Paraplegic Patients Research Articles

Improvement in Pulmonary Function with Short-term Rehabilitation Treatment in Spinal Cord Injury Patients

Cervical and upper thoracic spinal cord injury causes impairments in respiratory muscle performance, leading to variable degrees of pulmonary dysfunction and rendering deep breathing difficult for affected individuals. In this retrospective study, we investigated the effects of self-directed respiratory muscle training in this context by assessing pulmonary function relative to spinal cord injury characteristics. A total of 104 spinal cord injury patients (tetraplegia/paraplegia; 65/39, acute/subacute/chronic; 14/42/48) were admitted for short-term (4–8 weeks) in-patient clinical rehabilitation. Initial evaluation revealed a compromised pulmonary function with a percentage of predicted value of 62.0 and 57.5 in forced vital capacity in supine and forced vital capacity in sitting positions, respectively. Tetraplegic patients had more compromised pulmonary function compared with paraplegic patients. At follow-up evaluation, the percentage of predicted value of forced vital capacity in supine and sitting position improved overall on average by 11.7% and 12.7%, respectively. The peak cough flow improved by 22.7%. All assessed pulmonary function parameters improved significantly in all subgroups, with the greatest improvements found in patients with tetraplegia and subacute spinal cord injury. Therefore, short-term self-directed respiratory muscle training should be incorporated into all spinal cord injury rehabilitation regimens, especially for patients with tetraplegia and subacute spinal cord injury, as well as those with chronic spinal cord injury.

Prevalence of Shoulder Pain in Spinal Cord Injury Patients Referring to the Brain and Spinal Cord Injury Research Center of Tehran University of Medical Sciences

BackgroundSpinal cord injury (SCI) is a catastrophic event that influences all aspects of the life of the patients and their families. It may have many acute or chronic complications. One of the most common complications is shoulder pain, which particularly occurs in wheelchair users.ObjectivesThis study aimed to estimate the prevalence of shoulder pain in paraplegic spinal cord injury patients who were referred to our clinic.MethodsWe included 70 spinal cord injury patients in our study according to inclusion criteria. Demographic data and SCI-related factors were recorded. The disabilities of the arm, shoulder, and hand (DASH) questionnaire was used to assess shoulder pain in our patients.ResultsMean score of pain was 51 in cervical, 23 in thoracic and 12 in lumbar spinal cord injury according to the DASH questionnaire. The pain was more prevalent and severe in the cervical group.ConclusionsAccording to our study, it seems that shoulder pain has a relatively high prevalence and is more severe in cervical quadriplegic SCI patients that may be due to muscle imbalance around the shoulder. Therefore, this problem should be noted in the course of managing these patients.

A Systematic Methodology to Analyze the Impact of Hand-Rim Wheelchair Propulsion on the Upper Limb.

Manual wheelchair propulsion results in physical demand of the upper limb extremities that, because of its repetitive nature, can lead to chronic pathologies on spinal cord injury patients. The aim of this study was to design and test a methodology to compare kinematic and kinetic variables of the upper limb joints when propelling different wheelchairs. Moreover, this methodology was used to analyze the differences that may exist between paraplegic and tetraplegic patients when propelling two different wheelchairs. Five adults with paraplegia and five adults with tetraplegia performed several propulsion tests. Participants propelled two different wheelchairs for three minutes at 0.833 m/s (3 km/h) with one minute break between the tests. Kinematic and kinetic variables of the upper limb as well as variables with respect to the propulsion style were recorded. Important differences in the kinetic and kinematic variables of the joints of the upper limb were found when comparing paraplegic and tetraplegic patients. Nevertheless, this difference depends on the wheelchair used. As expected, in all tests, the shoulder shows to be the most impacted joint.

Implementation of Artificial Intelligence Wheel Chair for Differently-abled Person

The vehicle is designed by taking into consideration of the physically challenged people especially the paraplegic patients. These people are living in our vicinity with paralyzed legs, their mode of transport from one place to another is through the wheel chairs. The normal wheel chair has to be operated manually with more man power, this eventually makes tiresome for people to cover long distances, in order to overcome such hardships faced by those people artificial intelligent wheel chair is proposed work. The vehicle is being controlled by the analog sensors fitted in the patient’s hand. The device used here is an accelerometer MPU 6050 sensor. The arduino nano board and arduino uno board is acting as an interface between the accelerometer and RF transmitter, DC gear motor and the RF receiver respectively. Coding is developed be the principles of accelerometer in x, y and z directions. The vehicle moves in all four direction according to the gesture of the patient. On the whole the vehicle is patient friendly and cost efficient.

Evaluation of Lower Extremities’ Vascular Characteristics in Myelomeningocele Patients: A Case-Control Study

Objective: Myelomeningocele (MMC) is the most common neural tube defect. Patients with MMC have multiple risk factors for venous thrombosis, but this complication rarely occurs. This lower rate of venous thrombosis in MMC children could be related to some characteristics of the vessels in the lower extremities. This study aimed at finding explanations for this dilemma. Methods: A case-control study was designed in the Children’s Hospital Medical Center, Tehran considering paraplegic patients with MMC as the case group and nonparaplegic MMC patients as a control group. Doppler ultrasound was performed to evaluate femoral and popliteal arterial and venous properties. Results: Patients aged from 8 months to 12 years were evaluated. The mean diameter of the femoral arteries was 3.73 ± 0.23 and 4.72 ± 0.39 mm among paraplegic and nonparaplegic MMC patients, respectively (p = 0.02). The femoral artery flow was 0.52 ± 0.08 and 0.75 ± 0.06 L/min, respectively in the case and control groups (p = 0.015). The diameters of the femoral veins were 4.85 ± 0.34 and 5.13 ± 0.32 mm in the case and control groups, respectively (p > 0.05). Besides, the blood flows of the case and control groups’ femoral veins were 0.27 ± 0.08 and 0.14 ± 0.01 L/min, respectively (p = 0.6). It turned out that lower extremities’ arteries in the case group had significantly lower blood flow and diameter compared to those of the control group. However, the same venous properties did not show any significant differences. Conclusion: The decreased arterial flow along with the unchanged venous properties leads to less stasis and better drainage of the blood, which in turn might result in a lower incidence of deep vein thrombosis.

Inhibition of ADAMTS-4 Expression in Olfactory Ensheathing Cells Enhances Recovery after Transplantation within Spinal Cord Injury.

Spinal cord injury (SCI) induces permanent loss of sensitive and motor functions below the injury level. To date, a wide variety of cells has been used as biotherapies to cure SCI in different animal paradigms. Specifically, olfactory ensheathing cells (OECs) is one of the most promising. Indeed, OECs have been shown to enhance recovery in many animal studies. Moreover, OECs transplantation has been applied to a paraplegic patient and have shown beneficial effects. However, it has been reported that the significant level of recovery varies among different patients. Therefore, it is of primary importance to enhance the regenerative efficiency of OECs for better translations. Recently, it has been shown that inhibiting ADAMTS4 expression in glial cells in vitro increases their synthesis of neurotrophic factors. We hypothesized that the expression of neurotrophic factors secreted by OECs can be increased by the deletion of ADAMTS4. Taking advantage of ADAMTS4-/- mouse line, we produce ADAMTS4 deficient primary OEC cultures and then we investigated their regenerative potential after SCI. By using quantitative polymerase chain reaction, bioluminescence imaging, measurement of locomotor activity, electrophysiological studies, and immunohistochemistry, our results show that ADAMTS4-/- olfactory bulb OEC (bOECs) primary cultures upregulate their trophic factor expression in vitro, and that the transplantation of ADAMTS4-/- bOECs in a severe SCI model increases functional recovery and tissue repair in vivo. Altogether, our study reveals, for the first time, that primary bOEC cultures transplantation can be potentialized by inhibition of the expression of ADAMTS4.

A study to assess the various factors and treatment modalities of pressure sore in a tertiary care hospital

Background: Pressure sores can cause physical, social and psychological suffering. The distress is caused by local factors such as pain, wound exudates and malodour (which may lead to social isolation), delayed rehabilitation (which may result in economic hardship), and serious complications such as cellulitis, osteomyelitis, septicemia, limb amputation and death. The objective of the study was to assess the various factors affecting the outcome of pressure sore and various treatment modalities in the management of pressure sore.Methods: A hospital based prospective study was carried out from August 2007 to January 2010 at V S Medical College, Ahmedabad, Gujarat. All the cases admitted with pressure sores in the hospital across all the departments were included in the study. A total of 50 cases of pressure sores which met our inclusion criteria were included in the study.Results: 50 patients of pressure sore were studied out of which, 28 (56%) patients are non-paraplegics and 22 (44%) patients are paraplegic. The most common site is sacral region 45 (60.8%), followed by ischial region 12 (16.2%) and Trochanteric region 10 (13.5%). 47 (94%) patients were treated with systemic antibiotics and 6 (12%) patients were treated with muscle relaxants for spasticity.Conclusions: Non ambulatory paraplegic patients with deep pressure sores needs surgical intervention to cover the pressure sore; while non-paraplegic patients with superficial pressure sores can be treated successfully by conservative line of management and deep pressure sores needs to be operated.

Influence of percentage of body-weight support on gait in patients with traumatic incomplete spinal cord injury

BackgroundBody-weight-supported treadmill training (BWSTT) is a treatment method to help patients with incomplete spinal cord injuries to restore the capability to walk again.ObjectiveThis study aimed to assess the effects of different percentages of body-weight-support locomotor training on the enhancement of gait for persons with incomplete spinal cord injuries.Subjects and methodsTwenty male paraplegic persons, with the statistical parameters [mean ± SD] age 32.53 ± 1.793 years, height 175.71 ± 1.658 cm, weight 71.59 ± 2.442 kg, and body mass index 23.18 ± 0.828 kg/m2) were picked by convenience sampling. Ten patients were randomly allocated to the body-weight treadmill training 30% group (Group A); and ten patients to the body-weight treadmill training 40% group (Group B). The two groups were exercised for 1h every set, at two sets weekly for 1.5 months. Body-weight-supported treadmill training was divided into a 15-min warm-up on a stationary bicycle, 45-min body-weight-supported treadmill training with 30 and 40% body weight and finally, a 10-min cool down as we started loading with 10% of body weight of each patient until reach 30% or 40% according to his group.ResultsThe resultant data revealed that there are significant distinctions between the body-weight treadmill training 30% and the with body-weight treadmill training 40% groups in regards to alterations in the walking speed, step length, and stride length (p < 0.001), cadence (p = 0.009).ConclusionBody-weight-supported treadmill training 40% in comparison with body-weight-supported treadmill training 30% can enhance both the quantity and quality of gait in paraplegic patients (ASIA B, C, and D classification).

Bio-inspired standing balance controller for a full-mobilization exoskeleton.

This paper presents a novel method to perform automatic standing balance in a full mobilization exoskeleton. It exploits the locked ankle and the curved foot sole of the exoskeleton TWIICE. The idea is to use the knees to roll the sole and change the position of the contact point with the floor, which allows to stabilize without an actuated ankle.This controller is biologically inspired, originating from a previous experiment with the passive exoskeleton CAPTUR and healthy subjects. Then, a simulation model was built to test the observed balance strategy. Finally, the controller was implemented on the actual actuated exoskeleton, without a wearer for the time being, to experimentally check the basic operation. The next planned step is to test its actual performance with healthy subjects, then paraplegic patients.

Mechanical Development of a Scalable Structure for Adolescent Exoskeletons.

Over the past decade, many medical lower limb exoskeletons have been developed and exploited. The advantage of such a systems is to ensure the mobility of paraplegic patients, as well as their physical rehabilitation. However, existing solutions have not been widely available among the disabled population, particularly adolescents, due to the limitations of their conception caused by the rapid physical growth and morphological variation of this population.In this paper, a new scalable structure of the exoskeleton is proposed as a feasible solution to the problem of morphological changes. As this is the first time the generic term "scalability" has been used, its requirements and design methods, including the morphological changes and alignment, are presented in detail to better meet the growing needs for such a promising device. The evaluation of the proposed scalable structure shows a promising utility that is illustrated by several experimental scenarios: the load capacity of the structure, the efficiency of the fixation mechanisms, the validation of the hip alignment mechanism and finally the validation of the evolutionary structure.

하반신 마비환자용 동력보행보조기의 보행 단계 구분을 위한 지면반력센서 개발

본 연구에서는 하반신 마비환자용 동력보행보조기(PGO: Powered Gait Orthosis)의 보행단계구분을 위한 지면반력센서를 개발 하였다. 이를 위해 왕복보행보조기(RGO: Reciprocal Gait Orthosis)를 착용하고 재활훈련을 수행중인 하지마비환자 3명을 대상으로 보행 시 나타나는 COP(Center of Pressure)궤적과 지면반력 특성을 분석하였다. 척수손상환자의 족저압력은 일반인의 1/3정도로 측정되었고, 환자마다 각각 다른 COP궤적이 발생하였다. 분석된 결과를 기반으로 센서의 측정범위와 위치를 선정하였으며, 이를 통해 FSR기반의 지면반력센서 시제품을 개발하였다. 개발된 지면반력센서를 이용하여 RGO를 착용한 하지마비 장애인이 보행할 때 나타나는 족저압력과 COP를 측정하였다. 측정된 데이터는 임계치 구분방법으로 보행을 4단계(초기접지기, 중간입각기, 말기입각기, 유각기)로 구분하였으며, ANOVA-test를 통해 각 보행단계별 압력간의 차이가 서로 유의한 차이가 있음을 확인하였다(p0.01). 이는 본 논문에서 제안한 지면반력센서가 보행단계를 구분하는데 활용될 수 있음을 보여준다.

Gamification Smartphone Application for Leg Physical Therapy

The need to treat illnesses or deterioration of the legs caused by accidents, rheumatism, muscular weakness, paralysis or bone diseases has increased. Paraplegic patients need physical therapy to mitigate their condition. This study developed a gamification smartphone application for leg physical therapy. The application was implemented for patients using Android Operating System smartphones. The smartphone was attached to the walking support equipment. The accelerometer sensor of the smartphone was utilized to measure distance, time, and number of steps. The application acquired data from the sensor, and processed and stored the data in a server, to enable assessment of critical conditions. Moreover, this system would report the evaluation of physical therapy on a weekly basis. Alerts of physiotherapy treatment could be set in this application. The advantages of the application include increasing the patient’s motivation for the therapy, performed by themselves at home, and the results could be used for planning treatments by a physician.

Myoelectric Gaming in the Rehabilitation of Patients with C7 Spinal Cord Injury

This paper analyses the role of myoelectric games in the rehabilitation of paraplegic patients. The University of Valladolid neuromuscular training system, UVa-NTS platform, which allows the myoelectric command of computer applications, has been introduced in rehabilitation sessions of a group of paraplegic patients. The experiments took place both at the University of Valladolid and at the National Hospital for Paraplegics of Toledo in Spain. A homogeneous population of five patients with a C7 spinal cord injury was compared with a group of control subjects. The myoelectric control was performed with the flexor carpi radialis and the extensor carpi radialis muscles. The myoelectric routines were timed and the game scores measured. Notwithstanding the reduced mobility of the patients, they achieved fast adaptation and better timings than the control subjects in the first experiment (p &lt; 0.001), although this difference was reduced in further experiments. Both patients and control subjects played satisfactorily with the Myo-Pong game. However, the improvement in the scores was better for the control subjects between sessions (p = 0.009) when compared with the patients (p = 0.978). The results show that patients and control subjects were able to perform and reached similar scores. However, patients’ improvement in further rehabilitation sessions was lesser than when compared with the control subjects.

Medical-legal aspects and risk management

Complications of spinal surgery are an important source of professional liability judgments for trauma surgeons and neurosurgeons who develop this subspecialty. The disc pathology leads all the rankings of claims against these professionals. [1,2,3] This situation does not attract attention, given that lumbar and cervical disc hernias are frequent affections and more and more surgeons are turning to this activity. For the current neurosurgeon, the pathology of the spine tends to represent 50% of its benefits [4]. The high cost of agreements and sentences in cases of spinal surgeries is a reflection of the infrequent but severe damage that can occur when working millimeters from the spinal cord and nerve roots. Spine surgery has all the ingredients that can make a trial a nightmare. In general, patients with pathologies that do not threaten life, where the main symptom (pain) has a strong subjective component and where often the opinions of experts differ between conservative and radical approaches. There are several alternatives that are not always adequately reported to the patient, who may be surprised at evolutions that were not anticipated. On the other hand, in the case of quadriplegic or paraplegic patients, the costs of lost profits and future expenses are usually millionaires [5,6,7,8]. It is an extensive, varied and complex discipline and there are many authors who suggest the need to convert it into a new specialty [4] [9,10]. Spinal surgery is technically difficult and acquiring the necessary skills demands years of learning. The margin of error is minimal and only careful attention to detail in the pre, intra and postoperative ensures consistent good results. When complications arise and judgments for professional responsibility, the rush in the surgical decision (except in cases of clear urgency) and the lack of adequate information to the patient are usually aspects widely debated by all parties.

A paraplegic patient with fever and leucocytosis: not always what it seems

A 54-year-old obese woman with a history of spina bifida was admitted to the hospital with malaise and fever accompanied by leucocytosis, thrombocytosis, and hypercalcaemia. As treatment for neurogenic bladder dysfunction she had a suprapubic catheter. Diagnostic workup for osteomyelitis revealed an unknown mass originating from the urinary bladder on MRI of the pelvis. Further diagnostic analyses showed that the mass was a squamous-cell carcinoma (SCC) with laboratory abnormalities as paraneoplastic phenomena mediated by PTH-related peptide and cytokines released by the SCC. Despite radiotherapy the patient died within two months after initial diagnosis. Squamous-cell carcinoma of the bladder is rare in western countries. In unresectable or metastatic disease survival rates are low due to low responsiveness to standard chemotherapy. Concurrent chemoradiotherapy might be an alternative in unresectable or locally advanced disease; however, evidence to support this is lacking. The poor survival in these patients raises the question of whether high-risk groups for SCC of the bladder, like paraplegic patients or patient with neurogenic bladder dysfunction, should receive screening even though the ideal starting point and frequency are still unknown.

Mechanical design optimization of a series elastic actuator considering the control performance

Purpose Actuators for human-interactive robot systems require transparency and guaranteed safety. An actuation system is called transparent when it is able to generate an actuation force as desired without any actuator dynamics. The requirements for the transparent actuation include high precision and large frequency bandwidth in actuation force generation, zero mechanical impedance and so on. In this paper, a compact rotary series elastic actuator (cRSEA) is designed considering the actuation transparency and the mechanical safety. Design/methodology/approach The mechanical parameters of a cRSEA are optimally selected for the controllability, the input and output torque transmissibility and the mechanical impedance by simulation study. A mechanical clutch that automatically disengages the transmission is devised such that the human is mechanically protected from an excessive actuation torque due to any possible controller malfunction or any external impact from a collision. The proposed cRSEA with a mechanical clutch is applied to develop a wearable robot for incomplete paraplegic patients. To verify torque tracking performance and disengagement of the mechanical clutch, experiments were conducted. Findings As the effects of the gear ratio, N1, on the four control performance indexes are conflicting, it should be carefully selected such that the controllability and the output torque transmissibility are maximized, while the disturbance torque transmissibility and the mechanical impedance are minimized. When the four control performance indexes were equally weighted, N1 was selected as 30. Experimental results showed that the designed cRSEA provided good control performances and the mechanical clutch worked properly. Originality/value It is important to design the actuator so as to maximize the control performance in accordance with its purpose. This paper presents the design guidelines for the SEA by introducing four control performance indexes and analyzing how the performance indexes vary according to the change of design parameter. From the viewpoint of practicality, a mechanical clutch design method that prevents excessive torque from being transmitted to the wearer and an analysis to solve the locking phenomenon when using a worm gear are presented, and a design method of SEA satisfying both control performance and practicality is presented.

Adjacent segment degeneration following spinal fusion of vertebral fractures in paraplegic patients

The effects of adjacent segment degeneration (ASD) after spinal fusion of vertebral fractures have previously not been demonstrated in patients with trauma-related paraplegia. The aim of this study was to evaluate the role of ASD in patients with paraplegia caused by vertebral fractures and to observe whether there is adifference between unilateral or combined spinal fusion in long-term results regarding the degeneration of cranial or caudal adjacent spinal segments. Atotal of 111 paraplegic patients with an average age of 45years who underwent spinal fusion of vertebral fractures were observed in aretrospective longitudinal study with afollow-up period of 4years. Conventional X‑ray images and magnetic resonance imaging (MRI) scans were used to assess the ASD in the adjacent free vertebral segments cranial and caudal to the spinal fusion using the following elements: ventral spondylophytes, intervertebral space, intervertebral disc signal in MRI, posterior spondylophytes, facet joint arthrosis, bone bridging and ossification of the anterior longitudinal ligament. Additionally, the classification by the American Spinal Injury Association (ASIA) impairment scale and spinal cord independence measure version3 score were surveyed. The 4‑year incidence of radiographically detectable ASD was 3-12 % in this study. The majority of ASDs were observed in the cranial segments adjacent to the interbody fusion. The dorsoventral spinal fusion showed the least effects on the adjacent segments. In conclusion, aconcept of prompt surgery using short dorsoventral segment fusion carried out by an interdisciplinary paralysis center is recommended. The role of natural degeneration processes and whether they are influenced by iatrogenic manipulation through the vertebral stabilization is unclear. For this reason it is important to further investigate strategies for ASD reduction in the future to ensure the best possible treatment success including the lowest degree of additional impairments for this special patient group.

Robot-assisted training can improve the bladder and intestinal functions of paraplegic patients

Objective To explore the clinical effect of training assisted by a lower limb rehabilitation robot on the bladder and intestinal function of paraplegic spinal cord injury survivors. Methods Thirty-eight paraplegic patients with spinal cord injury were divided according to their admission order into an experimental group (n=19) and a control group (n=19). Both groups were given conventional rehabilitation training, while the experimental group was additionally provided with robot-assisted lower limb training in three stages: adaptation, training and consolidation. It lasted 30 minutes daily, 5 days per week for 12 weeks. Before and after the training, an urodynamics examination system was used to evaluate the maximum urine flow, bladder capacity, residual urine volume, bladder pressure and detrusor pressure. Colon transit time, mean rectal pressure and intestinal function were measured using the colon transit test, a mean rectal pressure test, and the Functional Independence Measure (FIM) scale respectively. Results The average bladder volume, maximum urine flow rate, average urine flow rate, detrusor pressure, bladder compliance, average rectal pressure and intestinal FIM score of the robot training group after training were all significantly better than before the training, as were the average residual urine volume and colon transit time. After the training, the average bladder volume, maximum urine flow rate, average urine flow rate, detrusor pressure, bladder compliance and average rectal pressure of the robot training group were all significantly higher than those of the control group, while the average residual urine volume and colon transit time were significantly smaller. Then, 32% of the patients in the experimental group achieved no less than 6 points for their average FIM score, significantly higher than in the control group. Conclusion Robot-assisted lower limb training combined with comprehensive rehabilitation training can effectively improve the bladder and intestinal function of paraplegic patients after a spinal cord injury. Key words: Spinal cord injury; Paraplegia; Rehabilitation robots; Bladder function; Intestinal function

Tethered cord syndrome: surgical outcome of 43 cases and review of literatures

ObjectiveTo evaluate the surgical treatment of tethered cord syndrome (TCS), a prospective analysis of 43 patients operated at Neurosurgery Department Zagazig University hospitals from May 2013 to January 2017 with 1 year follow-up had been done.Patients and methodsAdult and children patients with tethered cord syndrome subjected to microscopic surgeries for release of cord and nerves tethering with exclusion of primary repair of meningiomyelocele, paraplegic patients, hydrocephalic patients, and ages below 2 years old. Magnetic resonance imaging (MRI) of the spine was done for all patients and urodynamic studies for patients more than 6 years old preoperative and postoperative after 1 year of surgery.ResultsTen patients were adults > 18 years old and male to female ratio was about 2:1. All patients presented with multiple clinical manifestations which either improved or stable during follow-up after surgery. Controllable complications occurred: cerebrospinal fluid (CSF) leak in 18.6% and wound infection in 4.7%. Urodynamic studies improved in 73% of patients after surgery and children showed significant improvement in all symptoms except back pain than adult patients.ConclusionMicroscopic surgery is of value for patients suffering tethered cord syndrome with low risk of complications.

Reference Joint Trajectories Generation of CUHK-EXO Exoskeleton for System Balance in Walking Assistance

This paper introduces a wearable exoskeleton suit CUHK-EXO that can help paraplegic patients regain their mobility to stand up, sit down, and walk. An offline design and online modification (ODOM) algorithm is proposed for the exoskeleton to generate reference joint trajectories during walking assistance. First, reference trajectories of CUHK-EXO are designed offline based on motion capture data considering leg geometry constraints. Then the human–exoskeleton system (HES) including a pair of crutches is modeled as an eight-link system for analysis. Since the relative position of system center of pressure (COP) is an important factor to indicate system balance during walking, it is estimated in real-time and monitored for exoskeleton control. Based on the system COP position, this paper further proposes the reference trajectories online modification method for CUHK-EXO to counteract disturbances applied to the HES, and hence stabilize system balance in the walking assistance. Finally, walking tests are performed in both healthy subjects and a paraplegic patient to validate the effectiveness of the proposed ODOM algorithm. Testing results demonstrate that knowing the COP desired areas of the wearer, the exoskeleton CUHK-EXO can counteract perturbations and decrease the wearer’s efforts, so as to maintain system balance with the ODOM algorithm.