Trunk muscle activity patterns and motion patterns of patients with motor complete spinal cord injury at T8 and T10 walking with different un-powered exoskeletons

The Journal of Spinal Cord Medicine, 2017 · DOI: 10.1080/10790268.2017.1319033 · Published: April 1, 2017

Spinal Cord Injury Assistive Technology Biomechanics

Simple Explanation

The study investigates how the level of spinal cord injury affects how well patients can walk using different types of exoskeletons that don't use motors. Two patients, one with a T8 injury and one with a T10 injury, were studied while they walked with three different un-powered exoskeletons: KAFO, RGO and ES-EXO. The researchers measured the activity of trunk muscles and tracked their movements to see how the different exoskeletons and injury levels impacted their walking patterns.

Study Duration

Two months gait-training

Participants

Two male subjects with complete spinal cord injury at T10 and T8

Evidence Level

Case series observational study

Key Findings

1
The patient with the T8 injury used their trunk muscles more when walking with all the exoskeletons, indicating higher effort for stability.
2
The T8 patient also showed greater pelvic movement when using the RGO and ES-EXO, suggesting they had to compensate more for their injury.
3
The energy-stored exoskeleton (ES-EXO) helped distribute muscle forces more evenly, increased walking speed, and improved the path of the body's center of mass.

Research Summary

This study explored the impact of neurological injury level on walking performance with different un-powered exoskeletons, focusing on trunk muscle activity and motion patterns. The main findings revealed differences in kinematics and muscle activation between patients with T8 and T10 spinal cord injuries while using KAFO, RGO, and ES-EXO devices. The ES-EXO showed potential advantages in evenly recruiting muscles and enhancing walking speed and stability compared to conventional un-powered exoskeletons.

Practical Implications

Rehabilitation Strategies

Tailored rehabilitation programs should consider the patient's neurological injury level to optimize exoskeleton use and improve walking outcomes.

Exoskeleton Design

ES-EXO design principles can be used to develop more effective un-powered exoskeletons that promote even muscle recruitment and enhance walking efficiency.

Clinical Practice

Clinicians can use the findings to inform the selection of appropriate exoskeletons for patients with different levels of spinal cord injury.

Study Limitations

1
Measurement error came from marker placement as the lower limb markers were attached to the exoskeletons.
2
The differences of un-powered exoskeletons in weight and size and physical quality of subjects could affect motion and muscle recruitment.
3
The spring stiffness and location of ES-EXO were related to energy storage and interacted with motion and muscle recruitment, thus the optimal parameters of springs should be determined in the future.

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