Characterization of unexpected postural changes during robot-assisted gait training in paraplegic patients

Abstract

Study design: This is a retrospective study. Objectives: The objectives of this study were to categorize unexpected postural changes (UPCs) during gait training in paraplegic patients with wearable gait-assist robots, to reveal the incidence of the UPC and its time-dependent changes during initial gait training period and to investigate neurological level-specific differences. Setting: This study was conducted in Fujita Health University, Aichi, Japan. Methods: We investigated five patients (46.2 ± 14.6 years; lesion level: T6:3, T12:2). All patients had previously achieved gait with wearable robot and walker at supervision level. The UPCs were counted for 2 years and classified according to their type. The time-course data were calculated from the incidence of UPCs for 10 days from initial gait training with the walker. The neurological level-specific differences were investigated between T6 and T12 injuries. Results: Eighty-five UPCs were observed and classified into three categories: anterior breakdown, posterior breakdown (PBD) and mal-timing. The average rate over the entire period was 0.96 ± 0.62 (incidents/h/subject). PBD, which was defined as hyperflexion of both hip joints, occurred with the highest frequency (0.64 ± 0.64 incidents/h/subject). During initial gait training, there was a gradual decrease in the occurrence of UPC. For neurological level-specific differences, UPCs were observed more frequently in T6 injuries (1.36 ± 0.35 incidents/h/subject) compared with T12 injuries (0.36 ± 0.31 incidents/h/subject). Conclusion: PBDs might be the result of near collisions between the trunk of the user and the walker, which make it difficult for the users to move their trunk over an anterior stance limb. Training that is focused upon well-timed forward movements of the walker might be required to avoid the occurrence of this common UPC.

Comparison of energy efficiency between Wearable Power-Assist Locomotor (WPAL) and two types of knee-ankle-foot orthoses with a medial single hip joint (MSH-KAFO)

“…Second, one person stayed behind him/her at all times since falling over backward was reported to occur most commonly during gait with WPAL. 22 Third, the training emphasized well-timed forward movement of the walker essential to avoiding falls due to unexpected postural changes. No falls were reported during the course of this study, nor were there complications such as pressure sores, cardiovascular stresses, pain or musculoskeletal problems.…”

Effectiveness of over-ground robotic locomotor training in improving walking performance, cardiovascular demands, secondary complications and user-satisfaction in individuals with spinal cord injuries: A systematic review

“…As a result of the unstable autonomic control after a SCI, these individuals have an increased risk of developing heart disease and stroke, with cardiovascular and respiratory dysfunctions being among the leading causes of death for people with SCI (30). This increased mortality risk means that early recognition and accurate management of cardiovascular dysfunctions are crucial to reducing their secondary risk profile (23,36,38).In this review, studies considering cardiovascular changes in HR and BP indicated no significant changes in HR with RLT interventions and reported variable BP changes within and post RLT. Two studies reported a significant increase in BP post-RLT (7,24), while the other 2 studies showed no changes across the intervention (13,20).…”

“…The remaining 21 studies did discuss potential biases, with 5 studies acknowledging competing interests, whereas the other 16 had none to declare. However, 9 of these 16 studies declared incorrectly, as they did not acknowledge the conflicts of interest related to being financially supported (11,13) and receiving salaries from exoskeleton companies (14,19,21,22,36) or performing the study to achieve FDA clearance for the exoskeleton company (12,24). It is relevant to note that due to the high cost of the robotic devices, subsidization is often required from the relevant companies for access and/or maintenance of the devices.…”

Wearable Power-Assist Locomotor for Gait Reconstruction in Patients With Spinal Cord Injury: A Retrospective Study

“…In the present study, patients with C5-C6 lesions did not reach an FAC score of 4 using the WPAL, on equality with using other WREs. However, patients with C7 lesions, even with motorcomplete SCIs, reached an FAC score of 4 even in patients with motor-complete because the WPAL has a high standing stability, which is a structural characteristic similar to medialtype orthoses (Saitoh et al, 1996;Tanabe et al, 2013b;Koyama et al, 2016).…”