Evaluation of Muscle Synergy During Exoskeleton-Assisted Walking in Persons With Multiple Sclerosis

Taimoor Afzal, Fangshi Zhu, Shih Chiao Tseng, John A. Lincoln, Gerard E. Francisco, Hao Su, Shuo Hsiu Chang

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Objective: Gait deficit after multiple sclerosis (MS) can be characterized by altered muscle activation patterns. There is preliminary evidence of improved walking with a lower limb exoskeleton in persons with MS. However, the effects of exoskeleton-assisted walking on neuromuscular modifications are relatively unclear. The objective of this study was to investigate the muscle synergies, their activation patterns and the differences in neural strategies during walking with (EXO) and without (No-EXO) an exoskeleton. Methods: Ten subjects with MS performed walking during EXO and No-EXO conditions. Electromyography signals from seven leg muscles were recorded. Muscle synergies and the activation profiles were extracted using non-negative matrix factorization. Results: The stance phase duration was significantly shorter during EXO compared to the No-EXO condition (p<0.05). Moreover, typically 3-5 modules were extracted in each condition. The module-1 (comprising Vastus Medialis and Rectus Femoris muscles), module-2 (comprising Soleus and Medial Gastrocnemius muscles), module-3 (Tibialis Anterior muscle) and module-4 (comprising Biceps Femoris and Semitendinosus muscles) were comparable between conditions. During EXO condition, Semitendinosus and Vastus Medialis emerged in module-5 in 7/10 subjects. Compared to No-EXO, average activation amplitude was significantly reduced corresponding to module-2 during the stance phase and module-3 during the swing phase during EXO. Conclusion: Exoskeleton-assistance does not alter the existing synergy modules, but could induce a new module to emerge, and alters the control of these modules, i.e., modifies the neural commands indicated by the reduced amplitude of the activation profiles. Significance: The work provides insights on the potential underlying mechanism of improving gait functions after exoskeleton-assisted locomotor training.

Original languageEnglish (US)
Pages (from-to)3265-3274
Number of pages10
JournalIEEE Transactions on Biomedical Engineering
Issue number10
StatePublished - Oct 1 2022


  • Exoskeletons
  • gait
  • multiple sclerosis
  • muscle synergy

ASJC Scopus subject areas

  • Biomedical Engineering


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