Exoskeleton Training and Trans-Spinal Stimulation for Physical Activity Enhancement After Spinal Cord Injury (EXTra-SCI): An Exploratory Study

Frontiers in Rehabilitation Sciences, 2022 · DOI: 10.3389/fresc.2021.789422 · Published: January 4, 2022

Spinal Cord Injury Assistive Technology Rehabilitation

Simple Explanation

This study explores how exoskeleton-assisted walking (EAW) and trans-spinal stimulation (TSS) can help people with spinal cord injury (SCI) improve their physical activity and health. Participants with chronic SCI underwent EAW training, and a subset also received TSS. The study measured changes in body composition, oxygen consumption, and muscle activity. The results showed that EAW training can reduce body fat and improve waist circumference, suggesting potential benefits for cardiometabolic health in people with SCI.

Study Duration

12 weeks

Participants

8 men with chronic SCI

Evidence Level

Exploratory Study

Key Findings

1
Twelve weeks of EAW training significantly attenuated markers of obesity relevant to cardiometabolic health in eight men with chronic SCI.
2
Reductions from baseline were found in seated waist circumference (−2.2%, P = 0.036), seated abdominal circumference (−2.9%, P = 0.05), and supine abdominal circumference (−3.9%, P = 0.017).
3
Percent fat was also reduced from BL for the total body (−1.4%, P = 0.018), leg (−1.3%, P = 0.018), and trunk (−2%, P = 0.036) regions.

Research Summary

This study investigated the effects of exoskeleton-assisted walking (EAW) training, with and without trans-spinal stimulation (TSS), on body composition, oxygen consumption, and physical activity in individuals with chronic spinal cord injury (SCI). The results indicated that 12 weeks of EAW training led to significant reductions in waist and abdominal circumferences, as well as decreases in total body, leg, and trunk fat percentages. While the addition of TSS showed individualized responses in muscle activity during EAW, further research is needed to determine the optimal protocols and potential benefits of combining EAW and TSS for SCI rehabilitation.

Practical Implications

Cardiometabolic Health Improvement

EAW training can be a valuable intervention to reduce central adiposity and improve cardiometabolic health in individuals with chronic SCI.

Personalized Rehabilitation Strategies

The variable responses to TSS highlight the need for personalized rehabilitation strategies that consider individual characteristics and needs.

Future Research Directions

Further studies with larger sample sizes are warranted to explore the combined effects of EAW and TSS on muscle activation and functional outcomes in individuals with SCI.

Study Limitations

1
Small sample size limited the statistical power and generalizability of the findings.
2
Lack of control over dietary habits and physical activity outside of the study may have influenced the body composition results.
3
The TSS outcomes are limited to sub-groups of participants, and the exploratory nature of EMG and extra-assistance step outcomes warrants further investigation.

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