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.

This systematic review aimed to explore comprehensive evidence on the efficacy of the 3D-printed ankle-foot orthoses (AFOs) on gait parameters in individuals with neuromuscular and/or musculoskeletal ankle impairments. Electronic databases including PubMed, Scopus, Web of Science, Embase, ProQuest, Cochrane, and EBSCOhost were searched from inception to August 2023. Ten studies that had participants with ankle impairments, as a result of stroke, cerebral palsy, mechanical trauma, muscle weakness, or Charcot-Marie-Tooth disease, investigated the immediate effects of the 3D-printed AFOs on gait parameters were included. Methodological rigor was evaluated using the modified Downs & Black index. The gait parameters included lower extremity joint angles, moments, and work/power, plantar pressures, spatiotemporal measures, and patient satisfaction were improved with the 3D-printed AFOs when compared to the no-AFO (i.e. barefoot, or shoe-only) conditions. 3D-printed AFOs revealed similar functional efficacy as conventional AFOs. Notably, the level of patient satisfaction regarding fitting and comfort was higher with the 3D-printed AFOs. Although the study on the effects of the 3D-printed AFOs are limited, emerging evidence indicates their effectiveness in improving gait biomechanics and functions. To further confirm their effects, rigorous randomized control studies with larger sample sizes and longer follow-ups on the effects are warranted in the future.

Impaired neuromuscular function in individuals with diabetes can adversely affect gait kinematics, kinetics, and electromyography, potentially increasing the risk of serious complications such as plantar ulcers and amputations. However, it remains unclear whether these changes are associated with alterations in muscle synergies. This study aims to examine muscle synergies in individuals with diabetes. Surface electromyography recordings were obtained from seven lower extremity muscles (vastus lateralis, rectus femoris, biceps femoris, semitendinosus, lateral gastrocnemius, soleus, and tibialis anterior) during 20 trials of barefoot walking. Eleven individuals with type 2 diabetes without diabetic neuropathy and ten age-matched controls were recruited. Variations in synergy complexity were assessed by the number of synergies needed to account for >90 % of the total variance in the electromyography data, total variance accounted for by one synergy, and total variance accounted for by four synergies. Synergy weights and activations for a four-synergy solution were compared using cosine similarity. An electromyography co-contraction index was computed for agonist and antagonist pairs of muscles. Those with diabetes did not significantly differ from controls in the number of synergies, total variance accounted for by one synergy, total variance accounted for by four synergies, or synergy composition. However, they demonstrated higher levels of variability in synergy composition similarity. These results indicate that, at the group level, individuals with diabetes without neuropathy employ largely similar motor control strategies as their healthy counterparts while walking, and previously reported variations in gait biomechanics in this population may be attributed to peripheral neuromuscular dysfunction.