An integrated gait rehabilitation training based on Functional Electrical Stimulation cycling and overground robotic exoskeleton in complete spinal cord injury patients: Preliminary results

Abstract

The aim of this study is to investigate the effects of an integrated gait rehabilitation training based on Functional Electrical Stimulation (FES)-cycling and overground robotic exoskeleton in a group of seven complete spinal cord injury patients on spasticity and patient-robot interaction. They underwent a robot-assisted rehabilitation training based on two phases: n=20 sessions of FES-cycling followed by n= 20 sessions of robot-assisted gait training based on an overground robotic exoskeleton. The following clinical outcome measures were used: Modified Ashworth Scale (MAS), Numerical Rating Scale (NRS) on spasticity, Penn Spasm Frequency Scale (PSFS), Spinal Cord Independence Measure Scale (SCIM), NRS on pain and International Spinal Cord Injury Pain Data Set (ISCI). Clinical outcome measures were assessed before (T0) after (T1) the FES-cycling training and after (T2) the powered overground gait training. The ability to walk when using exoskeleton was assessed by means of 10 Meter Walk Test (10MWT), 6 Minute Walk Test (6MWT), Timed Up and Go test (TUG), standing time, walking time and number of steps. Statistically significant changes were found on the MAS score, NRS-spasticity, 6MWT, TUG, standing time and number of steps. The preliminary results of this study show that an integrated gait rehabilitation training based on FES-cycling and overground robotic exoskeleton in complete SCI patients can provide a significant reduction of spasticity and improvements in terms of patient-robot interaction.

Effects of Robot-Assisted Gait Training in Individuals with Spinal Cord Injury: A Meta-analysis

“…The other one trial was excluded for analysis because the participants in this trial had no spasticity [52]. Out of the four non-RCTs analyzed, 2 studies [49,50] use MAS as their outcome measure on 28 participants. The other two studies [42,43] used AS to assess 23 participants for spasticity ( Figure 3).…”

“…Results of Primary Outcomes: Pain. Two RCTs [44,45] and 3 non-RCTs [43,49,50] were included for analysis. Eighty-four and 31 participants were involved in RCT and non-RCT studies, respectively.…”

“…The pooled mean difference (random effects model) of RCTs and non-RCTs were -0.890 and -1.676, respectively. The level of pain ranged from painless [44] to moderate [49,50] (Figure 4).…”

“…From the 18 studies, 7 trials were done in the United States [36][37][38][39][40][41][42], 2 in Spain [43,44], 2 in Switzerland [45,46], 2 in Canada [47,48], 2 in Italy [49,50], 2 in Japan [51,52], and one in Germany [53].…”

A Functional Electrical Stimulation System for Integration in an Exoskeleton

“…In recent years, there have been extensively carried out the researches on fitting exoskeletons with FES system [12][13][14][15][16], however, currently, there are a few ready-made FES systems on a medical market that could be used with exoskeletons. In addition to exoskeletons, active orthosis with FES are being developed [17,18].…”