Reducing Circumduction and Hip Hiking During Hemiparetic Walking Through Targeted Assistance of the Paretic Limb Using a Soft Robotic Exosuit.

Only eight people took part, and marker obstruction meant the paretic hip hiking analysis included seven people and the non-paretic hip hiking analysis included six people. The powered condition was always tested after the unpowered condition, and the order was not randomised, so learning, fatigue, or carryover from the powered walk could have affected the comparison. The study measured immediate changes during two 8 minute treadmill trials, not long-term walking, community mobility, falls, or function after rehabilitation. Ankle foot orthoses were not allowed during exosuit testing, and two participants normally used one, so the paper does not show how to switch from an ankle foot orthosis to this device. The exosuit was tethered to an off-board actuation unit, so it is not a portable device for clinic or community use. The authors did not compare the powered exosuit with usual care, an ankle foot orthosis, or another gait training device. The correlation and regression analyses were exploratory and used a small sample, so the link between knee flexion and hip hiking should be treated cautiously. The participants were able to walk for six minutes without another person's support, so the findings may not apply to people with more severe walking impairment.

Do not conclude that the powered exosuit is a proven treatment for hemiparetic walking or that ankle dorsiflexion assistance alone caused the reductions. The powered suit assisted both plantarflexion and dorsiflexion, the authors note forces could also act about the knee, and the order was not randomised, so the small immediate changes may reflect the whole suit, order, fatigue, or carryover.