[Identify and model the determinants of walking in neuromuscular diseases to optimize function assistance in daily life].

Lower-limb exoskeletons are promising devices to support walking and transfers in individuals with neuromuscular diseases (NMDs). However, the actual effects of these devices on gait in individuals with these pathologies remain largely unknown because existing devices are based on assistance algorithms whose relevance to the compensatory strategies specific to NMDs has yet to be demonstrated. Within our research program, we conducted a multiparametric analysis during gait combining kinematic, electromyographic, muscle strength and subjective perception data. Our findings indicate on the one hand that, compared to healthy subjects, patients with NMD present a decrease in walking performance which is associated with reduced cadence, longer stance duration, shorter step length and duration, reduced ankles angles at gait cycle initiation, lower muscle strength, and increased variability in hip kinematics. On the other hand, the evaluation of two commercial exoskeletons (Keeogo® and Myosuit) revealed, despite safe use, a global decrease in walking performance compared to that evaluated without these devices, due to complex redistributions of muscular activity. Key determinants of performance remained similar with and without assistance, highlighting the current limitations of these devices. Future directions involve developing individualized musculoskeletal models to optimize assistance towards an optimized personalization.