Project Summary/Abstract
Cerebral palsy (CP) is the most common childhood physical disability. CP causes gait disorders that are
associated with decreased mobility, increased pain, and low quality of life. A primary contributor to gait deficits
in CP is ankle impairment. Due to the lack of ankle power generation, people with CP adopt crouched, inefficient
gait patterns that negatively affect their joint health. To date, gait rehabilitation that employs task specificity and
intensity has achieved the best clinical outcomes, and incline walking stands out as a promising gait intervention
because it shares similar locomotion and requires greater muscular effort compared to level walking. A major
concern is that the challenges of walking on an incline may result in exacerbated gait patterns that negatively
affect long-term mobility and joint health. Therefore, this project will investigate two distinct strategies to improve
ankle function and gait in incline walking in CP: the first will provide ankle assistance from a wearable exoskeleton
to passively improve ankle mechanics, and the other uses ankle moment biofeedback to incentivize active
improvement in ankle mechanics.
The purpose of this project is to investigate whether ankle assistance and ankle moment biofeedback can
improve lower limb extension, ankle mechanics, and joint loads during incline walking in CP. Aim 1 will test the
hypothesis that ankle assistance can increase lower limb extension and ankle moment and power, and decrease
joint loads in incline walking compared to incline walking with no assistance. Aim 2 will determine the effect of
ankle moment biofeedback during incline walking without and with assistance. The hypothesis is that
biofeedback will increase lower limb extension and ankle moment and power but will not change joint loads, and
that walking with biofeedback and assistance will increase lower limb extension and ankle moment and power,
and reduce joint loads. The proposed research will offer two strategies - assistive device and biofeedback - to
improve gait mechanics and joint loads in incline walking in CP. Both will directly contribute to pediatric CP gait
training and the lifelong musculoskeletal function and joint health of this population. By understanding the impact
of each tool, clinicians and researchers can make informed decisions to use assistance and/or biofeedback to
achieve specific clinical goals (i.e., reduce joint loads, increase neuromuscular engagement, reduce crouch, etc.)
for patients with different levels of impairment. The fellowship training will expand the applicant’s expertise in
musculoskeletal modeling and mechatronics, and provide mentorship and experience in clinical study design,
clinical trial management, and biostatistics. The completion of the study will be the foundation of a career as an
independent investigator to achieve the long-term research goal of developing and evaluating evidence-based
interventions to facilitate precise, personalized, and progressive rehabilitation for people with neuromuscular
impairments.
