Safety and feasibility of exoskeleton-assisted walking during acute/sub-acute SCI in an inpatient rehabilitation facility: A single-group preliminary study

The Journal of Spinal Cord Medicine, 2020 · DOI: 10.1080/10790268.2019.1671076 · Published: January 1, 2020

Spinal Cord Injury Assistive Technology Rehabilitation

Simple Explanation

This study explores whether using robotic exoskeletons is safe and practical for people with recent spinal cord injuries during their inpatient rehabilitation. The researchers looked at how often adverse events occurred and how well participants complied with the exoskeleton walking program. The findings suggest that exoskeleton training can be safe and feasible, but careful monitoring is needed to minimize risks like low blood pressure.

Study Duration

Not specified

Participants

12 participants (age: 28–71 years; 58% AIS D; 58% male) with neurological levels of injuries ranging from C2 to L3

Evidence Level

Single group observational study

Key Findings

1
Symptomatic hypotension was the most common adverse event, occurring at a rate of 111 events per 1000 exoskeleton-hours.
2
Participants achieved a mean protocol compliance of 54%.
3
58% of participants achieved at least minimal assistance when walking with the device.

Research Summary

This study investigated the safety and feasibility of exoskeleton-assisted walking (EAW) for individuals with acute/sub-acute spinal cord injury (SCI) in an inpatient rehabilitation setting. The results indicated that EAW is generally safe, with symptomatic hypotension being the most common adverse event. Protocol compliance was moderate, and a majority of participants achieved minimal assistance with the device. The study concludes that EAW can be a safe and feasible supplemental locomotor training activity for SCI inpatients with ambulation goals, but sufficient controls are needed to minimize risks.

Practical Implications

Clinical Monitoring

Clinicians should actively monitor for exoskeleton-specific adverse events, particularly symptomatic hypotension, to ensure patient safety.

Session Duration

Scheduled EAW sessions should aim for at least 30 minutes of up-time to maximize standing time, walk time, and step count, potentially improving lower extremity motor scores.

Progressive Assistance

The SmartAssist function should be used progressively ('adaptive' then 'fixed') to increase the Rating of Perceived Exertion (RPE) component of EAW intensity, considering the participant's skill level.

Study Limitations

1
Small sample size limits generalizability.
2
Single group design without randomization or blinding introduces potential for bias.
3
The study did not assess the efficacy of EAW in SCI-AIR.

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