s disease. There are no studies that compare the LBPP to the body weight supported treadmill (BWST). Furthermore, to the best of our knowledge, the LBPP treadmill has not yet been evaluated on for its effectiveness in treating traumatic brain injury (TBI) or spinal cord injury (SCI). Conclusion: There was insufficient evidence to support the claim that LBPP is effective and superior to other gait training methods. Larger randomized control studies with sufficient sample sizes are needed to better understand the potential effects of the LBPP treadmill intervention on the functional performance of people with neurological disorders.