Mobility Skills With Exoskeletal-Assisted Walking in Persons With SCI: Results From a Three Center Randomized Clinical Trial

Frontiers in Robotics and AI, 2020 · DOI: 10.3389/frobt.2020.00093 · Published: August 4, 2020

Simple Explanation

This study investigates how well people with spinal cord injuries (SCI) can improve their walking abilities using exoskeletons. The goal was to see how many training sessions were needed to achieve walking milestones. Participants with chronic SCI were given exoskeletal-assisted walking (EAW) training three times a week for 36 sessions. Their walking performance was measured using tests like the 10-meter walk test, 6-minute walk test, and Timed-Up-and-Go test. The study found that many participants achieved significant improvements in their walking abilities with the help of exoskeletons, and that the number of sessions needed to reach certain milestones could inform clinical practice and home use recommendations.

Study Duration

36 sessions, striving to be completed in 12 weeks

Participants

50 participants with chronic (≥6 months) non-ambulatory SCI

Evidence Level

RCT

Key Findings

1
At 12 sessions, 62%, 70%, and 72% of participants achieved the 10MWT, 6MWT, and TUG milestones, respectively.
2
By 36 sessions, 80%, 82%, and 84% achieved the 10MWT, 6MWT, and TUG criteria, respectively.
3
The rate of improvement in the walking tests was unrelated to the level, completeness, or duration of SCI.

Research Summary

This randomized clinical trial assessed the feasibility and effectiveness of exoskeletal-assisted walking (EAW) training for individuals with chronic spinal cord injury (SCI) across three centers. Participants underwent 36 sessions of EAW training, and their mobility skills were evaluated using standardized walking tests. The study found that a significant proportion of participants achieved pre-defined mobility milestones within 12 to 36 sessions of EAW training, demonstrating the potential for improving walking velocity and distance. The type of exoskeleton device (ReWalk or Ekso) and neurological deficit influenced outcomes. The authors conclude that EAW training is safe and effective for individuals with SCI, with the number of sessions needed to achieve mobility goals varying based on individual characteristics and device used. These findings provide valuable guidelines for implementing EAW programs in clinical and personal settings.

Practical Implications

Clinical Practice

The study provides guidelines for the number of EAW sessions needed to achieve mobility milestones, which can inform clinical practice and physical therapy prescriptions.

Home and Community Use

The findings suggest that EAW can enable individuals with SCI to achieve functional mobility for personal use, particularly with devices like ReWalk, and highlight the importance of device selection and personalized training.

Future Research

Further investigations are needed to identify predictors of success with EAW and to develop screening tests for identifying individuals most likely to benefit from this intervention.

Study Limitations

1
High variability in the total number of steps taken in both devices.
2
The study was not designed to determine diﬀerences in the mobility test outcomes between the Ekso and ReWalk groups.
3
Limited by policies of third-party payers or government insurance coverage on number of training sessions.

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