Wearable exoskeleton control modes selected during overground walking affect muscle synergies in adults with a chronic incomplete spinal cord injury

• Published in: Spinal cord series and cases Vol. 6; no. 1; p. 26
• Main Authors: Escalona, Manuel J, Bourbonnais, Daniel, Goyette, Michel, Duclos, Cyril, Gagnon, Dany H
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 24.04.2020; Nature Publishing Group UK
• Subjects: Clinical medicine; Interdisciplinary aspects; Laboratories; Professional ethics; Rehabilitation; Robotics; Spinal cord injuries; Walking
• ISSN: 2058-6124; 2058-6124
• DOI: 10.1038/s41394-020-0269-6

Case series. Changes in the number of muscle synergies (MSs) and in the weighting of muscles composing each MS are typically altered following an incomplete spinal cord injury (iSCI). Wearable robotic exoskeletons (WRE) represent a promising rehabilitation option, though the effects of various WRE control modes on MSs still remain unknown. This case series characterizes how WRE control modes affect the number of MSs and the weighting of muscles composing each MS in individuals with iSCI. Pathokinesioly laboratory of a rehabilitation research center. Three participants with a chronic iSCI walked at a self-selected comfortable speed without and with a WRE set in two trajectory-controlled (Total Assistance, TOT; Assistance-as-Needed, ADAPT) and three non-trajectory controlled modes (High Assistance, HASSIST; High Resistance, HRESIST; NEUTRAL). Surface EMG of eight lower extremity (L/E) muscles was recorded and used to extract MSs using a nonnegative matrix factorization algorithm. Cosine similarity and weighting relative differences characterized similarities in MSs between individuals with iSCI and able-bodied controls. The mode providing movement assistance within a self-selected L/E trajectory (HASSIST) best replicated MSs in able-bodied controls during overground walking. MSs extracted with the trajectory-controlled modes differed to the greatest extent from able-bodied group MSs. Most WRE control modes did not replicate the motor control required for typical L/E muscle coordination during stereotypical overground walking. These results highlight the need to gain a better understanding of the effects of various control modes on L/E motor control for rehabilitation professionals to incorporate research evidence when selecting WRE control mode(s) during WRE locomotor interventions.