Abstract
BackgroundRobotic wearable exoskeletons have been utilized as a gait training device in persons with spinal cord injury. This pilot study investigated the feasibility of offering exoskeleton-assisted gait training (EGT) on gait in individuals with incomplete spinal cord injury (iSCI) in preparation for a phase III RCT. The objective was to assess treatment reliability and potential efficacy of EGT and conventional physical therapy (CPT).MethodsForty-four individuals were screened, and 13 were eligible to participate in the study. Nine participants consented and were randomly assigned to receive either EGT or CPT with focus on gait. Subjects received EGT or CPT, five sessions a week (1 h/session daily) for 3 weeks. American Spinal Injury Association (ASIA) Lower Extremity Motor Score (LEMS), 10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), Timed Up and Go (TUG) test, and gait characteristics including stride and step length, cadence and stance, and swing phase durations were assessed at the pre- and immediate post- training. Mean difference estimates with 95% confidence intervals were used to analyze the differences.ResultsAfter training, improvement was observed in the 6MWT for the EGT group. The CPT group showed significant improvement in the TUG test. Both the EGT and the CPT groups showed significant increase in the right step length. EGT group also showed improvement in the stride length.ConclusionEGT could be applied to individuals with iSCI to facilitate gait recovery. The subjects were able to tolerate the treatment; however, exoskeleton size range may be a limiting factor in recruiting larger cohort of patients. Future studies with larger sample size are needed to investigate the effectiveness and efficacy of exoskeleton-assisted gait training as single gait training and combined with other gait training strategies.Trial registrationClinicaltrials.org, NCT03011099, retrospectively registered on January 3, 2017.
Highlights
Robotic wearable exoskeletons have been utilized as a gait training device in persons with spinal cord injury
A substantial number of research studies have demonstrated that neural plasticity and cortical reorganization could occur through systematic execution of taskspecific training which leads to recovery of walking after sustaining neurological injury [6,7,8,9,10,11]
The secondary objective of the study was to investigate the potential efficacy of exoskeleton-assisted gait training (EGT) on motor and gait performance compared to conventional physical therapy (CPT) gait training
Summary
Robotic wearable exoskeletons have been utilized as a gait training device in persons with spinal cord injury. A study by Duncan et al showed no superiority of BWSTT over home-based physical therapy in improving the functional level of walking and reducing the incidence of falls in individuals with stroke [14]. These findings could be explained, partly by the difference in gait kinematics and subject involvement between treadmill and overground walking. To have more effective gait training that follows task-specific training principles, overground gait training with body weight support features from exoskeleton robotic devices should be considered
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