Effects of robotic-assisted gait training on the central vascular health of individuals with spinal cord injury: A pilot study

Abstract

Objective: To investigate the effect of a short-term, robotic-assisted (exoskeleton) gait training (RGT) program on central and peripheral hemodynamic measures in patients with spinal cord injury (SCI). Design: Parallel group, non-randomized trial with before (baseline) and after (follow-up) assessments. Setting: Single-center, community-based neuro-physiotherapy practice. Participants: Twelve individuals with SCI (ASI A to C). Interventions: Participants completed either a 5-day RGT program plus physiotherapy (n = 6), or a usual care physiotherapy only program (control group; n = 6). The RGT program consisted of daily 60-min physiotherapy and 90-min of RGT. Outcome measures were measured before and after the rehabilitation program. Main outcome measure(s): The primary outcome measure was arterial wave reflection (Augmentation index [AIx]), with central and peripheral blood pressures also reported. Data are presented as mean (SD) and effect sizes (partial eta squared; η 2 p). Results: There was a significant reduction in AIx (30 ± 18-21 ± 15%; η 2 p =0.75) and mean arterial pressure (89 ± 11-82 ± 10 mmHg; η 2 p =0.47) following completion of the RGT program (both P < 0.05). There were no changes in these measures for the control group. Although not significantly different, medium to large effects were observed in favor of RGT for all other central and peripheral measures (η 2 p =0.06-0.21), except for heart rate and pulse pressure (η 2 p <0.04). Conclusions: RGT using an exoskeleton is a promising therapy for improving cardiovascular health in patients with SCI. Specifically, this study indicates decreased arterial wave reflection and supports the need for larger randomized controlled trials. Trial Registration: Clinical trials Registry (https://clinicaltrials.gov/; NCT03611803).

Walking improvement in chronic incomplete spinal cord injury with exoskeleton robotic training (WISE): a randomized controlled trial

“…Robotic exoskeleton-based gait training is reported to have a beneficial effect on cardiovascular health in individuals with SCI [ 20 ], a potential improvement of bone health [ 21 ], and psychological benefit [ 22 ]. Evidence is controversial for training-related improvement on independent gait function as measured by walking speed [ 23 , 24 ].…”

Safety and Feasibility of a Novel Exoskeleton for Locomotor Rehabilitation of Subjects With Spinal Cord Injury: A Prospective, Multi-Center, and Cross-Over Clinical Trial

“…The mean pre-training blood pressure was 121/77 (SD = 1.43/7.4) mmHg, while the mean post-training blood pressure was 129/83 (SD = 4.09/7.4) mmHg. Faulkner et al conducted a pilot study on walking training assisted by an Ekso exoskeleton robot for the SCI population (Faulkner et al, 2019 ). The results showed that arterial wave reflection could be improved by a mean reduction of 9% and the training led to favorable changes in mean arterial pressure and central diastolic blood pressure, with mean decreases of 5 and 7 mmHg, respectively.…”

Efficacy of Robot-Assisted Gait Therapy Compared to Conventional Therapy or Treadmill Training in Children with Cerebral Palsy: A Systematic Review with Meta-Analysis

“…The improvements observed in gait speed, walking distance and the E dimension of gross motor function, in comparison to CT, are clinically relevant regarding the personal autonomy of CP children. The RAGT physical exercise approach improves aerobic capacity and increases gait speed and walking distance [99], which allows for performing more activities of daily living requiring movement without getting tired and without needing so much assistance from relatives or caregivers. This meta-analysis provides relevant evidence regarding RAGT as the better therapeutic option, compared to CT, for the recovery of the gait speed and dynamic balance associated with locomotion.…”