Retraining walking over ground in a powered exoskeleton after spinal cord injury: a prospective cohort study to examine functional gains and neuroplasticity

Journal of NeuroEngineering and Rehabilitation, 2019 · DOI: https://doi.org/10.1186/s12984-019-0585-x · Published: August 30, 2019

Spinal Cord Injury Assistive Technology Neurorehabilitation

Simple Explanation

Powered exoskeletons can help people with spinal cord injuries stand and walk. This study uses the ReWalk exoskeleton to see how much training is needed to walk well, and how the nervous system changes with training. The study also looks at how well the ReWalk works in a home setting. Participants with spinal cord injuries trained to walk in the ReWalk for 12 weeks, and their progress, balance, sensation, and muscle strength were measured. The study found that about 45 training sessions are needed to become proficient in walking with the ReWalk. Some participants also showed improvements in balance. The majority of participants could walk on uneven surfaces outdoors, but some had limitations in home-like environments.

Study Duration

12 weeks

Participants

12 participants with chronic motor complete or incomplete spinal cord injury

Evidence Level

Prospective cohort study

Key Findings

1
Walking proficiency in the ReWalk requires about 45 sessions of training.
2
Training was accompanied by functional improvements in some, especially in people with incomplete injuries.
3
The progression in training indicated about 45 sessions to reach 80% of final performance in training.

Research Summary

This study evaluated the effectiveness of the ReWalk exoskeleton for individuals with spinal cord injury, focusing on training progression, neuroplasticity, and usability in home environments. The results indicated that approximately 45 training sessions are needed to achieve walking proficiency with the ReWalk, and that the training led to functional improvements, particularly among those with incomplete injuries. The study also found that the ReWalk enabled participants to walk on uneven outdoor surfaces, although limitations were encountered in home-like environments, suggesting areas for further device and training optimization.

Practical Implications

Rehabilitation Programs

Rehabilitation programs can use the findings to structure ReWalk training, planning for approximately 45 sessions to achieve optimal walking proficiency.

Device Improvement

Device manufacturers can focus on improving the ReWalk's usability in home environments, addressing limitations encountered by users.

Patient Selection

Clinicians can consider the potential for functional improvements, particularly among individuals with incomplete spinal cord injuries, when recommending ReWalk training.

Study Limitations

1
Small number of participants (n = 10 providing full data sets).
2
The study is exploratory, and where statistics are included, they must be interpreted with caution.
3
We did not include a control group, based on the assumption that people with chronic injuries are not likely to improve spontaneously, but this remains a potential source of bias.

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