Autonomous Powered Ankle Exoskeleton Improves Foot Clearance and Knee Hyperextension After Stroke: A Case Study

Hemiparetic gait is often characterized by ankle weakness, resulting in decreased propulsion and clearance, as well as knee hyperextension. These gait deviations reduce speed and efficiency while increasing the risk of falls and osteoarthritis. Powered ankle exoskeletons have the potential to address these issues. However, only a handful of studies have investigated their effects on hemiparetic gait. The results are often inconsistent, and the biomechanical analysis rarely includes the knee or hip joint or a direct clearance measure. In this case study, we assess the ankle, knee, and hip biomechanics with and without a new autonomous powered ankle exoskeleton across different speeds and inclines. Exoskeleton assistance resulted in more normative kinematics at the subject's self-selected walking speed. The paretic ankle angle at heel strike increased from 10° plantarflexed without the exoskeleton to 0.5° dorsiflexed with the exoskeleton, and the peak plantarflexion angle during swing decreased from 28° without the exoskeleton to 12° with the exoskeleton. Furthermore, stance knee flexion increased from 7° without the exoskeleton to 20° with the exoskeleton. Finally, foot clearance increased with the exoskeleton for all conditions between 3.1 cm and 5.4 cm. This case study highlights new mechanisms for powered ankle exoskeletons to improve hemiparetic gait.