Therapist-Exoskeleton-Patient Interaction for Gait Therapy

TL;DR

This paper introduces a novel physical human-robot-human interaction paradigm using lower-limb exoskeletons to enhance gait therapy for stroke patients, combining robotic support with therapist involvement.

Contribution

The study presents a new bidirectional interaction framework for gait rehabilitation that improves therapy effectiveness by integrating therapist intuition with robotic assistance.

Findings

pHRHI training increased joint range of motion

improved step metrics and muscle activation

enhanced patient motivation

Abstract

Following a stroke, individuals often experience mobility and balance impairments due to lower-limb weakness and loss of independent joint control. Gait recovery is a key goal of rehabilitation, traditionally achieved through high-intensity therapist-led training. However, manual assistance can be physically demanding and limits the therapist's ability to interact with multiple joints simultaneously. Robotic exoskeletons offer multi-joint support, reduce therapist strain, and provide objective feedback, but current control strategies often limit therapist involvement and adaptability. We present a novel gait rehabilitation paradigm based on physical Human-Robot-Human Interaction (pHRHI), where both the therapist and the post-stroke individual wear lower-limb exoskeletons virtually connected at the hips and knees via spring-damper elements. This enables bidirectional interaction, allowing the therapist to guide movement and receive haptic feedback. In a study with eight chronic stroke patients, pHRHI training outperformed conventional therapist-guided treadmill walking, leading to increased joint range of motion, step metrics, muscle activation, and motivation. These results highlight pHRHI's potential to combine robotic precision with therapist intuition for improved rehabilitation outcomes.