Stroke is the leading cause of severe disability in adults resulting in mobility, balance, and coordination deficits. Because of this, walking recovery has a significant impact on stroke patients' quality of life. To improve rehabilitation techniques, robotic exoskeletons are being increasingly used during physiotherapy sessions. The use of robotic exoskeletons enhances conventional poststroke rehabilitation via intense and task-oriented training. To achieve a normal gait pattern, it is essential to restore the correct activation timing of the lower limb muscles.~Designed by Ekso Bionics, EksoNR is the first exoskeleton device to receive FDA clearance for rehabilitation use with patients with acquired brain injury and stroke patients. EksoNR has several settings that can be adapted to have the best user experience possible and to provide individual-specific training. This study is being proposed to better understand the impact of each setting on stroke recovery and user experience. The two key outcomes are 1) to decipher the relationship between EksoNR robotic control settings and the biomechanics of walking; and 2) to uncover the psychological experiences during EksoNR use. To achieve these outcomes, the investigators are going to measure the effects of Swing Assist EksoNR settings on Gait kinematics; Kinetics; Muscle activity and Activation Timing; and User Experience.~The investigators will use a two-way repeated-measures design with a group (2 levels, healthy and stroke patients) as between factor and settings (4 levels) and user experience as within factors. It is an intra-subject design with an allocation ratio of 1/1. The healthy and stroke patients will have the same age limits.~Because there has not been a lot of research yet about the effect of different settings of the EksoNR on the rehabilitation of stroke patients or on the user experience using the EksoNR this study will use an exploratory framework. The purpose is to investigate what the different outcomes are for all the settings on biomechanical factors: muscle activity, kinematics and spatiotemporal factors.~The experiments will be conducted at the Brubotics Rehabilitation Research Center at the Vrije Universiteit Brussel (VUB)'s Brussels health campus (centrally located between Universitair Ziekenhuis Brussel (UZBrussel), Erasmushogeschool Brussel (EhB ) campus Jette and VUB Jette), led by Prof. Eva Swinnen and Prof. Nina Lefeber.~The participant needs to go to Brubotics Rehabilitation Research Center to perform two or three sessions in total with a break of 10 days (about 1 and a half weeks) in between.~Session 1 - Take in Session (1h) - At the beginning of this session the informed consent will be signed. Afterwards, the research team will prepare the settings and inquire about patient history, functional history, and physical evaluation. During the physical evaluation, it is necessary to do a gross assessment of strength, range of motion, and spasticity/tone; a detailed assessment of critical range of motion measurements; a qualitative assessment of pelvic posture and lumbar mobility; and check skin integrity. The patients walk with the EksoNR for at least 20 minutes.~Session 2 (1h) - This is a session to get familiar with walking with EksoNR for at least 20 minutes. It is only for stroke patients who have never walked with EksoNR, for that reason, if a patient has already used EksoNR before, will only do Session 1 + Session 3, skipping Session 2.~Session 3 (2h) - Each participant is going to walk 7 min (or min 25 gait cycles) in every condition, the order being randomly assigned and concealed from the patient (Trial 1- 4). For the random generation, each setting is going to be labelled and the sequence is going to be generated at the beginning of the session with a Matlab script. This script will randomly sort an array for each participant. Between trials, there is a rest of 5 min. During all walking trials, participants are allowed to stop and rest if necessary and research staff provided non-contact guarding for safety. In this session, kinetic data, spatio-temporal parameters, muscle activity and patient experience are going to be analyzed.~To make the analysis, the program Statistical Package for the Social Sciences (SPSS) version 27.0.1 will be used with a significance level set at 0,05. All data were summarized by using medians, standard deviations and means.
Further studies are needed to provide more detailed information on the potential effects of robotic gait training in general, as well as on the influence on gait movement patterns in particular. Patient perspectives and feedback contribute to the continuous development of exoskeletal technology. For these reasons, the main objective of this study is to decipher the relationship between EksoNR's robotic control settings and walking biomechanics in stroke patients and healthy subjects; the second objective is to discover the user experience during the use of EksoNR.