Intensity of overground robotic exoskeleton training in two persons with motor-complete tetraplegia: a case series

Spinal Cord Series and Cases, 2023 · DOI: https://doi.org/10.1038/s41394-023-00584-4 · Published: June 21, 2023

Spinal Cord Injury Assistive Technology Rehabilitation

Simple Explanation

This case series explores the potential of overground robotic exoskeletons (ORE) as an aerobic exercise modality for individuals with motor-complete tetraplegia. Two male participants, one with chronic and one with acute tetraplegia, underwent ORE training while their exercise intensity was measured using a portable metabolic system. The study found that ORE exercise can be a safe and feasible way for individuals with tetraplegia to stand and walk, but may not consistently elicit moderate-to-vigorous physical activity.

Study Duration

Not specified

Participants

Two male participants with motor-complete tetraplegia

Evidence Level

Case Series

Key Findings

1
Participant A (chronic injury) achieved MVPA for 3% of the ORE session, while Participant B (acute injury) achieved MVPA for 12% of the session.
2
Heart rate was found to be a poor predictor of exercise intensity in both participants, supporting the use of direct measures of intensity like VO2.
3
The discrepancy in exercise intensity between participants may be due to the chronicity of injury and the ORE settings used.

Research Summary

This case series investigated the use of overground robotic exoskeletons (OREs) as an aerobic exercise modality in two individuals with motor-complete tetraplegia of varying chronicity. The majority of the ORE session duration was categorized as light intensity (<3 METs), though MET levels consistent with MVPA were observed in both participants. The results support the exploration into utilizing OREs as a modality to perform aerobic exercise in an upright position in individuals with motor-complete tetraplegia.

Practical Implications

Rehabilitation Strategy

ORE exercise can be a safe and feasible option for individuals with tetraplegia to engage in upright activity and walking exercise.

Exercise Prescription

Clinicians and fitness professionals can use this information to develop exercise prescriptions that allow individuals with motor-complete tetraplegia to participate in recommended levels of physical activity.

Future Research

Larger investigations are warranted to explore the safety, tolerability, and efficacy of OREs, with or without neuromodulation, in facilitating sufficient levels of MVPA in individuals with motor-complete tetraplegia.

Study Limitations

1
The small sample size (two participants) limits the generalizability of the findings.
2
Intensity was estimated from VO2 using MET values derived from research involving individuals with spinal cord injuries of varying chronicity, level, and completeness and does not account for individual variations in fat-free mass.
3
The intervention described herein (ORE exercise) with concurrent direct measures of intensity (portable metabolic testing) may not be generalizable to all rehabilitation facilities due to the cost of the equipment as well as the specialized staff needed to operate them.

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