Exoskeleton-assisted gait in chronic stroke: An EMG and functional near-infrared spectroscopy study of muscle activation patterns and prefrontal cortex activity

Clin Neurophysiol. 2020 Aug;131(8):1775-1781. doi: 10.1016/j.clinph.2020.04.158. Epub 2020 May 18.


Objectives: Gait impairment dramatically affects stroke patients' functional independence. The Ekso™ is a wearable powered exoskeleton able to improve over-ground gait abilities, but the relationship between the cortical gait control mechanisms and lower limbs kinematics is still unclear. Our aims are: to assess whether the Ekso™ induces an attention-demanding process with prefrontal cortex activation during a gait task; to describe the relationship between the gait-induced muscle activation pattern and the prefrontal cortex activity.

Methods: We enrolled 22 chronic stroke patients and 15 matched controls. We registered prefrontal cortex (PFC) activity with functional Near-Infrared Spectroscopy (fNIRS) and muscle activation with surface-electromyography (sEMG) during an over-ground gait task, performed with and without the Ekso™.

Results: We observed prefrontal cortex activation during normal gait and a higher activation during Ekso-assisted walking among stroke patients. Furthermore, we found that muscle hypo-activation and co-activation of non-paretic limb are associated to a high prefrontal metabolism.

Conclusions: Among stroke patients, over-ground gait is an attention-demanding task. Prefrontal activity is modulated both by Ekso-assisted tasks and muscle activation patterns of non-paretic lower limb. Further studies are needed to elucidate if other Ekso™ settings induce different cortical and peripheral effects.

Significance: This is the first study exploring the relationship between central and peripheral mechanisms during an Ekso-assisted gait task.

Keywords: Exoskeleton device; Gait; Lower extremity; Personalized medicine; Prefrontal cortex; Stroke.

MeSH terms

  • Aged
  • Biomechanical Phenomena
  • Electromyography
  • Exercise Therapy
  • Exoskeleton Device*
  • Female
  • Gait / physiology*
  • Humans
  • Male
  • Middle Aged
  • Muscle, Skeletal / diagnostic imaging*
  • Muscle, Skeletal / physiopathology
  • Prefrontal Cortex / diagnostic imaging*
  • Prefrontal Cortex / physiopathology
  • Spectroscopy, Near-Infrared
  • Stroke / diagnostic imaging*
  • Stroke / physiopathology
  • Stroke Rehabilitation