Exoskeletal-assisted walking may improve seated balance in persons with chronic spinal cord injury: a pilot study

Spinal Cord Series and Cases, 2021 · DOI: https://doi.org/10.1038/s41394-021-00384-8 · Published: February 10, 2021

Spinal Cord Injury Assistive Technology Rehabilitation

Simple Explanation

This study investigates whether using exoskeletal-assisted walking (EAW) can improve seated balance in individuals with chronic spinal cord injury (SCI). Participants with SCI received EAW training using a powered exoskeleton. Before and after the training, their seated balance was measured using computerized dynamic posturography, which assesses endpoint excursion (EPE), maximal excursion (MXE), and directional control (DCL). The study found that EAW training led to significant improvements in seated balance, specifically in total-direction EPE and MXE, suggesting that EAW may enhance seated balance for individuals with chronic motor complete SCI.

Study Duration

Not specified

Participants

8 participants with chronic motor complete SCI and 7 able-bodied participants

Evidence Level

Level 3; Pre-post intervention study

Key Findings

1
Seated balance significantly improved in total-direction endpoint excursion (EPE) after EAW training (P < 0.01).
2
Seated balance significantly improved in total-direction maximal excursion (MXE) after EAW training (P < 0.017).
3
Modified functional reach test (MFRT) results and sub-scales of physical functioning improved after EAW training, though these improvements were not statistically significant.

Research Summary

This pilot study explored the potential of exoskeletal-assisted walking (EAW) to improve seated balance in individuals with chronic motor complete spinal cord injury (SCI). Eight participants with SCI received EAW training using a ReWalk™ exoskeleton, and their seated balance was assessed before and after the training. The results showed significant improvements in total-direction endpoint excursion (EPE) and maximal excursion (MXE) after EAW training, indicating enhanced seated balance. The study concludes that EAW training may have the potential to improve seated balance for persons with chronic motor complete SCI, suggesting another potential benefit of using EAW training.

Practical Implications

Therapeutic potential

EAW can be a therapeutic modality for mobility, recovery of walking, or as an activity-based exercise program, with improvement in seated balance.

Clinical application

Clinicians can design more efficient EAW training programs for people with SCI, considering its impact on seated balance.

Enhanced independence

Improvements in seated balance may translate to better seated safety and more independence for wheelchair users with SCI.

Study Limitations

1
Small sample size may lower the study power and generalizability.
2
The study mostly used biomechanical tests rather than directly measuring activities of daily living requiring seated balance function.
3
Lack of a SCI control group who received standard of care of physical therapy as a comparison.

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