ABSTRACT NUMBER: ESOC2026A1514 ADAPTIVE CONTROL ANKLE ROBOTICS INTEGRATED WITH PHYSIOTHERAPY FOR SEVERE HEMIPARESIS IN SUBACUTE STROKE: A CASE REPORT

Abstract Background and aims Adaptive control ankle robotics is a promising but underexplored strategy for stroke rehabilitation. AMBLE is a wireless impedance-controlled ankle exoskeleton with foot switches that adapt dorsiflexion across gait sub-events. We describe integrated ankle robotics and physiotherapy during subacute stroke recovery. Methods A 46-year-old man with subacute ischemic stroke, right hemiparesis, and foot drop underwent AMBLE training after reaching dependent ambulation (FAC 1) at 15 weeks post-stroke. He completed thirty 45-minute AMBLE-assisted sessions over 6 weeks, plus matched conventional therapy. Assessments at baseline (T0), post-training (T1), and 12-week follow-up (T2) included FAC, Fugl-Meyer Lower Extremity (FM), 10MWT, 6MWT, Berg Balance Scale (BBS), Dynamic Gait Index (DGI), and gait biomechanics. Results Robotics training data shows steps/session increased 3X, cadence 2X, and paretic heel first foot strikes from <4% to 40% over 6 weeks training. Improvements in mobility outcomes between T0 and T1 were maintained at T2:FM+11(12->23->24), 10MWT+0.32 m/s(0.24->0.45->0.56 m/s), 6MWT +109 m(71->115 m->180), BBS +12(37->46->49), and DGI +7(0->9->7). Gait analysis showed improved FAC (1->4->4), velocity (0.12->0.25->0.25 m/s), paretic step length (-0.07->0.14->0.14 m), % stance time (72->63->59%), and dorsiflexion angle (-8.8->0.58->0.82°) during unassisted over-ground walking. Conclusions Adaptive ankle robotics can be integrated with therapist-guided rehabilitation in subacute stroke with severe hemiparesis. Randomized trials are warranted to compare this approach with conventional therapy. Conflict of interest Charlene Macko and Richard Macko receive fundings from Next Step Robotics. All other authors have nothing to disclose.