Project Summary/Abstract Cerebral palsy (CP) is the most common childhood physical disability. CP causes gait disorders that are associated with decreased mobility, increased pain, and low quality of life. A primary contributor to gait deficits in CP is ankle impairment. Due to the lack of ankle power generation, people with CP adopt crouched, inefficient gait patterns that negatively affect their joint health. To date, gait rehabilitation that employs task specificity and intensity has achieved the best clinical outcomes, and incline walking stands out as a promising gait intervention because it shares similar locomotion and requires greater muscular effort compared to level walking. A major concern is that the challenges of walking on an incline may result in exacerbated gait patterns that negatively affect long-term mobility and joint health. Therefore, this project will investigate two distinct strategies to improve ankle function and gait in incline walking in CP: the first will provide ankle assistance from a wearable exoskeleton to passively improve ankle mechanics, and the other uses ankle moment biofeedback to incentivize active improvement in ankle mechanics. The purpose of this project is to investigate whether ankle assistance and ankle moment biofeedback can improve lower limb extension, ankle mechanics, and joint loads during incline walking in CP. Aim 1 will test the hypothesis that ankle assistance can increase lower limb extension and ankle moment and power, and decrease joint loads in incline walking compared to incline walking with no assistance. Aim 2 will determine the effect of ankle moment biofeedback during incline walking without and with assistance. The hypothesis is that biofeedback will increase lower limb extension and ankle moment and power but will not change joint loads, and that walking with biofeedback and assistance will increase lower limb extension and ankle moment and power, and reduce joint loads. The proposed research will offer two strategies - assistive device and biofeedback - to improve gait mechanics and joint loads in incline walking in CP. Both will directly contribute to pediatric CP gait training and the lifelong musculoskeletal function and joint health of this population. By understanding the impact of each tool, clinicians and researchers can make informed decisions to use assistance and/or biofeedback to achieve specific clinical goals (i.e., reduce joint loads, increase neuromuscular engagement, reduce crouch, etc.) for patients with different levels of impairment. The fellowship training will expand the applicant’s expertise in musculoskeletal modeling and mechatronics, and provide mentorship and experience in clinical study design, clinical trial management, and biostatistics. The completion of the study will be the foundation of a career as an independent investigator to achieve the long-term research goal of developing and evaluating evidence-based interventions to facilitate precise, personalized, and progressive rehabilitation for people with neuromuscular impairments.

Project Narrative Many children with cerebral palsy have gait dysfunction that limits their life-long mobility and independence. This proposal aims to enhance gait training efficacy and safety in children with CP by using an ankle assistive device and biofeedback. Findings from this work will facilitate pediatric CP rehabilitation and contribute to the healthy development of this vulnerable population.