Changes in Kinematic and Spatiotemporal Gait Parameters With a Biarticular Lower Limb Exosuit for Adolescents With Crouch Gait During Level Walking and Stair Climbing

Abstract

Crouch gait is a prevalent walking abnormality among children with cerebral palsy, characterized by excessive knee and hip flexion during walking. This condition often limits children’s engagement in physical activities and daily life. Current exoskeleton solutions targeting the knee joint in this population are either tethered or bulky, hindering practical integration into daily routines. In this cross-sectional study, we evaluated the impact of a biarticular cable-driven exosuit, originally designed for adults, on the gait pattern of adolescents with crouch gait. Participants completed level walking and stair climbing trials under three conditions: without the exosuit (noMyo), with the exosuit inactive (MyoOff), and with the exosuit active (MyoOn). Kinematic and spatiotemporal gait metrics were analyzed using 3D motion capture. Five male adolescents with mild to moderate crouch participated. Results revealed significant improvements in mean knee and hip extension during the assisted phase (5 to 50% of the gait) with MyoOn compared to noMyo, increasing by 6 (range: 0 - 12) and 12 (range: 4 - 24) degrees, respectively, during level walking. During stair climbing, knee and hip extension improved in the stance phase of the trailing leg in the MyoOn condition compared to MyoOff. Only the hip angles improved in the MyoOn condition compared to noMyo. Spatiotemporal metrics showed no improvement. Stride length shortened significantly in both MyoOn and MyoOff. These findings demonstrate the exosuit’s potential to address extension deficits in crouch gait, although its weight may limit improvements in spatiotemporal gait characteristics. Developing a lighter, child-specific version could expand accessibility to a broader pediatric population.