This study evaluates a novel Virtual Reality (VR)-integrated visual feedback system designed to enhance limb propulsion during robot-assisted gait rehabilitation in individuals post-stroke. In collaboration with CUREXO, a rehabilitation robotics company, the system is embedded within the Morning Walk® end-effector robot and provides real-time visual feedback to facilitate symmetrical use of the paretic and non-paretic limbs. The goal is to address gait asymmetry commonly observed in hemiparetic stroke survivors by promoting improved paretic leg propulsion, which is a key contributor to forward movement during walking.

A total of 30 participants (15 stroke, 15 healthy controls) aged 20 years or older will undergo single-session gait training using the VR-robot system. Participants will be assessed using spatiotemporal gait parameters, muscle activity, foot pressure, and vertical ground reaction forces. Additional safety measures-including a saddle-type weight support and real-time heart rate monitoring via smartwatch-are implemented to ensure a safe and controlled training environment. This study aims to test the feasibility and effectiveness of this VR-based system in improving gait symmetry and functional walking capacity in people recovering from stroke.

Introduction and Purpose:

People with hemiparetic stroke often exhibit gait asymmetry due to reduced propulsion from the paretic leg. This contributes to overreliance on the non-paretic leg and leads to inefficient, energy-consuming walking patterns. Traditional rehabilitation, including robot-assisted gait training, typically emphasizes repetitive motion but lacks a specific focus on propulsion, limiting its potential to promote neuroplasticity and symmetrical gait.

To address this limitation, the research team has developed a Virtual Reality (VR)-based visual feedback system that delivers real-time, individualized cues aimed at improving paretic limb propulsion. This system is integrated into the Morning Walk® end-effector rehabilitation robot developed by CUREXO. By encouraging active use of the paretic limb, the intervention is designed to reduce compensatory movement strategies and improve gait symmetry.

Study Objectives:

The primary objective is to evaluate the feasibility and effectiveness of this VR-enhanced limb propulsion training system. The study compares spatiotemporal gait parameters between individuals post-stroke and healthy controls, with the goal of determining whether real-time visual feedback can improve bilateral coordination and reduce asymmetry.

Participants:

A total of 30 participants (15 post-stroke, 15 healthy) aged 20 years or older will be recruited. Stroke participants must have experienced a stroke at least one month prior to enrollment and be able to walk at least 10 meters with or without assistive devices. Healthy controls must walk independently without assistance.

Methods:

Each participant will complete a single-session gait training protocol with pre- and post-assessments. Equipment used includes:

Zeno Walkway: Overground gait mat to assess spatiotemporal gait parameters before and after training.

Morning Walk® Robot: End-effector rehabilitation device with integrated VR propulsion visual feedback system.

Delsys EMG Sensors: For analysis of bilateral lower extremity muscle activity.

Tekscan In-Shoe Sensors: To measure ground reaction forces and foot pressure during walking.

Smartwatch Monitoring: To track heart rate during training as an indicator of exertion (data not stored or transmitted).

Procedures:

Baseline Assessments: Collection of demographic data, health history, physical function, height, and weight.

Pre-Training Gait Assessment: Overground walking trials using the Zeno Walkway.

VR Robot Gait Training: Participants walk with the Morning Walk® robot while receiving propulsion-related visual feedback in VR.

Post-Training Gait Assessment: Re-evaluation using the Zeno Walkway to assess changes in gait performance.

Data Collection:

Real-time biomechanical data (spatiotemporal parameters, EMG, and foot pressure/GRFs) will be collected and analyzed. Smartwatch data will only be viewed during the session and will not be stored.

Risks and Safety:

Risks are minimal. The Morning Walk® robot features a saddle-type support system and protective surrounds to prevent falls. Minor skin irritation may occur from EMG electrodes. All data will be stored securely on password-protected devices.

Significance:

This study is the first to integrate a VR-based propulsion feedback system into an end-effector gait training robot. It is expected to enhance paretic limb engagement, promote symmetrical gait patterns, and support motor learning through individualized feedback and neuroplastic adaptation.

Inclusion Criteria:

• Adults aged 20 years or older.
• For post-stroke participants:
• Diagnosis of stroke at least 1 month prior to participation.
• Able to walk at least 10 meters with or without assistive devices.

For healthy participants:

° Must walk independently without assistive devices.

Exclusion Criteria:

• Individuals with a life expectancy of less than one year.
• Comatose individuals.
• Individuals unable to follow three-step commands.
• Individuals with lower limb amputation.
• Individuals with poorly controlled diabetes (e.g., foot ulceration).
• Individuals with legal blindness.
• Individuals with progressive neurological conditions.
• Medically unstable individuals.
• Individuals with significant musculoskeletal impairments.
• Individuals with congestive heart failure or unstable angina.
• Individuals with peripheral vascular disease.
• Individuals with severe neuropsychiatric disorders (e.g., dementia, cognitive deficits, or severe depression).