The Effect of Exoskeletal-Assisted Walking on Spinal Cord Injury Bowel Function: Results from a Randomized Trial and Comparison to Other Physical Interventions

Journal of Clinical Medicine, 2021 · DOI: 10.3390/jcm10050964 · Published: March 2, 2021

Spinal Cord Injury Assistive Technology Gastroenterology

Simple Explanation

This study investigates whether exoskeletal-assisted walking (EAW) can help improve bowel function in individuals with spinal cord injury (SCI). Bowel issues like incontinence and constipation are common after SCI. The study compared EAW to usual activity (UA) in a randomized, controlled trial. They used surveys to assess bowel function, stool consistency, and quality of life related to bowel management. The results showed that EAW might help some people with SCI have more regular bowel movements and better stool consistency. However, the overall impact on quality of life wasn't significant.

Study Duration

12 weeks per arm

Participants

50 participants with chronic SCI

Evidence Level

Level 1: Randomized, controlled, crossover clinical trial

Key Findings

1
EAW reduced the amount of time needed for the bowel program in 24% of the participants.
2
A trend toward normalization of stool form was noted with EAW.
3
EAW produces a greater positive effect in men than women and may be more effective in motor-complete individuals with respect to stool consistency.

Research Summary

This study evaluated the impact of exoskeletal-assisted walking (EAW) on bowel function in individuals with spinal cord injury (SCI) compared to usual activity (UA). The study found some improvements in bowel evacuation time and stool consistency with EAW, but no significant changes in overall patient-reported outcomes for bowel management difficulties. Subgroup analyses suggested potential benefits of EAW for men and individuals with motor-complete injuries, highlighting the need for further research to understand the nuances of EAW's impact on bowel function in different SCI populations.

Practical Implications

Rehabilitation strategy

EAW can be considered as a complementary therapy to manage bowel dysfunction in SCI patients, especially for men and those with motor-complete injuries.

Personalized approach

Bowel management plans should be tailored to individual needs, considering factors like gender, injury completeness, and time since injury.

Future Research

Further research is needed to explore the specific mechanisms by which EAW affects bowel function and to identify which individuals are most likely to benefit.

Study Limitations

1
The 10Q bowel function survey was not previously validated.
2
The study population was heterogeneous, which might have obscured some of the treatment effects.
3
The study did not investigate the underlying physiological mechanisms responsible for the observed changes in bowel function.

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