A multifaceted hybrid ES-robotic device for gait training in individuals with neurological disorders

Francesca Dell’Eva, Eleonora Guanziroli, Viola Camerini, Marta Gandolla, Laura Brignole, Stefano Maludrottu, Emanuele Gruppioni, Giancarlo Ferrigno, Franco Molteni, Emilia Ambrosini () and Alessandra Pedrocchi
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Francesca Dell’Eva: Politecnico di Milano
Eleonora Guanziroli: Villa Beretta Rehabilitation Center
Viola Camerini: Politecnico di Milano
Marta Gandolla: Politecnico di Milano, Polo Territoriale di Lecco
Laura Brignole: Politecnico di Milano
Stefano Maludrottu: Italian Institute of Technology IIT
Emanuele Gruppioni: Istituto Nazionale Assicurazione contro gli Infortuni sul Lavoro
Giancarlo Ferrigno: Politecnico di Milano
Franco Molteni: Villa Beretta Rehabilitation Center
Emilia Ambrosini: Politecnico di Milano
Alessandra Pedrocchi: Politecnico di Milano

Nature Communications, 2025, vol. 16, issue 1, 1-16

Abstract: Abstract The integration of robotics and Electrical Stimulation (ES) in neurorehabilitation leverages robotics’ precise task execution alongside ES-induced motor learning, muscle conditioning, and cardiovascular benefits. We propose a hybrid system for overground gait training, combining neuromuscular ES and a motorized exoskeleton. Different combination modalities are proposed: ES-motor cooperation for the swinging knee, synchronized but independent ES and motor assistance for hip movements and for the knee during stance, and ES-only for the non-actuated ankle. Twelve non-disabled subjects and eleven participants with neurological disorders tested the system under two conditions: exoskeleton-only and hybrid. The hybrid condition reduced knee motor torque by 48% during swing without compromising tracking accuracy, showing that ES can effectively drive limb motion. Neurological participants rated the hybrid system as more usable than the exoskeleton alone (median 5-point improvement of System Usability Scale). These findings support the feasibility of hybrid ES-motorized exoskeletons in clinical settings. Future studies should investigate their potential to enhance therapeutic outcomes.

Date: 2025
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DOI: 10.1038/s41467-025-63474-3

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