Efficacy of the Exoskeleton application in the spinal cord injury patient's rehabilitation

Abstract

500,000 people are injured spine each year. A real revolution in the rehabilitation and expansion of the barrier-free environment was the Exoskeletons appearance. Evaluation of the safety and effectiveness of the Exoskeleton + FES application in the SCI rehabilitation was the aim of this study. In total 92 of SCI patients, 6 months after incomplete SCI; thoracic region. Lower paraparesis − < 3 points (Muscle Strength Grading Scale); muscle tone − < 3 points (Ashworth scale); safe function of the upper extremities. Two groups patients had robotic-assisting walking: 46 patients had Lokomat + FES (control group), 46 patients had Exoskeleton + FES (study group). Rehabilitation course included 15 trainings. Safety was assessed via physical and instrumental examination (blood pressure, heart rate, saturation, electrocardiography). Truck stability was evaluated via video analyses. Spine muscles below SCI and gluteus were tested with electromyography during strength test. Physiological cost index was calculated using MacGregor's equation. Significant changes in the neurological status were not revealed in both groups. BP values were changed by not more than 15% from baseline, HR and ECG was within acceptable values. The saturation was 96–99%. PCI decreased at average by 32%. Basic group had better results in Strength test: ratio “Average strength/Myogram average amplitude” was increased. Maximum strength after trainings didn’t change but signal amplitude decreased that means improvements in back and gluteus muscles control. Spectral analysis of the ground reactions comparing dynamic walking parameters was done. Spectral power decreased after 15th training on Exoskeleton. Decreasing of the spectral density on Fx, Fy and Fz means that patient‘s gait became more stable in longitudinal and transverse directions. We can do conclusions on the safety and clinical efficacy of the Exoskeleton + FES application in the SCI patient‘s rehabilitation. And Exoskeleton is not only an assistive device, but also an instrument for rehabilitation treatment.