EXO-WALK: Exosuit-Assisted Walking Automaticity and Locomotion Kinetics


The neural control of walking ranges on a spectrum of automaticity: from highly automatic walking that requires minimal attention to non-automatic that requires high attention. Automatic walking is predominantly driven by neural pathways that include subcortical brain regions and spinal cord, while non-automatic, attention-based walking relies heavily on prefrontal cortex—the part of the brain that is considered the “thinking” region and is responsible for executive functions such as memory and attention.

Whereas typical adult walking is usually highly automatic, one of the consequences of stroke is a compensatory shift towards use of more attention-demanding walking control. That is, whereas healthy individuals take advantage of automatic neural pathways to rarely have to think about the way they are walking, stroke often damages these neural pathways. Consequently, people post-stroke have to rely on their “thinking” brain region (i.e., prefrontal cortex) for the neural control of walking, and are thus often thinking about the way they are walking. When the “simple” act of walking requires high cognitive load, we say that walking automaticity is reduced.

Stroke-induced brain injury to the neural pathways responsible for automatic walking also results in visible gait compensations—i.e., an asymmetrical, slow, and energetically effortful gait. Our team has developed a soft, wearable robotic exosuit that provides external mechanical assistance to the paretic limb, and we have shown walking with the exosuit reduces gait asymmetry, increases walking speed, and reduces walking effort. Moreover, users with post-stroke hemiparesis have subjectively reported improvements in walking automaticity during exosuit-assisted walking. In this study, we are seeking to use portable functional neuroimaging (functional near-infrared spectroscopy–fNIRS) to directly quantify the effects of the soft robotic exosuit on walking automaticity during overground walking, with testing both in our research laboratory in and in real-world settings.

Project Lead

Regina Sloutsky, PT, DPT


Terry Ellis, PhD, PT, FAPTA

Conor Walsh, PhD

David Boas, PhD

Meryem Yucel, PhD

Samuel Montero-Hernandez, PhD

Teresa Baker, PT, DPT, NCS 

Michael Hwang, PT, DPT, CSCS


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