Energy Efficiency and Patient Satisfaction of Gait With Knee-Ankle-Foot Orthosis and Robot (ReWalk)-Assisted Gait in Patients With Spinal Cord Injury

Abstract

Objective To compare the energy efficiency of gait with knee-ankle-foot orthosis (KAFO) and robot-assisted gait and to develop a usability questionnaire to evaluate the satisfaction of walking devices in paraplegic patients with spinal cord injuries.Methods Thirteen patients with complete paraplegia participated and 10 completed the evaluation. They were trained to walk with KAFO (KAFO-gait) or a ReWalk robot (ReWalk-gait) for 4 weeks (20 sessions). After a 2-week wash-out period, they switched walking devices and underwent 4 additional weeks of training. Two evaluations were performed (after 2 and 4 weeks) following the training periods for each walking device, using the 6-minute walking test (6MWT) and 30-minute walking test (30MWT). The spatiotemporal variables (walking distance, velocity, and cadence) and energy expenditure (heart rate, maximal heart rate, the physiologic cost index, oxygen consumption, metabolic equivalents, and energy efficiency) were evaluated duringthe 6MWT and 30MWT. A usability evaluation questionnaire for walking devices was developed based on the International Organization for Standardization/International Electrotechnical Commission guidelines through expert consultation.Results The ReWalk-gait presented significant advantages in energy efficiency compared to KAFO-gait in the 6MWT and 30MWT; however, there were no differences in walking distance or speed in the 30MWT between ReWalk-gait and KAFOgait. The usability test demonstrated that ReWalk-gait was not superior to KAFO-gait in terms of safety, efficacy, efficiency, or patient satisfaction.Conclusion The robot (ReWalk) enabled patients with paraplegia to walk with lower energy consumption compared to KAFO, but the ReWalk-gait was not superior to KAFO-gaitin terms of patient satisfaction.

Effects of Wearable Powered Exoskeletal Training on Functional Mobility, Physiological Health and Quality of Life in Non-ambulatory Spinal Cord Injury Patients

“…Regarding the distance of 6MWT, the average value reported in a meta-analysis was 98 m, which is longer than our study's value (49.13 ± 15.22 m). 22 However, the 6MWT result in this study could be thought to be significant for Korean SCI patients, given that the mean value of Kwon's study conducted with Korean patients using the ReWalk was 39.1 ± 5.4 m. 26 In fact, there are no EAW studies of racial or national differences at the 6MWT distance.…”

The Effects of Powered Exoskeleton Gait Training on Cardiovascular Function and Gait Performance: A Systematic Review

“…The design of the selected studies included case series/reports ( n = 7) [ 34 , 35 , 36 , 41 , 42 , 44 , 47 ], pilot studies ( n = 1) [ 28 ], prospective open label ( n = 1) [ 39 ], self-controlled feasibility ( n = 1) [ 31 ], longitudinal cohort ( n = 1) [ 40 ], prospective cohort ( n = 1) [ 38 ], randomised crossover trial ( n = 2) [ 37 , 43 ], open label prospective quasi-experimental ( n = 1) [ 30 ], prospective single group observational ( n = 1) [ 14 ], experimental ( n = 5) [ 22 , 29 , 32 , 33 , 45 ], cross sectional ( n = 1) [ 21 ] and comparative ( n = 1) [ 46 ] studies. The studies were conducted in the USA ( n = 13) [ 14 , 22 , 28 , 32 , 34 , 35 , 37 , 39 , 40 , 41 , 42 , 44 , 45 ], UK ( n = 2) [ 29 , 31 ], Canada ( n = 2) [ 21 , 38 ], Korea ( n = 2) [ 36 , 43 ], Italy ( n = 2) [ 33 , 47 ] and Australia ( n = 1) [ …”

“…The gender of participants was not disclosed by one study, the remaining studies ( n = 22) were comprised of 151 males and 65 females ( Table 1 ). The participants from n = 19 studies [ 14 , 21 , 22 , 29 , 30 , 31 , 33 , 34 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 47 ] were SCI patients, one study involved individuals with MS [ 28 ], another study consisted of stroke patients [ 37 ] and one study involved able-bodied participants [ 32 ]. One study involved patients with MS and stroke as well as healthy individuals [ 46 ].…”

“…The powered exoskeleton devices used throughout the selected studies included the EKSO ( n = 6) [ 28 , 30 , 35 , 40 , 41 , 44 ], Ekso GT ( n = 5) [ 21 , 30 , 33 , 42 , 45 ], ReWalk ( n = 6) [ 14 , 31 , 38 , 39 , 43 , 46 ], Indego ( n = 2) [ 22 , 34 ], Powered Gait Orthosis (PGO) ( n = 1) [ 29 ], Angelegs ( n = 1) [ 36 ], Hybrid Neuro-Prosthesis Exoskeleton ( n = 1) [ 32 ], SMA Exoskeleton ( n = 1) [ 37 ] and REX Bionics ( n = 1) [ 46 ]. Both the EKSO and Ekso GT were included in the intervention of one study [ 30 ].…”

“…Oxygen consumption during powered exoskeleton assisted walking was recorded in five studies; which consisted of SCI patients and able-bodied individuals. The mean results across the five studies collectively ranged from 9.0 ± 2.1 to 22.5 ± 3.4 mL·kg −1 ·min −1 [ 22 , 32 , 42 , 43 , 47 ]. Chang et al also examined the O 2 of non-exoskeleton assisted walking among able-bodied participants which was reported as 11.7 ± 2.0 mL·kg- 1 ·min −1 [ 32 ], which was similar to unpowererd knee, ankle and foot ortosis (KAFO) (11.8 ± 1.8 mL·kg −1 ·min −1 ) among SCI patients [ 43 ].…”