Repeated Robot-Assisted Unilateral Stiffness Perturbations Result in Significant Aftereffects Relevant to Post-Stroke Gait Rehabilitation

Due to hemiparesis, stroke survivors frequently develop a dysfunctional gait that is often characterized by an overall decrease in walking speed and a unilateral decrease in step length. With millions currently affected by this dysfunctional gait, robust and effective rehabilitation protocols are needed. Although robotic devices have been used in numerous rehabilitation protocols for gait, the lack of significant aftereffects that translate to effective therapy makes their application still questionable. This paper proposes a novel type of robot-assisted intervention that results in significant aftereffects that last much longer than any other previous study. With the utilization of a novel robotic device, the Variable Stiffness Treadmill (VST), the stiffness of the walking surface underneath one leg is decreased for a number of steps. This unilateral stiffness perturbation results in a significant aftereffect that is both useful for stroke rehabilitation and often lasts for over 200 gait cycles after the intervention has concluded. More specifically, the aftereffect created is an increase in both left and right step lengths, with the unperturbed step length increasing significantly more than the perturbed. These effects may be helpful in correcting two of the most common issues in post-stroke gait: overall decrease in walking speed and a unilateral shortened step length. The results of this work show that a robot-assisted therapy protocol involving repeated unilateral stiffness perturbations can lead to a more permanent and effective solution to post-stroke gait.