{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T07:45:13Z","timestamp":1782805513686,"version":"3.54.5"},"reference-count":26,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T00:00:00Z","timestamp":1782777600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background: Evidence on powered wearable exoskeleton gait training in patients with chronic hypoxic-ischemic encephalopathy (HIE) is virtually absent, and existing studies have focused on macroscopic functional outcomes while neglecting joint-level neuromuscular force-generation characteristics such as rate of force development (RFD). Objective: To examine the effects of a six-week powered exoskeleton gait training program on isometric hip strength and RFD, sit-to-stand (STS) performance, frontal-plane hip strength, and center-of-pressure (CoP) dynamics in a patient with chronic HIE-induced quadriparesis. Methods: A case report with pre- and post-intervention evaluation was conducted. A 47-year-old male with chronic HIE-induced quadriparesis (onset 2017) completed 18 sessions (three per week, six weeks) of powered lower-limb exoskeleton gait training. Outcomes included isometric hip peak force and RFD (DynaMo, Vald Performance), STS peak force and body mass-normalized RFD (ForceDecks, Vald Performance), frontal-plane hip strength (ForceFrame, Vald Performance), and CoP path length and mean velocity. Results: Hip extension peak force increased by 247\u2013256% bilaterally, and hip extension RFD increased by 174\u2013188%, whereas hip flexion peak force showed minimal change (+3.3\u20135.2%). Body mass-normalized STS RFD increased by 250% (10 to 35 N\u00b7s\u22121\u00b7kg\u22121), representing the largest relative gain. Hip abduction strength increased by 27.1\u201336.8% with improved bilateral symmetry; hip adduction imbalance reversed from right to left dominance. CoP path length and mean velocity each decreased by 3.7%. Conclusions: Six weeks of powered exoskeleton gait training selectively enhanced time-dependent neuromuscular output\u2014particularly RFD\u2014beyond maximal strength gains, with meaningful improvements in functional weight acceptance during STS. These findings support exoskeleton-based training as a promising rehabilitation strategy for patients with chronic CNS injury.<\/jats:p>","DOI":"10.3390\/brainsci16070688","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T05:58:04Z","timestamp":1782799084000},"page":"688","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Powered Exoskeleton Gait Training and Hip Rate of Force Development in Chronic Hypoxic-Ischemic Encephalopathy: A Case Study"],"prefix":"10.3390","volume":"16","author":[{"given":"Yukyoung","family":"Won","sequence":"first","affiliation":[{"name":"Major in Sports Medicine, Department of Medicine, CHA University of Medicine and Science, Pocheon 11160, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junggi","family":"Hong","sequence":"additional","affiliation":[{"name":"Graduate School of Sports Medicine, CHA University of Medicine and Science, Pocheon 11160, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.3233\/NRE-2010-0531","article-title":"Hypoxic-ischemic brain injury: Pathophysiology, neuropathology and mechanisms","volume":"26","author":"Busl","year":"2010","journal-title":"NeuroRehabilitation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.neulet.2012.08.053","article-title":"Neural tracts injuries in patients with hypoxic ischemic brain injury: DTI study","volume":"528","author":"Lee","year":"2012","journal-title":"Neurosci. 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