Muscle adaptations in acute SCI following overground exoskeleton + FES training: A pilot study

Frontiers in Rehabilitation Sciences, 2022 · DOI: 10.3389/fresc.2022.963771 · Published: October 13, 2022

Spinal Cord Injury Assistive Technology Rehabilitation

Simple Explanation

This study investigates whether using a robotic exoskeleton with functional electrical stimulation (FES) can help muscles after a spinal cord injury. Participants with recent spinal cord injuries were given either standard rehab or standard rehab plus exoskeleton and FES training. The study found that the exoskeleton group had better muscle volume improvements compared to the standard rehab group, suggesting it could be a helpful addition to treatment.

Study Duration

6 weeks

Participants

Six individuals with acute SCI

Evidence Level

Level 2: Randomized crossover pilot study

Key Findings

1
Significant improvements were observed in muscle volume in the exoskeleton intervention group when compared to only standard-of-care.
2
Static balance improved in both groups, with greater improvements seen in the intervention group.
3
IMAT results demonstrated a trend towards lower percent of fat inﬁltration during the intervention period compared to the control period

Research Summary

This study evaluated the combined effects of robotic exoskeleton and functional electrical stimulation (FES) training on muscle composition during over-ground gait training in persons with acute spinal cord injury (SCI). Early intervention with robotic exoskeleton may contribute to improved muscle function measured using MRI in individuals with acute SCI. Mobility training with robotic exoskeleton and FES as a complement to standard-of-care resulted in reduced muscle atrophy in acute SCI, promoting increases in muscle volume, and maintaining levels of muscle fat inﬁltration in the lower extremities, when compared to standard-of-care on its own.

Practical Implications

Improved Muscle Health

Early intervention with robotic exoskeletons and FES may mitigate detrimental effects of muscle atrophy and IMAT, increasing muscle metabolic health.

Potential for Early Mobility

The study suggests that patients were able to tolerate walking with the exoskeleton, thus helping them with early upright mobility, even with blood pressure regulation issues.

Better Long-Term Prognosis

These interventions could lead to better long-term prognosis including initiating early mobility in the right patients.

Study Limitations

1
Small sample size (N = 6) with a heterogeneous representation of patient profiles.
2
Lack of wash out period, which may have resulted in carryover effects.
3
Use of MRI to assess muscle changes may be cost-prohibitive.

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