Physiotherapy using a free-standing robotic exoskeleton for patients with spinal cord injury: a feasibility study

Abstract

Background

Evidence is emerging for the use of overground lower limb robotic exoskeletons in the rehabilitation of people with spinal cord injury (SCI), with suggested benefits for gait speed, bladder and bowel function, pain management and spasticity. To date, research has focused on devices that require the user to support themselves with a walking aid. This often precludes use by those with severe trunk, postural or upper limb deficits and places the user in a suboptimal, flexed standing position. Free-standing exoskeletons enable people with higher level injuries to exercise in an upright position. This study aimed to evaluate the feasibility of therapy with a free-standing exoskeleton for those with SCI, and to determine the potential health-related benefits of this intervention.

Methods

This 12-week intervention study with 12-week waitlist control and 12-week follow up, provided people with SCI scoring < 5 on the mobility section of the spinal cord independence measure (SCIM-III) twice weekly therapy in the REX (Rex Bionics, Auckland, NZ), a free-standing lower limb robotic exoskeleton. The primary outcome measure of interest was function, as measured on the SCIM-III. A battery of secondary outcomes was included. Participants also completed a survey on their perceptions of this treatment modality, to determine acceptability.

Results

Forty-one potential participants were screened for eligibility. Two females (one ASIA A, one ASIA C) and one male (ASIA B) completed all 24 intervention sessions, and the follow up assessment. One participant showed positive trends in function, fatigue, quality of life and mood during the intervention phase. Grip and quadriceps strength, and lower limb motor function improved in another. Two improved their percentage of lean body mass during the intervention phase. Remaining results were varied across patients, time points and outcomes. The intervention was highly acceptable to all participants.

Conclusion

With three of 41 potential participants being eligible and completing this study, our results show that there are potential benefits of exercise in a free-standing exoskeleton for people with severe mobility impairment due to SCI, for a small subset of patients. Further research is warranted to determine those most likely to benefit, and the type of benefit depending on the patient characteristics.

Trial registration The trial was registered prospectively on 20 April 2018 at www.anzctr.org.au/ (ACTRN12618000626268)

Supplementary Information

The online version contains supplementary material available at 10.1186/s12984-021-00967-4.

Contributors

Nicola Postol:

ORCID: http://orcid.org/0000-0002-2188-9078

[e-mail]

Journal

Journal ID (nlm-ta): J Neuroeng Rehabil

Journal ID (iso-abbrev): J Neuroeng Rehabil

Title: Journal of NeuroEngineering and Rehabilitation

Publisher: BioMed Central (London )

ISSN (Electronic): 1743-0003

Publication date (Electronic): 25 December 2021

Publication date PMC-release: 25 December 2021

Publication date Collection: 2021

Volume: 18

Affiliations

[1 ]GRID grid.266842.c, ISNI 0000 0000 8831 109X, University of Newcastle, ; Callaghan, Australia

[2 ]GRID grid.413648.c, Hunter Medical Research Institute, ; New Lambton Heights, Australia

[3 ]GRID grid.3006.5, ISNI 0000 0004 0438 2042, Hunter New England Local Health District, ; New South Wales, Australia

[4 ]GRID grid.1008.9, ISNI 0000 0001 2179 088X, University of Melbourne, ; Melbourne, Australia

Article

Publisher ID: 967

DOI: 10.1186/s12984-021-00967-4

PMC ID: 8709973

PubMed ID: 34953501

SO-VID: 5f5c777e-b7d0-49d7-b650-e7a21349a823

Copyright statement: © The Author(s) 2021

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Categories

Subject: Research

Custom metadata

issue-copyright-statement © The Author(s) 2021