{rfName}
A

Indexed in

License and use

Citations

26

Altmetrics

Article has an altmetric score of 6

Analysis of institutional authors

Lora-Millan JsCorresponding AuthorRocon EAuthor

Share

October 17, 2022
Publications
>
Article
No

A unilateral robotic knee exoskeleton to assess the role of natural gait assistance in hemiparetic patients

Publicated to:Journal Of Neuroengineering And Rehabilitation. 19 (1): 109- - 2022-01-01 19(1), DOI: 10.1186/s12984-022-01088-2

Authors: Lora-Millan JS; Sanchez-Cuesta FJ; Romero JP; Moreno JC; Rocon E

Affiliations

Consejo Superior de Investigaciones Científicas - Author
CSIC, Neural Rehabil Grp, Inst Cajal, Madrid, Spain - Author
Hosp Beata Maria Ana, Brain Damage Unit, Madrid, Spain - Author
Univ Francisco de Vitoria, Fac Ciencias Expt, Madrid, Spain - Author
Univ Politecn Madrid, Ctr Automat & Robot, CSIC, Madrid, Spain - Author
Univ Rey Juan Carlos, Dept Elect Technol, Madrid, Spain - Author
Universidad Francisco de Vitoria - Author
Universidad Francisco de Vitoria , Hospital Beata María Ana - Author
Universidad Politécnica de Madrid - Author
Universidad Politécnica de Madrid , Universidad Rey Juan Carlos - Author
See more

Abstract

BACKGROUND: Hemiparetic gait is characterized by strong asymmetries that can severely affect the quality of life of stroke survivors. This type of asymmetry is due to motor deficits in the paretic leg and the resulting compensations in the nonparetic limb. In this study, we aimed to evaluate the effect of actively promoting gait symmetry in hemiparetic patients by assessing the behavior of both paretic and nonparetic lower limbs. This paper introduces the design and validation of the REFLEX prototype, a unilateral active knee-ankle-foot orthosis designed and developed to naturally assist the paretic limbs of hemiparetic patients during gait. METHODS: REFLEX uses an adaptive frequency oscillator to estimate the continuous gait phase of the nonparetic limb. Based on this estimation, the device synchronically assists the paretic leg following two different control strategies: (1) replicating the movement of the nonparetic leg or (2) inducing a healthy gait pattern for the paretic leg. Technical validation of the system was implemented on three healthy subjects, while the effect of the generated assistance was assessed in three stroke patients. The effects of this assistance were evaluated in terms of interlimb symmetry with respect to spatiotemporal gait parameters such as step length or time, as well as the similarity between the joint's motion in both legs. RESULTS: Preliminary results proved the feasibility of the REFLEX prototype to assist gait by reinforcing symmetry. They also pointed out that the assistance of the paretic leg resulted in a decrease in the compensatory strategies developed by the nonparetic limb to achieve a functional gait. Notably, better results were attained when the assistance was provided according to a standard healthy pattern, which initially might suppose a lower symmetry but enabled a healthier evolution of the motion of the nonparetic limb. CONCLUSIONS: This work presents the preliminary validation of the REFLEX prototype, a unilateral knee exoskeleton for gait assistance in hemiparetic patients. The experimental results indicate that assisting the paretic leg of a hemiparetic patient based on the movement of their nonparetic leg is a valuable strategy for reducing the compensatory mechanisms developed by the nonparetic limb.

Keywords

asymmetrycoordinationgait symmetryindividualsphasereal-time estimaterehabilitationrobotic exoskeletonstrokestroke patientstrajectory generationunilateral assistancewalkingAnkle-foot orthosisBiomechanical phenomenaExoskeleton deviceGaitGait disorders, neurologicGait symmetryHemiparetic gaitHumansLower extremityParesisQuality of lifeRobotic exoskeletonRobotic surgical proceduresStrokeStroke patientsStroke rehabilitationUnilateral assistance

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Journal Of Neuroengineering And Rehabilitation due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position 3/68, thus managing to position itself as a Q1 (Primer Cuartil), in the category Rehabilitation. Notably, the journal is positioned above the 90th percentile.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 1.3. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 1.37 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 6.47 (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-27, the following number of citations:

  • WoS: 6
  • Scopus: 16

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-27:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 54.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 71 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 5.75.
  • The number of mentions on the social network X (formerly Twitter): 7 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.

Leadership analysis of institutional authors

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (LORA MILLÁN, JULIO SALVADOR) and Last Author (Rocón De Lima, Eduardo).

the author responsible for correspondence tasks has been LORA MILLÁN, JULIO SALVADOR.