Gait training after spinal cord injury: safety, feasibility and gait function following 8 weeks of training with the exoskeletons from Ekso Bionics

Baunsgaard, Carsten Bach; Nissen, Ulla Vig; Brust, Anne Katrin; Frotzler, Angela; Ribeill, Cornelia; Kalke, Yorck-Bernhard; León, Natacha; Gómez, Belén; Samuelsson, Kersti; Antepohl, Wolfram; Holmström, Ulrika; Marklund, Niklas; Glott, Thomas; Opheim, Arve; Benito, Juana Gómez; Murillo, Narda; Nachtegaal, Janneke; Faber, Willemijn; Biering‐Sørensen, Fin

doi:10.1038/s41393-017-0013-7

Cited by 133 publications

(197 citation statements)

References 36 publications

(42 reference statements)

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“…Several individual studies on specific exoskeletons and feasibility have been conducted. For example, the systems ReWalk [27,29,[39][40][41][42], Ekso [39,43,44], Indego [45,46], Exo-H2 [47], Arke [48], and X1 Mina [49] have been found to be practical for use. In addition to investigations of feasibility, several reviews have explored outcomes that relate to the efficacy of EAW.…”

Section: Lower Extremity Roboticsmentioning

confidence: 99%

Robotic Rehabilitation and Spinal Cord Injury: a Narrative Review

et al. 2018

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Mobility after spinal cord injury (SCI) is among the top goals of recovery and improvement in quality of life. Those with tetraplegia rank hand function as the most important area of recovery in their lives, and those with paraplegia, walking. Without hand function, emphasis in rehabilitation is placed on accessing one's environment through technology. However, there is still much reliance on caretakers for many activities of daily living. For those with paraplegia, if incomplete, orthoses exist to augment walking function, but they require a significant amount of baseline strength and significant energy expenditure to use. Options for those with motor complete paraplegia have traditionally been limited to the wheelchair. While wheelchairs provide a modified level of independence, wheelchair users continue to face difficulties in access and mobility. In the past decade, research in SCI rehabilitation has expanded to include external motorized or robotic devices that initiate or augment movement. These robotic devices are used with 2 goals: to enhance recovery through repetitive, functional movement and increased neural plasticity and to act as a mobility aid beyond orthoses and wheelchairs. In addition, lower extremity exoskeletons have been shown to provide benefits to the secondary medical conditions after SCI such as pain, spasticity, decreased bone density, and neurogenic bowel. In this review, we discuss advances in robot-guided rehabilitation after SCI for the upper and lower extremities, as well as potential adjuncts to robotics.

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Section: Lower Extremity Roboticsmentioning

confidence: 99%

Robotic Rehabilitation and Spinal Cord Injury: a Narrative Review

et al. 2018

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“…8 The physiological demand of such exoskeleton-assisted walking programs are comparable to self-reported exertion of an able-bodied person walking at 3 miles per hour and can elicit improvements in spasticity, without any serious adverse events. 8,9 Robotic exoskeletons may decrease seated time, increase standing and walking time, 10,11 thus, potentially ameliorating several of the chronic health-related consequences that negatively impact this population. 12,13 As RGT enables practitioners to increase the intensity and total duration of physical activity whilst maintaining a physiological gait pattern, 14 there may be a significant benefit for people with SCI to manage their risk of cardiovascular disease (CVD).…”

Section: Introductionmentioning

confidence: 99%

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

Faulkner

Martinelli²,

Cook³

et al. 2019

The Journal of Spinal Cord Medicine

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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).

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“…88 In this patient cohort, exoskeletons have been shown to be overall feasible with minor adverse events, such as low-grade pressure ulcers. 89 The first inves-tigations show promising data on improved gait function after completing an 8-week exoskeleton-based rehabilitation protocol. 89 The use of such devices in the ICU setting has not yet been investigated, and pilot-projects will shed more light on its feasibility, and effectiveness.…”

Section: Future Of Icu Mobilization: Robotics and Virtual Realitymentioning

confidence: 99%

“…89 The first inves-tigations show promising data on improved gait function after completing an 8-week exoskeleton-based rehabilitation protocol. 89 The use of such devices in the ICU setting has not yet been investigated, and pilot-projects will shed more light on its feasibility, and effectiveness. Exoskeletons can only be used in patients that are sufficiently stable to be mobilized out of the bed, and although the risk of injury to the staff is reduced, it does not eliminate the need for additional staff during the mobilization periods, especially if the patient is dependent on additional devices, such as a ventilator.…”

Section: Future Of Icu Mobilization: Robotics and Virtual Realitymentioning

confidence: 99%

Innovative ICU Solutions to Prevent and Reduce Delirium and Post–Intensive Care Unit Syndrome

Luetz

Grunow

Mörgeli

et al. 2019

Semin Respir Crit Care Med

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Delirium, the most common form of acute brain dysfunction affecting up to 80% of intensive care unit (ICU) patients, has been shown to predict long-term cognitive impairment, one of the domains in “Post-ICU Syndrome” (PICS). The ICU environment affects several potentially modifiable risk factors for delirium, such as disorientation and disruption, of the sleep–wake cycle. Innovative solutions aim to transform standard concepts of ICU room design to limit potential stressors, and utilizing the patient care space as a treatment tool, exerting positive, therapeutic effects. The main areas affected by most architectural and interior design modifications are sound environment, light control, floor planning, and room arrangement. Implementation of corresponding solutions is challenging considering the significant medical and technical demands of ICUs. This article discusses innovative concepts and promising approaches in ICU design that may be used to prevent stress and to support the healing process of patients, potentially limiting the impact of delirium and PICS.

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Gait training after spinal cord injury: safety, feasibility and gait function following 8 weeks of training with the exoskeletons from Ekso Bionics

Abstract: Exoskeleton training was generally safe and feasible in a heterogeneous sample of persons with SCI. Results indicate potential benefits on gait function and balance.

Cited by 133 publications

References 36 publications

Robotic Rehabilitation and Spinal Cord Injury: a Narrative Review

Robotic Rehabilitation and Spinal Cord Injury: a Narrative Review

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

Innovative ICU Solutions to Prevent and Reduce Delirium and Post–Intensive Care Unit Syndrome

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