Locomotor training using an overground robotic exoskeleton in long-term manual wheelchair users with a chronic spinal cord injury living in the community: Lessons learned from a feasibility study in terms of recruitment, attendance, learnability, performance and safety

Journal of NeuroEngineering and Rehabilitation, 2018 · DOI: https://doi.org/10.1186/s12984-018-0354-2 · Published: February 15, 2018

Spinal Cord Injury Assistive Technology Rehabilitation

Simple Explanation

This study investigated the practicality of using a robotic exoskeleton for walking in people with long-term spinal cord injuries. The research focused on how easy it was to recruit participants, how often they attended training, and whether they could learn to walk safely with the device. The findings suggest that such training programs are feasible and relatively safe, but highlight the need for pre-training exercises and careful risk assessment.

Study Duration

6 to 8 weeks

Participants

14 adults with complete motor SCI

Evidence Level

Level IV, Single-group longitudinal prospective feasibility study

Key Findings

1
The recruitment rate was 28.6%, with musculoskeletal impairments and time constraints being the main reasons for exclusion.
2
Participants showed significant improvements in standing time (45.3%), walking time (102.1%), and number of steps (248.7%) during the program.
3
One participant experienced bilateral calcaneal fractures, highlighting the need for fragility fracture risk assessment.

Research Summary

This study examined the feasibility and safety of a locomotor training program using a robotic exoskeleton for individuals with chronic spinal cord injury. The results indicated acceptable recruitment and attendance rates, significant improvements in walking ability, and a few adverse events. The study emphasizes the importance of pre-training rehabilitation and clinical practice guidelines to address potential risks like fractures.

Practical Implications

Pre-Training Programs

Develop rehabilitation programs to improve lower extremity range of motion and standing tolerance before exoskeleton training.

Fracture Risk Assessment

Implement clinical guidelines for assessing fragility fracture risk in individuals using overground robotic exoskeletons.

Recruitment Strategies

Consider flexible scheduling, alternative training locations, and temporary housing to improve participant recruitment.

Study Limitations

1
Small sample size of homogeneous participants
2
Absence of a control group
3
Generalizability limited to long-term manual wheelchair users with chronic SCI

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