Predicting Neuromuscular Engagement to Improve Gait Training with a Robotic Ankle Exoskeleton

The clinical efficacy of robotic rehabilitation interventions hinges on appropriate neuromuscular recruitment from the patient. The first purpose of this study was to evaluate the use of supervised machine learning techniques to predict neuromuscular recruitment of the ankle plantar flexors during walking with ankle exoskeleton resistance in individuals with cerebral palsy (CP). The second goal of this study was to utilize the predictive models of plantar flexor recruitment in the design of a personalized biofeedback framework intended to improve (i.e., increase) user engagement when walking with resistance. First, we developed and trained multilayer perceptrons (MLPs), a type of artificial neural network (ANN), utilizing features extracted exclusively from the exoskeleton's onboard sensors, and demonstrated 85-87% accuracy, on average, in predicting muscle recruitment from electromyography measurements. Next, our participants completed a gait training session while receiving audio-visual biofeedback of their personalized real-time planar flexor recruitment predictions from the online MLP. We found that adding biofeedback to resistance elevated plantar flexor recruitment by 24 ± 16% compared to resistance alone. This study highlights the potential for online machine learning frameworks to improve the effectiveness and delivery of robotic rehabilitation systems in clinical populations.