Acute effects of ankle exoskeleton on metabolic cost of walking in healthy children and children with cerebral palsy

Cerebral palsy (CP) is a definition for a group of permanent non-progressive motor disorders affecting movement and posture. There is no cure for the primary problem in CP but secondary deformities arising from it can be treated. Because CP affects movement and posture, exercise has been seen to imp...

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Main Author: Virtanen, Valtteri
Other Authors: Liikuntatieteellinen tiedekunta, Faculty of Sport and Health Sciences, Jyväskylän yliopisto, University of Jyväskylä
Format: Master's thesis
Language:eng
Published: 2025
Subjects:
Online Access: https://jyx.jyu.fi/handle/123456789/101126
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author Virtanen, Valtteri
author2 Liikuntatieteellinen tiedekunta Faculty of Sport and Health Sciences Jyväskylän yliopisto University of Jyväskylä
author_facet Virtanen, Valtteri Liikuntatieteellinen tiedekunta Faculty of Sport and Health Sciences Jyväskylän yliopisto University of Jyväskylä Virtanen, Valtteri Liikuntatieteellinen tiedekunta Faculty of Sport and Health Sciences Jyväskylän yliopisto University of Jyväskylä
author_sort Virtanen, Valtteri
datasource_str_mv jyx
description Cerebral palsy (CP) is a definition for a group of permanent non-progressive motor disorders affecting movement and posture. There is no cure for the primary problem in CP but secondary deformities arising from it can be treated. Because CP affects movement and posture, exercise has been seen to improve functionality in children with CP. Beside traditional physical therapy, robotic devices such as exoskeletons have shown potential in the treatment of CP. The purpose of this thesis is to investigate whether assistance and resistance of an ankle exoskeleton influences the metabolic cost of transport (MCOT) of walking in typically developed (TD) children and in children with CP and whether the response differs between these two groups. 11 children with CP (11–18 years old) and 11 TD children (8–18 years old) were recruited for this study. Subjects went through three treadmill walking trials including normal walking, exoskeleton assisted walking and exoskeleton resisted walking. Metabolic data and surface electromyography (EMG) from tibialis anterior, soleus, biceps femoris and vastus lateralis muscles were collected during these trials. The exoskeleton used in this study assisted with the force of 20% of body weight and resisted with the force of 10% of body weight on plantarflexion. On both assistance and resistance mode, exoskeleton assisted with the force of 3% of body weight on dorsiflexion. Exoskeleton assistance increased the MCOT of TD children by 14.5% and decreased the MCOT of children with CP by 5.2%. Exoskeleton resistance increased the MCOT by 31.1% in TD children and by 2.1% in children with CP. The changes were statistically significant in TD children but not in children with CP. The activity of vastus lateralis increased (12.7%) and there was a trend towards reduced soleus activity (4.9%) from normal walking to assisted walking in TD children. Additionally, there was a trend towards increased vastus lateralis activity (7.1%) from normal walking to assisted walking in children with CP. From normal walking to resisted walking, vastus lateralis activity increased (23.2%) and there was a trend towards increased soleus activity (8.1%) in TD children. No statistically significant changes in muscle activities from normal walking to resisted walking were seen in children with CP. The change in vastus lateralis activity was significantly different between TD and CP groups from normal walking to both exoskeleton conditions. In TD group, there was a correlation between the change in the MCOT and the change in biceps femoris activity (r = 0.66; p = 0.028) from normal walking to resisted walking. In CP group, there was a correlation between the change in the MCOT and the change in vastus lateralis activity from normal walking to assisted walking (r = 0.62; p = 0.041). These results show that TD children and children with CP response differently to the assistance and resistance of an exoskeleton. Differences in the changes in muscle activity of TD and CP groups suggest that increased vastus lateralis activity during exoskeleton walking in TD group may contribute to the increased MCOT that was not seen in CP group. More research is needed to investigate how adaptation to exoskeleton walking affects the MCOT in children with CP and how does the adaptation differ from TD children. CP-vamma on kattotermi, joka kuvastaa ryhmää pysyviä ei-eteneviä motorisia häiriöitä, jotka vaikuttavat yksilön asennon ja liikkumisen hallintaan. CP-vamma itsessään on parantumaton, mutta siitä johtuvia haasteita voidaan hoitaa. Koska CP-vamma vaikuttaa asennon ja liikkumisen hallintaan, on liikunnan havaittu olevan tehokas tapa tukea CP-vammaisten lasten toimintakykyä. Perinteisen fysioterapian lisäksi moottoroidut apuvälineet, kuten eksoskeletonit ovat osoittaneet potentiaalinsa CP-vamman hoidossa. Tämän tutkielman tarkoituksena on tutkia nilkan eksoskeletonin avustuksen ja vastustuksen vaikutusta kävelyn aineenvaihdunnalliseen kuormitukseen terveillä ja CP-vammaisilla lapsilla sekä näiden ryhmien vasteiden eroja. 11 CP-vammaista (11–18-vuotiaita) ja 11 tervettä lasta (8–18-vuotiaita) osallistui tähän tutkimukseen. Koehenkilöt suorittivat kolme eri kävelysuoritusta juoksumatolla: normaali, avustettu ja vastustettu kävely. Näiden suoritusten aikana mitattiin hengityskaasuja sekä tibialis anteriorin, soleuksen, biceps femoriksen ja vastus lateraliksen aktiivisuuksia elektromyografialla (EMG). Nilkan eksoskeleton avusti 20 % ja vastusti 10 % kehonpainosta plantaarifleksion suuntaan eri toimintatiloissa. Sekä avustus-, että vastustustilassa nilkan eksoskeleton avusti 3 % kehonpainosta dorsifleksion suuntaan. Eksoskeletonin avustus lisäsi terveiden lasten kävelyn aineenvaihdunnallista kuormitusta 14,5 % ja vähensi sitä CP-vammaisilla lapsilla 5,2 %. Eksoskeletonin vastustus lisäsi kävelyn aineenvaihdunnallista kuormitusta terveillä lapsilla 31,1 % ja CP-vammaisilla lapsilla 2,1 %. Muutokset olivat tilastollisesti merkitseviä vain terveiden lasten kohdalla. Vastus lateraliksen aktiivisuus lisääntyi terveillä lapsilla sekä avustetussa (12,7 %) että vastustetussa (23,2 %) kävelyssä verrattuna normaaliin kävelyyn. Soleuksen aktiivisuudessa oli terveillä lapsilla suuntaus kohti vähentynyttä aktiivisuutta avustetussa (4,9 %) ja kohti lisääntynyttä aktiivisuutta vastustetussa (8,1 %) kävelyssä verrattuna normaaliin kävelyyn. CP-vammaisilla lapsilla ei huomattu tilastollisesti merkitseviä muutoksia tarkasteltujen lihasten aktiivisuuksissa, mutta avustetussa kävelyssä havaittiin suuntaus kohti lisääntynyttä vastus lateraliksen aktiivisuutta (7,1 %) verrattuna normaaliin kävelyyn. Vastus lateraliksen aktiivisuuden muutos erosi ryhmien välillä merkitsevästi sekä avustuksessa että vastustuksessa. Terveiden ryhmässä havaittiin korrelaatio biceps femoriksen aktiivisuuden ja aineenvaihdunnallisen kuormituksen muutosten välillä vastustetussa kävelyssä (r= 0,66; p = 0,028). CP-vammaisten ryhmässä havaittiin korrelaatio vastus lateraliksen aktiivisuuden ja aineenvaihdunnallisen kuormituksen välillä avustetussa kävelyssä (r = 0,62; p = 0,041). Nämä tulokset osoittavat, että terveiden ja CP-vammaisten lasten vasteet eksoskeletonin avustukseen ja vastustukseen ovat erilaiset. Erot ryhmien välillä lihasaktiivisuuden muutoksessa saattavat viitata siihen, että terveiden lasten lisääntynyt aineenvaihdunnallinen kuormitus johtuu vastus lateraliksen aktiivisuuden lisääntymisestä, jota ei nähty CP-vammaisilla lapsilla. Lisää tutkimusta tarvitaan aktiivisen eksoskeletonin käyttöön adaptoitumisesta ja adaptoitumisen eroista terveillä ja CP-vammaisilla lapsilla.
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There is no cure for the primary problem in CP but secondary deformities arising from it can be treated. Because CP affects movement and posture, exercise has been seen to improve functionality in children with CP. Beside traditional physical therapy, robotic devices such as exoskeletons have shown potential in the treatment of CP. The purpose of this thesis is to investigate whether assistance and resistance of an ankle exoskeleton influences the metabolic cost of transport (MCOT) of walking in typically developed (TD) children and in children with CP and whether the response differs between these two groups.\n\n11 children with CP (11\u201318 years old) and 11 TD children (8\u201318 years old) were recruited for this study. Subjects went through three treadmill walking trials including normal walking, exoskeleton assisted walking and exoskeleton resisted walking. Metabolic data and surface electromyography (EMG) from tibialis anterior, soleus, biceps femoris and vastus lateralis muscles were collected during these trials. The exoskeleton used in this study assisted with the force of 20% of body weight and resisted with the force of 10% of body weight on plantarflexion. On both assistance and resistance mode, exoskeleton assisted with the force of 3% of body weight on dorsiflexion.\n\nExoskeleton assistance increased the MCOT of TD children by 14.5% and decreased the MCOT of children with CP by 5.2%. Exoskeleton resistance increased the MCOT by 31.1% in TD children and by 2.1% in children with CP. The changes were statistically significant in TD children but not in children with CP. The activity of vastus lateralis increased (12.7%) and there was a trend towards reduced soleus activity (4.9%) from normal walking to assisted walking in TD children. Additionally, there was a trend towards increased vastus lateralis activity (7.1%) from normal walking to assisted walking in children with CP. From normal walking to resisted walking, vastus lateralis activity increased (23.2%) and there was a trend towards increased soleus activity (8.1%) in TD children. No statistically significant changes in muscle activities from normal walking to resisted walking were seen in children with CP. The change in vastus lateralis activity was significantly different between TD and CP groups from normal walking to both exoskeleton conditions. In TD group, there was a correlation between the change in the MCOT and the change in biceps femoris activity (r = 0.66; p = 0.028) from normal walking to resisted walking. In CP group, there was a correlation between the change in the MCOT and the change in vastus lateralis activity from normal walking to assisted walking (r = 0.62; p = 0.041).\n\nThese results show that TD children and children with CP response differently to the assistance and resistance of an exoskeleton. Differences in the changes in muscle activity of TD and CP groups suggest that increased vastus lateralis activity during exoskeleton walking in TD group may contribute to the increased MCOT that was not seen in CP group. More research is needed to investigate how adaptation to exoskeleton walking affects the MCOT in children with CP and how does the adaptation differ from TD children.", "language": "en", "element": "description", "qualifier": "abstract", "schema": "dc"}, {"key": "dc.description.abstract", "value": "CP-vamma on kattotermi, joka kuvastaa ryhm\u00e4\u00e4 pysyvi\u00e4 ei-etenevi\u00e4 motorisia h\u00e4iri\u00f6it\u00e4, jotka vaikuttavat yksil\u00f6n asennon ja liikkumisen hallintaan. CP-vamma itsess\u00e4\u00e4n on parantumaton, mutta siit\u00e4 johtuvia haasteita voidaan hoitaa. Koska CP-vamma vaikuttaa asennon ja liikkumisen hallintaan, on liikunnan havaittu olevan tehokas tapa tukea CP-vammaisten lasten toimintakyky\u00e4. Perinteisen fysioterapian lis\u00e4ksi moottoroidut apuv\u00e4lineet, kuten eksoskeletonit ovat osoittaneet potentiaalinsa CP-vamman hoidossa. T\u00e4m\u00e4n tutkielman tarkoituksena on tutkia nilkan eksoskeletonin avustuksen ja vastustuksen vaikutusta k\u00e4velyn aineenvaihdunnalliseen kuormitukseen terveill\u00e4 ja CP-vammaisilla lapsilla sek\u00e4 n\u00e4iden ryhmien vasteiden eroja.\n\n11 CP-vammaista (11\u201318-vuotiaita) ja 11 tervett\u00e4 lasta (8\u201318-vuotiaita) osallistui t\u00e4h\u00e4n tutkimukseen. Koehenkil\u00f6t suorittivat kolme eri k\u00e4velysuoritusta juoksumatolla: normaali, avustettu ja vastustettu k\u00e4vely. N\u00e4iden suoritusten aikana mitattiin hengityskaasuja sek\u00e4 tibialis anteriorin, soleuksen, biceps femoriksen ja vastus lateraliksen aktiivisuuksia elektromyografialla (EMG). Nilkan eksoskeleton avusti 20 % ja vastusti 10 % kehonpainosta plantaarifleksion suuntaan eri toimintatiloissa. Sek\u00e4 avustus-, ett\u00e4 vastustustilassa nilkan eksoskeleton avusti 3 % kehonpainosta dorsifleksion suuntaan. \n\nEksoskeletonin avustus lis\u00e4si terveiden lasten k\u00e4velyn aineenvaihdunnallista kuormitusta 14,5 % ja v\u00e4hensi sit\u00e4 CP-vammaisilla lapsilla 5,2 %. Eksoskeletonin vastustus lis\u00e4si k\u00e4velyn aineenvaihdunnallista kuormitusta terveill\u00e4 lapsilla 31,1 % ja CP-vammaisilla lapsilla 2,1 %. Muutokset olivat tilastollisesti merkitsevi\u00e4 vain terveiden lasten kohdalla. Vastus lateraliksen aktiivisuus lis\u00e4\u00e4ntyi terveill\u00e4 lapsilla sek\u00e4 avustetussa (12,7 %) ett\u00e4 vastustetussa (23,2 %) k\u00e4velyss\u00e4 verrattuna normaaliin k\u00e4velyyn. Soleuksen aktiivisuudessa oli terveill\u00e4 lapsilla suuntaus kohti v\u00e4hentynytt\u00e4 aktiivisuutta avustetussa (4,9 %) ja kohti lis\u00e4\u00e4ntynytt\u00e4 aktiivisuutta vastustetussa (8,1 %) k\u00e4velyss\u00e4 verrattuna normaaliin k\u00e4velyyn. 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spellingShingle Virtanen, Valtteri Acute effects of ankle exoskeleton on metabolic cost of walking in healthy children and children with cerebral palsy Liikuntafysiologian opintosuunta Specialisation in Exercise Physiology
title Acute effects of ankle exoskeleton on metabolic cost of walking in healthy children and children with cerebral palsy
title_full Acute effects of ankle exoskeleton on metabolic cost of walking in healthy children and children with cerebral palsy
title_fullStr Acute effects of ankle exoskeleton on metabolic cost of walking in healthy children and children with cerebral palsy Acute effects of ankle exoskeleton on metabolic cost of walking in healthy children and children with cerebral palsy
title_full_unstemmed Acute effects of ankle exoskeleton on metabolic cost of walking in healthy children and children with cerebral palsy Acute effects of ankle exoskeleton on metabolic cost of walking in healthy children and children with cerebral palsy
title_short Acute effects of ankle exoskeleton on metabolic cost of walking in healthy children and children with cerebral palsy
title_sort acute effects of ankle exoskeleton on metabolic cost of walking in healthy children and children with cerebral palsy
title_txtP Acute effects of ankle exoskeleton on metabolic cost of walking in healthy children and children with cerebral palsy
topic Liikuntafysiologian opintosuunta Specialisation in Exercise Physiology
topic_facet Liikuntafysiologian opintosuunta Specialisation in Exercise Physiology
url https://jyx.jyu.fi/handle/123456789/101126 http://www.urn.fi/URN:NBN:fi:jyu-202503292947
work_keys_str_mv AT virtanenvaltteri acuteeffectsofankleexoskeletononmetaboliccostofwalkinginhealthychildrenandchild