Effects of overground walking with a robotic exoskeleton on lower limb muscle synergies

Les exosquelettes robotisés de marche (ERM) représentent une intervention prometteuse dans le domaine de la réadaptation locomotrice. Sur le plan clinique, les ERM facilitent la mise en application de principes de neuroplasticité. Jusqu'à présent, la majorité des études analysant les effets de l’ERM a été menée avec des ERM fournissant une assistance robotique complète le long d’une trajectoire de mouvements prédéfinie des membres inférieurs (MI) de façon à reproduire la marche de façon quasi parfaite à très basse vitesse. La nouvelle génération d’ERM, maintenant disponible sur le marché, propose de nouveaux modes de contrôles qui permettent, entre autres, une liberté de mouvement accrue aux MIs (c.-à-d. trajectoire non imposée) et une possibilité d’offrir une assistance ou résistance aux mouvements de différentes intensités surtout pendant la phase d’oscillation du cycle de marche. Cependant, les effets de ces modes de contrôles sur la coordination musculaire des MI pendant la marche au sol avec l’ERM, caractérisé via l’extraction de synergies musculaires (SM), restent méconnus. Cette thèse mesure et compare les caractéristiques des SM (c.-à-d. nombre, profils d’activation, composition musculaire et contribution relative des muscles) pendant la la marche au sol sans ou avec un ERM paramétré avec six différents modes de contrôle chez des individus en bonne santé (articles #1 et #2) et d’autres ayant une lésion médullaire incomplète (LMI) (article #3). Les signaux électromyographiques (EMG) des différents muscles clés des MI, enregistrés lors de la marche, ont été utilisés afin d’extraire les SM avec un algorithme de factorisation matricielle non négative. La similarité des cosinus et les coefficients de corrélation ont caractérisé les similitudes entre les caractéristiques des SM. Les résultats montrent que: 1) les profils d'activation temporelle et le nombre de SM sont modifiés en fonction de la vitesse de marche avec, entre autres une augmentation de la vitesse de marche entrainant une fusion de SM, chez les individus en bonne santé marchant sans ERM ; 2) lorsque ces derniers marchent avec un ERM, les différents modes de contrôle testés ne dupliquent pas adéquatement les SM retrouvées lors de la marche sans ERM. En fait, uniquement le mode de contrôle libérant la contrainte de trajectoire de mouvements des MIs dans le plan sagittal lors de la phase d’oscillation reproduit les principales caractéristiques des SM retrouvées pendant la marche sans ERM ; 3) le nombre et la composition musculaire des SM sont modifiés pendant la marche sans ERM chez les personnes ayant une LMI. Cependant, parmi tous les modes de contrôle étudiés, seul le mode de contrôle libérant le contrôle de la trajectoire de mouvements des MI et assistant l’oscillation du MIs (c.-à-d. HASSIST) permets l’extraction de SM similaire à celles observées chez des individus en santé lors d'une marche sans ERM. Dans l’ensemble, cette thèse a mis en évidence le fait que différentes demandes biomécaniques liées à la marche (c.-à-d. vitesse de marche, modes de contrôle de l’ERM) modifient le nombre et les caractéristiques de SM chez les personnes en santé. Cette thèse a également confirmé que la coordination musculaire, mise en évidence via l’analyse de SM, est altérée chez les personnes ayant une LMI et a tendance à se normaliser lors de la marche avec l’ERM paramétré dans le mode de HASSIST. Les nouvelles preuves appuieront les professionnels de la réadaptation dans le processus de prise de décision concernant la sélection du mode de contrôle des MIs lors de l’entrainement locomoteur utilisant avec un ERM.Wearable robotic exoskeletons (WRE) represent a promising rehabilitation intervention for locomotor rehabilitation training that aligns with activity-based neuroplasticity principles in terms of optimal sensory input, massed repetition, and proper kinematics. Thus far, most studies that investigated the effects of WRE have used WRE that provide full robotic assistance and fixed trajectory guidance to the lower extremity (L/E) to generate close-to-normal walking kinematics, usually at very slow speeds. Based on clinicians’ feedback, current commercially-available WRE have additional control options to be able to integrate these devices into the recovery process of individuals who have maintained some ability to walk after an injury to the central nervous system. In this context, WRE now offer additional degrees of movements for the L/E to move freely and different strategies to assist or resist movement, particularly during the gait cycle’s swing phase. However, the extent that these additional WRE control options affect L/E neuromuscular control during walking, typically characterized using muscle synergies (MSs), remains unknown. This thesis measures and compares MSs characteristics (i.e., number, temporal activation profile, and muscles contributing to a specific synergy [weightings]) during typical overground walking, with and without a WRE, in six different control modes, in abled-bodied individuals (Articles #1 and #2) and individuals with incomplete spinal cord injury (iSCI; Article #3). Surface EMG of key L/E muscles were recorded while walking and used to extract MSs using a non-negative matrix factorization algorithm. Cosine similarity and correlation coefficients characterized, grouped, and indicated similarities between MS characteristics. Results demonstrated that: 1) the number of MSs and MS temporal activation profiles in able-bodied individuals walking without WRE are modified by walking speed and that, as speed increased, specific MSs were fused or merged compared to MSs at slow speeds; 2) In able-bodied individuals walking with WRE, few WRE control modes maintained the typical MSs characteristics that were found during overground walking without WRE. Moreover, freeing the L/E swing trajectory imposed by the WRE best reproduced those MSs characteristics during overground walking without the WRE; and 3) After an iSCI, alterations to the number and the composition of MSs were observed during walking without WRE. However, of all WRE control modes that were investigated, only HASSIST (i.e., freeing WRE control over L/E swing trajectory while assisting the user’s self-selected trajectory) reproduced the number and composition of MSs found in abled-bodied individuals during overground walking without WRE. Altogether, the results of this thesis demonstrated that different walking-related biomechanical demands (i.e., walking speed) and most of the WRE control modes can alter some MSs, and their characteristics, in able-bodied individuals. This research also confirmed that impaired muscle coordination, assessed via MSs, can adapt when walking with a WRE set with specific control options (e.g., HASSIST). These MS adaptations mimicked typical MS characteristics extracted during overground walking. The evidence generated by this thesis will support the decision-making process when selecting specific L/E control options during WRE walking, allowing rehabilitation professionals to refine WRE locomotor training protocols

Mechanisms of Sensorimotor Impairment in Multiple Sclerosis

Sensorimotor impairments in people with multiple sclerosis (MS) might alter coordination and balance strategy during functional movements. People with MS often have symptoms such as weakness and discoordination in the lower limbs, resulting in poor walking and balance function. This decrease in function can result in falls, decreased community activity, unemployment, and reduced quality of life. As MS is a progressive disease resulting in a range of dysfunction, the amount of lower limb impairment can cause changes to walking and balance strategies to maintain functional performance. The overall objective of this dissertation was to quantify the impairment at the hip and ankle, and characterize the effects of impairment on walking and balance in MS. To quantify the lower limb impairment, a custom-built robot was used to impose movement to the legs about the hip and ankle joint separately. Joint torque and work done were used as quantitative measures of strength during isometric contraction and coordination during subject assisted leg movements in MS and healthy control subjects. To characterize the effect of impairment on functional movements, motion analysis was used to record kinematic and kinetic parameters during overground walking and during a challenging arm tracking task in standing. Hip and ankle sagittal moments were used to quantify the contribution of each joint to functional movement. The findings from these studies suggest that there is a greater sensorimotor impairment at the ankle than the hip in MS, resulting in a reduced reliance on the ankle during walking and an increased hip versus ankle strategy during upper body movements. This was observed by increased negative work at the ankle during assisted bilateral leg movements, reduced ankle moments during stance in gait, and increased hip versus ankle contribution during arm tracking movements in standing. These results indicate that differential impairment between the hip and ankle can drive changes to walking and balance strategy to maintain functional performance, highlighting the importance of joint specific rehabilitation methods in improving function in MS