# Use of a Powered Orthotic Exoskeleton to Promote Mobility Through Improved Squat, Knee Flexion and Loading of the Paretic Leg in Persons with Chronic Stroke

> **NIH VA I21** · JAMES J PETERS VA  MEDICAL CENTER · 2021 · —

## Abstract

Ninety percent of stroke survivors have clinically significant gait impairments that lead to secondary
medical complications, including cardiovascular deconditioning and reduced quality of life (QOL). Several
rehabilitative interventions that increase the level of activity and mobility have been shown to be beneficial.
Challenges posed by most of these locomotor gait training interventions require recurring visits to a
rehabilitation center. The recent development of novel powered exoskeletons offers a potential mechanism for
stroke survivors to improve mobility in the home and community. Although the predominant research using
these devices have been in persons with spinal cord injury, there are currently two devices approved by the FDA
for use in patients with stroke and additional devices are being developed. The Keeogo powered orthotic
exoskeleton is a novel device intended for persons with stroke who can ambulate but have gait impairment. This
device consists of a ridged orthotic structure placed over clothing on the legs and batteries to the power motors
that assist both knees in gait movement. The system monitors hip movement driven by the user and interprets
this movement to apply the appropriate assistance at the knee joint. This unique approach makes learning
intuitive, enabling the user only to acclimate to the system rather than learning how to control the device to
initiate the desired movement.
 This proposal is a randomized controlled pilot study. Fifteen veterans with chronic stroke (>6months)
and who retain some ability to take steps but have impaired gait will be recruited. Ten participants will be
randomized into the exoskeleton group and 5 into the control group. Both groups will be asked to complete 36
one-hour sessions of ambulation training. The exoskeleton group will train using the Keeogo powered orthotic
exoskeleton and the control group will train without using their own conventional aide.
 The primary aim is to determine the efficacy of training with this exoskeleton and its ability to improve
transfers to standing and sitting as assessed by the five times sit-to-stand test. A secondary aim will be to assess
effects of the device during overground ambulation. Outcome measurements to investigate changes of knee range
of motion and loading of the paretic limb will be accomplished using an instrumented goniometer; changes in
limb loading will be monitored using a foot pressure mapping system; and stepping parameters will be recorded
using the GaitRite carpet. An exploratory outcome of changes in energy expenditure during ambulation with and
without the powered exoskeleton will be assessed from a 6-minute walking test using a portable metabolic cart.
Additional exploratory outcome measures of QOL will be determined using the SF-36 and the Stroke Specific
Quality of Life Scale.
 Baseline testing for both groups will be performed while ambulating without the device and prior to
starting in the training program. The exoskelet...

## Key facts

- **NIH application ID:** 10155112
- **Project number:** 5I21RX003299-02
- **Recipient organization:** JAMES J PETERS VA  MEDICAL CENTER
- **Principal Investigator:** Ann Michele Spungen
- **Activity code:** I21 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-07-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10155112

## Citation

> US National Institutes of Health, RePORTER application 10155112, Use of a Powered Orthotic Exoskeleton to Promote Mobility Through Improved Squat, Knee Flexion and Loading of the Paretic Leg in Persons with Chronic Stroke (5I21RX003299-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10155112. Licensed CC0.

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