Walking improvement in chronic incomplete spinal cord injury with exoskeleton robotic training (WISE): a randomized controlled trial

Spinal Cord, 2022 · DOI: https://doi.org/10.1038/s41393-022-00751-8 · Published: January 29, 2022

Spinal Cord Injury Assistive Technology Rehabilitation

Simple Explanation

This study investigates whether using a robotic exoskeleton for gait training can improve walking ability in people with chronic incomplete spinal cord injury (iSCI). Participants with iSCI were divided into three groups: one receiving exoskeleton training, one receiving standard gait training, and a control group receiving no additional gait training. The study measured changes in walking speed and other walking-related outcomes after 12 weeks of training.

Study Duration

12 weeks

Participants

25 participants with chronic incomplete spinal cord injury (iSCI)

Evidence Level

Randomized Controlled Trial

Key Findings

1
Exoskeleton training can improve clinical ambulatory status in chronic SCI participants with independent stepping ability at baseline.
2
The proportion of participants with improvement in clinical ambulation category from home to community speed post-intervention was greatest in the Ekso group.
3
Improvements in raw gait speed were not statistically signiﬁcant at the group level.

Research Summary

This multi-site, randomized controlled trial investigated the efficacy of exoskeleton gait training compared to standard gait training or usual care in individuals with chronic incomplete spinal cord injury (iSCI). The study found that while there was no statistically significant improvement in overall gait speed, the exoskeleton group showed a greater proportion of participants improving in clinical ambulation category. The researchers conclude that exoskeleton robotic training can improve clinical ambulatory status in chronic SCI participants and that future trials should focus on participant inclusion criteria to improve outcomes.

Practical Implications

Rehabilitation Strategy

Exoskeleton training may be a viable option for improving clinical ambulation in individuals with iSCI who have some stepping ability.

Clinical Trial Design

Future studies should carefully consider participant selection criteria to identify individuals most likely to benefit from exoskeleton training.

Therapist Workload

Exoskeleton training may reduce the physical burden on therapists compared to manual gait training, although therapist frustration may be higher.

Study Limitations

1
The study was underpowered due to financial limitations.
2
There was no statistically significant difference in baseline features between the three groups.
3
There may have been a small increase in gait speed in the Passive Control group due to repeated assessment.

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