Abstract
Background: Mechanical orthoses are frequently withdrawn from the domestic use, due to the high energy required by walking. Purpose: This study aimed at assessing the metabolic expenditure of walking with an electrically-powered exoskeleton and to compare the energy cost of locomotion with the costs of passive or hybrid devices. Methods: Expiratory gases concentration and heart rate were measured during wheelchairand exoskeleton-assisted locomotion, at the most comfortable- and lower-speed in a paraplegic subject (female, 28 years, lesion level L1 , ASIA B). Energy cost of locomotion was calculated and compared to previously published data. Results: Oxygen consumption during exoskeleton-assisted walking at lower and comfortable speed (12.4±0.8, 15.5±0.9 ml·kg-1·min-1, respectively) were similar to the expenditure measured during wheelchair-ambulation at comfortable speed (14.5±0.7 ml·kg-1·min-1; P=ns). Walking energy cost was higher during locomotion with exoskeleton (0.69±0.05 and 0.63±0.04 ml·kg-1·m-1 for lower and comfortable speed, respectively, P<0.001 between speeds) than wheelchair-ambulation (0.15±0.01 and 0.16±0.01 ml·kg1 ·m-1 for lower and comfortable speed respectively, P<0.05 between speeds) but lower than those reported in previous studies. Conclusion: Considering the findings of this case report, compared to passive and hybrid orthoses, robotic exoskeleton increases walking speed and decreases energy-cost.
Highlights
The recovery of standing posture and walking ability in spinal cord injured patients may provide several benefits, either physiological and psychological, including improvement in physical and cardiorespiratory fitness, increase in bone mineral density,[1] independence, self-esteem,[2] and an enhancement of the independence in domestic setting due to the possibility to reach many other spaces by assuming the upright position
High energy expenditure associated to low gait speed has been reported for passive and hybrid orthoses in comparison with normal gait and wheelchair ambulation.[2,3,6]
While energy cost of locomotion of robotic assisted gait is well documented in body-weight support approach,[2,7] to our knowledge only one study investigated the acute cardio-respiratory response to over ground exoskeleton-assisted walking in paraplegic subjects[8] and a direct comparison between metabolic expenditure during wheelchair ambulation and bionic over ground locomotion within the same patient still lacks
Summary
The recovery of standing posture and walking ability in spinal cord injured patients may provide several benefits, either physiological and psychological, including improvement in physical and cardiorespiratory fitness, increase in bone mineral density,[1] independence, self-esteem,[2] and an enhancement of the independence in domestic setting due to the possibility to reach many other spaces by assuming the upright position. Orthotic devices (either passive or electrically assisted) have been frequently withdrawn by household use because of their encumbrance, the high effort required during wearing and removing it, the very low speed during locomotion and the high metabolic cost of locomotion (C).[2,3,4,5] high energy expenditure associated to low gait speed has been reported for passive (mechanical) and hybrid orthoses (mechanical orthoses combined with functional electrical stimulation) in comparison with normal gait and wheelchair ambulation.[2,3,6] Since the late ‘70s, robotic exoskeletons has been used in rehabilitation fields to restore autonomous walking. Purpose: This study aimed at assessing the metabolic expenditure of walking with an electrically-powered exoskeleton and to compare the energy cost of locomotion with the costs of passive or hybrid devices
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