Haeun Park

This case study investigated the effects of a novel self-balancing robotic-assisted knee–ankle–foot orthosis (RA-KAFO) on gait function and reducing physical effort in a 52-year-old male with an incomplete lumbar 4–5 spinal cord injury (SCI). The participant underwent gait trials under three conditions: overground walking with crutches, RA-KAFO with crutches, and self-balancing RA-KAFO, across both comfortable and fast walking speeds. Results indicated significant improvements with the self-balancing RA-KAFO, including increased functional ambulation category (FAC) scores, reduced rate of perceived exertion (RPE), faster 10-m walk test velocities, and normalized knee joint kinematics. These findings demonstrate that the self-balancing RA-KAFO may offer superior gait stability and efficiency compared with conventional orthotic systems, highlighting its potential as an effective intervention in SCI rehabilitation.

While “passive” hip–knee–ankle–foot orthoses (HKAFOs) have been developed to enhance walking mobility for individuals with complete spinal cord injury, self-balancing robotic assisted hip–knee–ankle–foot orthoses (SRA-HKAFOs) have not been compared. The aim of this study was to compare therapeutic differences in kinematics and temporal–spatial parameters between “powered” HKAFOs and SRA-HKAFOs in individuals with complete spinal cord injury under both slow and fast walking conditions. A patient with a complete T11 spinal cord injury underwent the “powered” HKAFOs and SRA-HKAFOs under slow and fast walking conditions. Outcome measures included the functional ambulation category (FAC), perceived rate of exertion, walking speed, and hip and knee joint kinematics during a 10[ ]m walking test (10[ ]MWT). SRA-HKAFOs showed substantial improvements compared to “powered” HKAFOs in the FAC (from level 0 to 3), perceived rate of exertion, walking speed, and hip and knee joint kinematics during the 10[ ]MWT. The SRA-HKAFO system may provide promising clinical evidence as an alternative, powerful robotic gait-assisted vehicle to maximize independence in ambulation by enhancing hip and knee joint kinematics. The temporal–spatial gait parameters in patients with complete spinal cord injury were also improved.

Background: Extracellular matrix (ECM) stiffness is increasingly recognized as a key pathological factor in musculoskeletal and aging-related disorders. Although cell-based therapies—particularly mesenchymal stem cells (MSCs)—hold regenerative potential, their effectiveness is significantly reduced in fibrotic and mechanically rigid environments. Objective: This review compares ECM-targeted and cell-based therapies, with a focus on their mechanistic basis, limitations, and potential for integration in regenerative strategies. Summary: Pathological ECM stiffening, driven by lysyl oxidase (LOX)–mediated collagen crosslinking, chronic inflammation, and Piezo channel activation, alters cell–matrix interactions and promotes tissue degeneration. Therapeutic interventions such as LOX inhibitors, low-intensity pulsed ultrasound (LIPUS), and antifibrotic agents show promise in reversing matrix rigidity and restoring tissue biomechanics. In contrast, the success of MSC therapies is often hindered by impaired viability, reduced paracrine activity, and disrupted immunomodulation in stiffened ECM. Mechanosensitive pathways—including YAP/TAZ, integrins, and Piezo1/2—play critical roles in mediating this dysfunction. Conclusion: Effective tissue regeneration requires a permissive mechanical and biochemical microenvironment. Rather than treating ECM remodeling as ancillary, it should be prioritized as a foundational therapeutic target. Preconditioning the ECM enhances the efficacy of cell-based therapies, suggesting that matrix normalization is essential for long-term regenerative success. Targeting ECM stiffness may therefore represent the most decisive step in overcoming barriers to musculoskeletal and aging-related tissue repair.

Wearable robotic-assisted gait technologies have brought new possibilities for millions with gait dysfunction, yet a self-balancing robot that facilitates independent mobility is still lacking. We developed the Miracle, a walker-based self-balancing robot designed for community-dwelling ambulation, to fill this gap. However, the system’s concurrent validity and reliability had not been assessed prior to this study. This study aimed to establish the concurrent validity and reliability of the Miracle system’s kinematic measurements by comparing them with those from the gold standard Vicon gait analysis system. Our advanced Miracle robotic system, which incorporates artificial intelligence (AI)-enhanced sensing, was tested against the Vicon motion capture system, equipped with eight infrared cameras (Vicon Motion Systems, Oxford, UK), to validate measurements of hip and knee angular displacement. Data were analyzed using Python software. The Miracle system demonstrated excellent concurrent validity, with [ ] values ranging from 0.913 to 0.999, and strong test–retest reliability, with intraclass correlation coefficients between 0.927 and 0.982 for hip and knee joints under both slow and fast walking conditions. These findings confirm the Miracle system’s accuracy and reliability, supporting its clinical application in rehabilitation settings. The precise kinematic data it provides could enable clinicians to develop tailored gait training protocols and facilitate independent, safe ambulation for patients with gait impairments, thereby enhancing mobility and social integration in real-world environments.

This study aimed to investigate the efficacy of the novel “MIRACLE” smart shoes in improving gait performance, particularly toe-walking and foot clearance, in a child with cerebral palsy (CP) demonstrating limited ankle dorsiflexion during gait. This single-case study conducted observational gait assessments and joint kinematic analysis to compare the effects of the MIRACLE smart shoes with those of the regular shoes during overground walking. One child with CP who exhibited abnormal toe-walking and limited foot clearance participated in the study. The MIRACLE smart shoes were developed to increase tibialis anterior activation and decrease excessive gastrocnemius activation during gait by applying a customized talus strap and BOA ^® closure system to promote ankle dorsiflexion. Gait performance was evaluated with the dynamic gait index (DGI), the physician rating scale (PRS), and ankle joint kinematic analysis via ImageJ software. The DGI score improved from 16 (with regular shoes) to 20 (with MIRACLE shoes), an 18.4% increase, with significant improvements observed in the “gait level surface” and “step over obstacle” tasks. Additionally, the PRS demonstrated improvements in overall gait mechanics, specifically in ankle dorsiflexion control. ImageJ analysis confirmed improved dorsiflexion kinematics during the swing phase of gait. The MIRACLE smart shoes effectively enhanced gait performance by resolving toe-walking and poor foot clearance in a child with CP. These results indicate that the MIRACLE shoes provide a promising alternative to conventional interventions, offering immediate improvements in functional mobility and reducing fall risk.

Haeun Park, PT, BPT, Chanhee Park, PT, BPT, Joshua (Sung) Hyun You, PT, PhD. Phys. Ther. Korea 2022;29:215-24. https://doi.org/10.12674/ptk.2022.29.3.215