Rehabilitation of Acute Vs. Chronic Patients With Spinal Cord Injury With a Neurologically Controlled Hybrid Assistive Limb Exoskeleton: Is There a Difference in Outcome?

Abstract

This study aimed to assess the outcome of acute and chronic participants with spinal cord injury (SCI) after 12 weeks of bodyweight supported treadmill training (BWSTT) with a hybrid assistive limb exoskeleton (HAL). Acute participants were defined as ≤12 months between SCI and training, chronic participants >12 months between SCI and training. We assessed whether HAL-assisted BWSTT is advantageous for acute and chronic participants and if length of time post injury impacts the outcome of HAL-assisted BWSTT. As the primary outcome, we assessed the time needed for the 10 meter walk test (10MWT). Hundred and twenty-one individuals participated in a 12-week HAL-assisted BWSTT five times a week. We regularly conducted a 10MWT, a 6 minute walk test (6MWT), and assessed the walking index for spinal cord injury (WISCI II) and lower extremity motor score (LEMS) to evaluate the gait performance without the exoskeleton. Distance and time were recorded by the treadmill while the participant was walking with the exoskeleton. All participants benefit from the 12-week HAL-assisted BWSTT. A significant difference between acute and chronic participants' outcomes was found in 6MWT, LEMS, and WISCI II, though not in 10MWT. Although chronic participants improved significantly lesser than acute participants, they did improve their outcome significantly compared to the beginning. Hybrid assistive limb-assisted BWSTT in the rehabilitation of patients with SCI is advantageous for both acute and chronic patients. We could not define a time related cut-off threshold following SCI for effectiveness of HAL-assisted BWSTT.

Impact of Robotic-Assisted Gait Training in Subacute Spinal Cord Injury Patients on Outcome Measure

“…A comparative analysis of the investigated group and control group showed a significantly greater effect of RAGT on MS and WISCI-II parameters compared to S0. This study confirmed the improvement in these parameters previously reported in the literature, both in patients using exoskeletons alone and in patients using Lokomat alone [12,[33][34][35]. Alshram et al, in a meta-analysis concerning the impact of RAGT devices such as Lokomat, found that this therapy did not always improve MS scores [16].…”

Mobile and wearable technologies for the analysis of Ten Meter Walk Test: A concise systematic review

“…The authors of [ 45 ] assessed the outcome of acute and chronic participants with spinal cord injury after 12 weeks of bodyweight-supported treadmill training with a hybrid assistive limb exoskeleton. The study included 110 participants (89 males and 21 females), with an average age of 44.3 years, ranging from 16 to 74 years.…”

“…Additionally, the study’s design does not allow for an acceptable inferential analysis, necessitating follow-up clinical studies to evaluate the posed theory. Zieriacks et al [ 45 ] The Ten Meter Walk Test result, which measures ambulation speed, is more clinically applicable. In the Ten Meter Walk Test, acute and chronic subjects dramatically increased their test results.…”

“… Time; Motion Optotrak Certus; Chronometer Physical problems Spinal cord injury Valenzuela et al [ 44 ] 2021 1 female and 3 males The authors worked with teenagers with cerebral palsy who were categorized as having level II gross motor function in a two-week, 1.5-h per day intense treatment using a non-immersive virtual reality exercise game. Motion Nintendo® Wii Brain diseases Cerebral Palsy Zieriacks et al [ 45 ] 2021 21 females and 89 males The study aimed to determine the functional and motor recovery in the post-acute phases of neurorehabilitation in participants with acute and chronic Spinal Cord Injury. Time Chronometer Physical problems Spinal Cord Injury Ali et al [ 46 ] 2020 9 females and 13 males The study aimed to evaluate the effects of a task-oriented circuit class training program on the capacity to walk and balance in subacute stroke patients.…”

Robotic rehabilitation therapy using Hybrid Assistive Limb (HAL) for patients with spinal cord lesions: a narrative review

“…Zieriacks et al. [18] compared outcomes of HAL walking rehabilitation between patients with acute and chronic spinal cord injury. Patients with acute and chronic spinal cord injury both showed significant recovery of walking parameters, including results for 10 m and 6 min walking tests, and improvement in WISCI-II score.…”