Respiratory, cardiovascular and metabolic responses during different modes of overground bionic ambulation in persons with motor-incomplete spinal cord injury: A case series

Abstract

Overground bionic ambulation with variable assistance can substantially increase cardiorespiratory and metabolic responses; however, these responses vary widely across participants and overground bionic ambulation modes.

Differences in Acute Metabolic Responses to Bionic and Nonbionic Ambulation in Spinal Cord Injured Humans and Controls

“…Only 1 study 8 has investigated bionic ambulation bouts of a duration likely to be applied in clinical practice (45-60min) or prescribed for exercise (30-60min). Most studies of bionic ambulation have focused on considerably shorter bouts of walking, [11][12][13][14] which fall below the recommended exercise guidelines. 15 Additionally, previous research has examined very small test populations and case reports 8,13,14 and tested bionic ambulation in controlled laboratory conditions of temperature and surface friction.…”

“…Most studies of bionic ambulation have focused on considerably shorter bouts of walking, [11][12][13][14] which fall below the recommended exercise guidelines. 15 Additionally, previous research has examined very small test populations and case reports 8,13,14 and tested bionic ambulation in controlled laboratory conditions of temperature and surface friction. [11][12][13][14] To more realistically assess the performance characteristics and potential benefits of these devices requires untethered ambulation under ambient conditions of temperature and humidity, walking on higher friction surfaces, and testing during longer walks.…”

“…15 Additionally, previous research has examined very small test populations and case reports 8,13,14 and tested bionic ambulation in controlled laboratory conditions of temperature and surface friction. [11][12][13][14] To more realistically assess the performance characteristics and potential benefits of these devices requires untethered ambulation under ambient conditions of temperature and humidity, walking on higher friction surfaces, and testing during longer walks. Thus, this investigation (1) examined potential differences in the energy cost and fuel substrate use measured in persons with SCI and noninjured persons while seated, standing, and self-paced walking in a bionic exoskeleton (SCI) or bipedal ambulation (controls); (2) examined whether there was an upward drift in metabolism while standing and ambulating and; (3) tested effects of a single bout of bionic ambulation on postchallenge glycemia in persons with SCI.…”

“…Substrate oxidation rates were derived from expired gas concentrations ( _ VO 2 and volume of carbon dioxide) averaged at rest and over minutes[14][15][29][30], and 44-45 of the 45-minute seated, standing, and walking bouts. The proportion of energy expenditure (EE) derived from carbohydrate (CHO) and fat in addition to rates of whole-body CHO and fat oxidation were calculated using stoichiometric equations assuming negligible protein oxidation20 : %EE from CHO Z ð½RER À 0:71 = 0:29Þ Â 100 %EE from fat Z 100 À %EE from CHO where _ VO 2 is expressed in liters per minute and RER is respiratory exchange ratio (RERZcarbon dioxide consumption per unit time/oxygen consumption per unit time [ _ VO 2 ]).…”

IS PHYSICAL EXERCISE EFFECTIVE FOR IMPROVING VO2max IN PERSONS WITH SCI? A SYSTEMATIC REVIEW

“…As a result, complex multifactorial health effects occur, particularly those associated with endocrine and metabolic disorders (diabetes mellitus, dyslipidemia, obesity), which have been worryingly developing over the past several years, thereby increasing the risk of cardiovascular morbidity and mortality in persons with SCI (Escalona, Brosseau, Vermette, Comtois, Duclos, Aubertin-Leheudre & Gagnon, 2018). SCI is the cause of paralysis of the lower extremities, which limits the ability of a man to walk, often resulting in the use of wheelchairs (Kressler, Wymer & Domingo, 2018).…”