Cardiorespiratory Responses to 10 Weeks of Exoskeleton-Assisted Overground Walking Training in Chronic Nonambulatory Patients with Spinal Cord Injury

Abstract

Exercise intensity of exoskeleton-assisted walking in patients with spinal cord injury (SCI) has been reported as moderate. However, the cardiorespiratory responses to long-term exoskeleton-assisted walking have not been sufficiently investigated. We investigated the cardiorespiratory responses to 10 weeks of exoskeleton-assisted walking training in patients with SCI. Chronic nonambulatory patients with SCI were recruited from an outpatient clinic. Walking training with an exoskeleton was conducted three times per week for 10 weeks. Oxygen consumption and heart rate (HR) were measured during a 6-min walking test at pre-, mid-, and post-training. Exercise intensity was determined according to the metabolic equivalent of tasks (METs) for SCI and HR relative to the HR reserve (%HRR). Walking efficiency was calculated as oxygen consumption divided by walking speed. The exercise intensity according to the METs (both peak and average) corresponded to moderate physical activity and did not change after training. The %HRR demonstrated a moderate (peak %HRR) and light (average %HRR) exercise intensity level, and the average %HRR significantly decreased at post-training compared with mid-training (31.6 ± 8.9% to 24.3 ± 7.3%, p = 0.013). Walking efficiency progressively improved after training. Walking with an exoskeleton for 10 weeks may affect the cardiorespiratory system in chronic patients with SCI.

Exoskeleton Training and Trans-Spinal Stimulation for Physical Activity Enhancement After Spinal Cord Injury (EXTra-SCI): An Exploratory Study

“…Another potential tool to help persons with SCI meet physical activity guidelines is powered robotic exoskeletons, the use of which has greatly expanded in recent years (16)(17)(18)(19)(20). Exoskeletons offer a unique opportunity for persons with SCI to experience standing and walking at a low metabolic cost (16,(21)(22)(23).…”

Exoskeleton-based exercises for overground gait and balance rehabilitation in spinal cord injury: a systematic review of dose and dosage parameters

“…One (n = 1) study had a comparison group of individuals with acute SCI/D who underwent the same exoskeleton protocol [ 46 ]. As for the geographical distribution of study sites, five (n = 5) were developed in the United States [ 6 , 33 , 44 , 47 , 48 ], four (n = 4) in Italy [ 43 , 45 , 49 , 50 ], two (n = 2) in Canada [ 51 , 52 ], two (n = 2) in China [ 41 , 53 ] and two (n = 2) in Korea [ 54 , 55 ], one (n = 1) in France [ 56 ], one (n = 1) in Japan [ 46 ], one (n = 1) in South Africa [ 42 ], and one (n = 1) from a 7 site (Denmark, Germany, the Netherlands, Norway, Spain, Sweden and Switzerland) multicenter study in Europe [ 28 ], Fig. 2 displays the countries of origin for 18 studies, except for the multicenter study in Europe, which is the most active region investigating overground exoskeletons training for gait and balance rehabilitation among individuals with SCI/D.…”

Comparing walking with knee-ankle-foot orthoses and a knee-powered exoskeleton after spinal cord injury: a randomized, crossover clinical trial

“…We used the definition proposed by Martini et al 52 , which was used to determine gait efficiency in elderly people when using a robotic hip exoskeleton. Walking efficiency refers to the amount of oxygen consumed per 1 kg of body weight to walk a 1 m distance 53,54 .…”

“…We used the definition proposed by Martini et al 52 , which was used to determine gait efficiency in elderly people when using a robotic hip exoskeleton. Walking efficiency refers to the amount of oxygen consumed per 1 kg of body weight to walk a 1 m distance 53 , 54 . where [ml/s/kg] is the filtered oxygen uptake rate, [ml/s/kg] is the average baseline oxygen uptake rate recorded during the second minute of the resting period, [s] is the walking start time, [s] is the walking final time, and L [m] is the distance covered during the test.…”