Overground walking with a robotic exoskeleton elicits trunk muscle activity in people with high-thoracic motor-complete spinal cord injury

Journal of NeuroEngineering and Rehabilitation, 2018 · DOI: https://doi.org/10.1186/s12984-018-0453-0 · Published: October 31, 2018

Spinal Cord Injury Assistive Technology Rehabilitation

Simple Explanation

The study investigates trunk muscle activation during robotic-assisted walking in individuals with spinal cord injury (SCI). It compares two robotic gait training devices: the Lokomat and the Ekso. The Lokomat provides gait training on a treadmill with trunk support, while the Ekso is used overground and requires active participation for weight shifting. The study found that Ekso-assisted walking elicits greater trunk muscle activation compared to the Lokomat in people with high thoracic motor-complete SCI.

Study Duration

Not specified

Participants

8 SCI subjects and 8 able-bodied subjects

Evidence Level

Not specified

Key Findings

1
Ekso-assisted walking elicits greater activation of trunk muscles compared to Lokomat-assisted walking, even after controlling for the use of hand-held assistive devices.
2
Similar levels of trunk EMG activation were observed between Ekso overground and Ekso on the treadmill, indicating that differences between Ekso and Lokomat could not be attributed to the use of a hand-held gait aid.
3
The level of trunk EMG activation during Lokomat walking was not different than that recorded during quiescent supine lying.

Research Summary

This study compared trunk muscle activation during walking with two robotic exoskeletons (Lokomat and Ekso) in people with high thoracic motor-complete SCI. The key finding was that Ekso-assisted walking effectively activated trunk muscles, even surpassing the activation levels achieved during attempted voluntary contractions. The study suggests that overground exoskeleton-assisted gait training could be a valuable approach to recruit and retrain trunk musculature in individuals with motor-complete paralysis, potentially improving postural stability.

Practical Implications

Rehabilitation strategy

Overground exoskeleton-assisted gait training could be used to recruit and retrain trunk musculature in people with motor-complete paralysis.

Improved Postural Stability

The reactivation and training of trunk muscles could support normal postural control synergies and ultimately improve seated postural control in people with SCI.

Device Development

Continued development of rehabilitation devices that could be effective for facilitating trunk muscle activation along with other health benefits in people with motor-complete SCI is supported.

Study Limitations

1
The study did not record trunk kinematics or account for the forces exerted by the upper limbs on the walker or siderails.
2
Walking speed had to be matched between the Lokomat and Ekso to allow for an appropriate comparison.
3
The Ekso provides full body weight bearing, which is not possible to achieve in the Lokomat with people with high thoracic motor-complete SCI.

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