Robot-Aided Training of Propulsion During Walking: Effects of Torque Pulses Applied to the Hip and Knee Joints During Stance

We sought to evaluate the effects of the application of torque pulses to the hip and knee joint via a robotic exoskeleton in the context of training propulsion during walking. Based on our previous study, we formulated a set of conditions of torque pulses applied to the hip and knee joint associated with changes in push-off posture, a component of propulsion. In this work, we quantified the effects of hip/knee torque pulses on metrics of propulsion, specifically hip extension (HE) and normalized propulsive impulse (NPI), in two experiments. In the first experiment, we exposed 16 participants to sixteen conditions of torque pulses during single strides to observe the immediate effects of pulse application. In the second experiment, we exposed 16 participants to a subset of those conditions for 200 strides to quantify short-term adaptation effects. During pulse application, NPI aligned with the expected modulation of push-off posture, while HE was modulated in the opposite direction. The timing of the applied pulses, early or late stance, was crucial, as the effects were often in the opposite direction when changing timing condition. Extension torque applied at late stance increased HE in both experiments - range of change in HE: (2.9 ± 0.4 deg, 7.7 ± 1.0 deg), p <; 0.001. The same conditions resulted in a negative change in NPI only in the single pulse experiment - change in NPI for knee torque: -3.0 ± 0.4 ms, p <; 0.001 - and no significant change for hip torque. Also, knee extension and flexion torque during early and late stance, respectively, increased NPI during single pulse application - range of change in NPI: (3.8, 4.6) ± 0.8 ms, p <; 0.001. During repeated pulse application, NPI increased for late stance flexion torque - range of change in NPI: (4.5 ± 0.7 ms, 4.8 ± 0.8 ms), p <; 0.001 , but not late stance extension torque. After exposure, we observed positive after-effects in HE in three conditions - range of change in HE: (2.0 ± 0.3 deg, 3.7 ± 0.7 deg) p <; 0.001 - and significant positive after-effects in NPI for early stance flexion torques - change in NPI: (2.7 ± 0.6 ms, p <; 0.001). These results indicate that positive propulsive after-effects can be achieved through repeated exposure to torque pulses.