Exoskeleton Training May Improve Level of Physical Activity After Spinal Cord Injury: A Case Series

Abstract

To determine whether the use of a powered exoskeleton can improve parameters of physical activity as determined by walking time, stand up time, and number of steps in persons with spinal cord injury (SCI). Three men with complete (1 C5 AIS A and 2 T4 AIS A) and one man with incomplete (C5 AIS D) SCI participated in a clinical rehabilitation program. In the training program, the participants walked once weekly using a powered exoskeleton (Ekso) for approximately 1 hour over the course of 10 to 15 weeks. Walking time, stand up time, ratio of walking to stand up time, and number of steps were determined. Oxygen uptake (L/min), energy expenditure, and body composition were measured in one participant after training. Over the course of 10 to 15 weeks, the maximum walking time increased from 12 to 57 minutes and the number of steps increased from 59 to 2,284 steps. At the end of the training, the 4 participants were able to exercise for 26 to 59 minutes. For one participant, oxygen uptake increased from 0.27 L/min during rest to 0.55 L/min during walking. Maximum walking speed was 0.24 m/s, and delta energy expenditure increased by 1.4 kcal/min during walking. Body composition showed a modest decrease in absolute fat mass in one participant. Exoskeleton training may improve parameters of physical activity after SCI by increasing the number of steps and walking time. Other benefits may include increasing energy expenditure and improving the profile of body composition.

The feasibility of using exoskeletal‐assisted walking with epidural stimulation: a case report study

“…Survivors with clinically complete SCI are confined to a wheelchair for mobility . The transition from free, over ground ambulation to wheelchair use results in adverse changes in body composition, cardiovascular health, and a significant socioeconomic burden . Restoration of locomotion has been the focus of years of research aimed at ameliorating several comorbidities and securing independence after SCI .…”

“…Restoration of locomotion has been the focus of years of research aimed at ameliorating several comorbidities and securing independence after SCI . Despite these efforts, few have offered potential solutions for the restoration of locomotion after SCI, partially because of the high metabolic demand and a reliance on upper extremity muscles during walking …”

“…These interventions require labor intensive commitments from multiple well‐trained personnel, making clinical applications of SCES difficult due to increasing number of SCI cases per year, lack of trained staff, cost involved in rehabilitation as well as commitment from the patient and their families. In our previous work, we have shown improvements to different walking parameters during EAW in persons with incomplete and complete SCI . EAW is designed to offer overground weight‐bearing gait while allowing various levels of lower extremity movements based on the level of swing assistance provided by the device.…”

“…EAW is designed to offer overground weight‐bearing gait while allowing various levels of lower extremity movements based on the level of swing assistance provided by the device. A detailed description about different levels of swing assistance provided by EAW was published elsewhere . Therefore, it provides an opportunity to facilitate walking at a low‐metabolic cost for persons with SCI when walking with 100% swing assistance …”

“…Additionally, despite limited walking speeds (<0.4 m·s −1 ), EAW is also less labor intensive for the rehabilitation teams. High‐intensity locomotor training has been linked to improving gait speed and muscle coordination .…”