Robotic exoskeleton training improves walking in adolescents with acquired brain injury

A team of New Jersey researchers has shown that gait training using robotic exoskeletons improved motor function in adolescents and young adults with acquired brain injury.

The article, “Kinetic gait changes after robotic exoskeleton training in adolescents and young adults with acquired brain injury” (doi: 10.1155/2020/8845772), was published October 28, 2020 in Applied Bionics and Biomechanics. It is available open access at: https://www.hindawi.com/journals/abb/2020/8845772/

The authors are Kiran Karunakaran, PhD, Naphtaly Ehrenberg, MS, and Karen Nolan, PhD, from the Center for Mobility and Rehabilitation Engineering Research at Kessler Foundation, and JenFu Cheng, MD, and Katherine Bentley, MD, from Children’s Specialized Hospital. Drs. Karunakaran, Nolan, Cheng, and Bentley are also affiliated with the Department of Physical Medicine and Rehabilitation at Rutgers New Jersey Medical School.

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Acquired brain injury often results in hemiparesis, causing significant deficits in balance and gait that adversely affect functional ambulation and participation in activities of daily living. Gait training using robotic exoskeletons offers an option for motor rehabilitation in individuals with hemiparesis, but few studies have been conducted in adolescents and young adults. Findings from a preliminary study in this age group show promise for this intervention, according to Drs. Karunakaran and Nolan.

Robotic gait training with a participant with ABI administered by a trained physical therapist.
Robotic gait training with a participant with ABI administered by a trained physical therapist. Credit: Applied Bionics and Biomechanics

Participants included seven individuals (aged 13 to 28 years) with acquired brain injury (ABI) and hemiparesis and one healthy control. The ABI group included individuals with brain injuries due to anoxia, trauma, and stroke. All participants received 12 45-minute sessions of high-dose, repetitive gait training in a robotic exoskeleton (EksoGT, Ekso Bionics, Inc.) over a 4-week period. The gait training was administered by a licensed physical therapist supervised by a member of the research team.

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“At the end of the 4-week training, participants had progressed to a more normal gait pattern,” said Dr. Karunakaran, “including improved loading, a longer step length and faster walking speed” Although results are promising, Dr. Nolan acknowledged the limitations of the study, including small sample size and lack of a control group: “Further study is needed to confirm the training effect in this age group with ABI, optimal dosing for the training protocol, and the durability of functional improvements.”


Kessler Foundation

Journal Reference

Kinetic Gait Changes after Robotic Exoskeleton Training in Adolescents and Young Adults with Acquired Brain Injury



Acquired brain injury (ABI) is one of the leading causes of motor deficits in children and adults and often results in motor control and balance impairments. Motor deficits include abnormal loading and unloading, increased double support time, decreased walking speed, control, and coordination.

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These deficits lead to diminished functional ambulation and reduced quality of life. Robotic exoskeletons (RE) for motor rehabilitation can provide the user with consistent, symmetrical, goal-directed repetition of movement, as well as balance and stability. 


The goal of this preliminary prospective before and after study is to evaluate the therapeutic effect of RE training on the loading/unloading and spatial-temporal characteristics in adolescents and young adults with chronic ABI.


Seven participants diagnosed with ABI between the ages of 14 and 27 years participated in the study. All participants received twelve 45 minute sessions of RE gait training.

The bilateral loading (linearity of loading and rate of loading), speed, step length, swing time, stance time, and total time were collected using Zeno™ walkway (ProtoKinetics, Havertown, PA, USA) before and after RE training.


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Results from the study showed improved step length, speed, and an overall progression towards healthy bilateral loading, with linearity of loading showing a significant therapeutic effect (p <  0.05).


These preliminary results suggest that high dose, repetitive, consistent gait training using RE has the potential to induce recovery of function in adolescents and young adults diagnosed with ABI.

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