Recommendations for clinical decision-making when offering exoskeletons for community use in individuals with spinal cord injury

Personal powered exoskeletons (PPE) offer individuals with spinal cord injury (SCI) the opportunity to ambulate in their home and community, potentially providing physiological and psychosocial benefits. This paper provides guidance for clinicians by outlining an expert consensus for a PPE decision-making algorithm, along with a discussion of potential benefits based on early evidence. The goal is to bridge the knowledge gap by providing expert consensus from clinicians experienced in personal powered exoskeleton (PPE) prescription to help clinicians identify appropriate PPE patients.

• 1
  Early evidence suggests positive effects of PPE ambulation on cardiorespiratory function, such as improvements in Oxygen Consumption (VO2), Cost of Transport (CT), Forced Vital Capacity, and Forced Expiratory Volume in 1 s (FEV1).
• 2
  Exoskeleton use has been reported to have positive impacts such as decreased bowel program time, normalized stool consistency, and lessening incontinence and constipation.
• 3
  Studies have indicated a positive effect on perceived spasticity and Modified Ashworth Scale scores after powered exoskeleton use, as well as a reduction in pain.