Implementing the exoskeleton Ekso GTTM for gait rehabilitation in a stroke unit – feasibility, functional benefits and patient experiences

Abstract

Background Reports on the implementation of exoskeletons for gait rehabilitation in clinical settings are limited. Objectives How feasible is the introduction of exoskeleton gait training for patients with subacute stroke in a specialized rehabilitation hospital? What are the functional benefits and the patient experiences with training in the Ekso GTTM exoskeleton? Design Explorative study. Methods During an 18 months inclusion period, 255 in-patients were screened for eligibility. Inclusion criteria were; walking difficulties, able to stand 10 min in a standing frame, fitting into the robot and able to cooperate. One-hour training sessions 2–3 times per week for approximately 3 weeks were applied as a part of the patients’ ordinary rehabilitation programme. Assessments: Functional Independence Measure, Motor Assessment Scale (MAS), Ekso GTTM walking data, patient satisfaction and perceived exertion of the training sessions (Borg scale). Results Two physiotherapists were certified at the highest level of Ekso GTTM. Twenty-six patients, median age 54 years, were included. 177 training sessions were performed. Statistical significant changes were found in MAS total score (p < 0.003) and in the gait variables walking time, up-time, and a number of steps (p < 0.001). Patients reported fairly light perceived exertion and a high level of satisfaction and usefulness with the training sessions. Few disadvantages were reported. Most patients would like to repeat this training if offered. Conclusions Ekso GTTM can safely be implemented as a training tool in ordinary rehabilitation under the prerequisite of a structured organization and certified personnel. The patients progressed in all outcome measures and reported a high level of satisfaction. Implications for rehabilitation The powered exoskeleton Ekso GTTM was found feasible as a training option for in-patients with severe gait disorders after stroke within an ordinary rehabilitation setting. The Ekso GTTM must be operated by a certified physiotherapist, and sufficient assistive personnel must be available for safe implementation. Patients' perceived exertion when training in the Ekso GTTM was relatively low. The patients expressed satisfaction with this training option.