Individuals with chronic hemiparesis post-stroke exhibit gait impairments that require functional rehabilitation through training. Exoskeletal robotic assistive devices can provide a user with continuous assistance but impose movement restrictions. There are currently devices that allow unrestricted movement but provide assistance only intermittently at specific points of the gait cycle. Our design, a cable-driven active leg exoskeleton (C-ALEX), allows the user both unrestricted movement and continuous force assistance throughout the gait cycle to assist the user in new walking patterns. In this study, we assessed the ability of C-ALEX to induce a change in the walking patterns of ten post-stroke participants using a singlesession training protocol. The ability of C-ALEX to accurately provide forces and torques in the desired directions was also evaluated to compare its design performance to traditional rigidlink designs. Participants were able to reach 91% ± 12% of their target step length and 89% ± 13 % of their target step height. The achieved step parameters differed significantly from participant baselines (p < 0.05). To quantify the performance, the forces in each cable’s out of the plane movements were evaluated relative to the in-plane desired cable tension magnitudes. This corresponded to an error of under 2Nm in the desired controlled joint torques. This error magnitude is low compared to the system command torques and typical adult biological torques during walking (2-4%) [1]. These results point to the utility of using non-restrictive cable-driven architectures in gait retraining, in which future focus can be on rehabilitating gait pathologies seen in stroke survivors.

We aimed to provide a critical review of measurement properties of mHealth technologies used for stroke survivors to measure the amount and intensity of functional skills, and to identify facilitat...

Background and Purpose: Social determinants of health (SDOH), including social networks, impact disability and quality of life post-stroke, yet the direct influence of SDOH on functional change remains undetermined. We aimed to identify which SDOH predict change on the modified Rankin Scale (mRS) within 90 days after stroke hospitalization. Methods: Stroke patients from the Transitions of Care Stroke Disparities Study (TCSDS) were enrolled from 12 hospitals in the Florida Stroke Registry. TCSDS aims to identify disparities in hospital-to-home transitions after stroke. SDOH were collected by trained interviewers at hospital discharge. The mRS was assessed at discharge, 30- and 90-day post-stroke. Multinomial logistic regression models examined contributions of each SDOH to mRS improvement or worsening (compared to no change) from discharge to 30- and 90-day, respectively. Results: Of 1190 participants, median age was 64 years, 42% were women, 52% were non-Hispanic White, and 91% had an ischemic stroke. Those with a limited social support network had greater odds of functional decline at 30 days (aOR = 1.39, 1.17–1.66), adjusting for age and onset to arrival time and at 90 days (aOR = 1.50, 1.10–2.05) after adjusting for age. Results were consistent after further adjustment for additional SDOH and participant characteristics. Individuals living with a spouse/partner had reduced odds of functional decline at 90 days (aOR = 0.74, 0.57–0.98); however, results were inconsistent with more conservative modeling approaches. Conclusion: The findings highlight the importance of SDOH, specifically having a greater number of individuals in your social network in functional recovery after stroke.

Gait recovery after stroke is a primary goal of rehabilitation, therefore it is imperative to develop technologies that accurately identify gait impairments after stroke. Markerless motion capture (MMC) is an emerging technology that has been validated in healthy individuals. Our study aims to evaluate the validity of MMC against an instrumented walkway system (IWS) commonly used to evaluate gait in stroke survivors. Nineteen participants performed three comfortable speed (CS) and three fastest speed (FS) walking trials simultaneously recorded with IWS and MMC system, KinaTrax (HumanVersion 8.2, KinaTrax Inc., Boca Raton, FL, USA). Pearson’s correlation coefficient and intraclass correlation coefficient (ICC (3,1), 95%CI) were used to evaluate the agreement and consistency between systems. Furthermore, Bland–Altman plots were used to estimate bias and Limits of Agreement (LoA). For both CS and FS, agreements between MMC and IWS were good to excellent in all parameters except for non-paretic single-limb support time (SLS), which revealed moderate agreement during CS. Additionally, stride width and paretic SLS showed poor agreement in both conditions. Biases eliminated systematic errors, with variable LoAs in all parameters during both conditions. Findings indicated high validity of MMC in measuring spatiotemporal gait parameters in stroke survivors. Further validity work is warranted.

Objective To identify race/ethnic disparities in rehabilitation services after stroke and characterize the independent associations of each of race/ethnicity and rehabilitation to functional recovery post-stroke. Methods The Transitions of Care Stroke Disparities Study (TCSD-S) is a prospective cohort study designed to reduce disparities and to optimize the transitions of care for stroke survivors throughout the state of Florida. Participant characteristics were extracted from the American Heart Association’s Get-With-The-Guidelines-Stroke dataset. Rehabilitation services, and modified Rankin Scale were recorded via follow up phone calls at 30- and 90-days after hospital discharge. Logistic regression models adjusted for potential confounders were used to determine: 1) race/ethnic differences in rehabilitation services received; 2) race/ethnic differences in functional change from discharge to 30- and 90-days, respectively; and 3) the influence of rehabilitation on functional change from discharge to 30- and 90-days. Results Of 1,083 individuals, 43% were female, 52% were Non-Hispanic White (NHW), 22% were Non-Hispanic Black (NHB), and were 22% Hispanic. Individuals who engaged in rehabilitation were more likely to show improvements [aOR=1.820, 95%CI (1.301,2.545)] at 90-days from hospital discharge. Irrespective of rehabilitation services, there were no differences in functional change between NHW and NHB individuals, yet Hispanic individuals were less likely to improve [aOR=0.647, 95%CI (0.425,0.983)] compared to NHW. Additionally, Hispanic individuals were significantly less likely to receive any rehabilitation services [aOR=0.626, 95%CI (0.442,0.886)] and were half as likely to receive outpatient services [aOR=0.543, 95%CI (0.368,0.800)] as compared to NHW. Conclusions Rehabilitation is key to functional improvement after stroke. We are making strides in health equity between NHW and NHB individuals, yet there remain disparities in functional outcomes and in rehabilitation services particularly for Hispanic individuals after stroke.