Device-Training for Individuals with Thoracic and Lumbar Spinal Cord Injury Using a Powered Exoskeleton for Technically Assisted Mobility: Achievements and User Satisfaction

Objective. Results of a device-training for nonambulatory individuals with thoracic and lumbar spinal cord injury (SCI) using a powered exoskeleton for technically assisted mobility with regard to the achieved level of control of the system after training, user satisfaction, and effects on quality of life (QoL). Methods. Observational single centre study with a 4-week to 5-week intensive inpatient device-training using a powered exoskeleton (ReWalk™). Results. All 7 individuals with SCI who commenced the device-training completed the course of training and achieved basic competences to use the system, that is, the ability to stand up, sit down, keep balance while standing, and walk indoors, at least with a close contact guard. User satisfaction with the system and device-training was documented for several aspects. The quality of life evaluation (SF-12v2™) indicated that the use of the powered exoskeleton can have positive effects on the perception of individuals with SCI regarding what they can achieve physically. Few adverse events were observed: minor skin lesions and irritations were observed; no falls occurred. Conclusions. The device-training for individuals with thoracic and lumbar SCI was effective and safe. All trained individuals achieved technically assisted mobility with the exoskeleton while still needing a close contact guard.

[1]  W. Donovan,et al.  International Standards For Neurological Classification Of Spinal Cord Injury , 2003, The journal of spinal cord medicine.

[2]  A V Nene,et al.  Energy cost of paraplegic locomotion with the ORLAU ParaWalker , 1989, Paraplegia.

[3]  B. Andrews,et al.  Augmentation of the Oswestry Parawalker orthosis by means of surface electrical stimulation: gait analysis of three patients , 1987, Paraplegia.

[4]  R. D'ambrosia,et al.  The RGO Generation II: muscle stimulation powered orthosis as a practical walking system for thoracic paraplegics. , 1989, Orthopedics.

[5]  Andrei Krassioukov,et al.  International standards for neurological classification of spinal cord injury, revised 2011. , 2012, Topics in spinal cord injury rehabilitation.

[6]  J. Ware,et al.  A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. , 1996, Medical care.

[7]  L. Miller,et al.  Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: systematic review with meta-analysis , 2016, Medical devices.

[8]  D. Graupe,et al.  Stochastically-modulated stimulation to slow down muscle fatigue at stimulated sites in paraplegics using functional electrical stimulation for leg extension , 2000, Neurological research.

[9]  H. Hermens,et al.  Paraplegic locomotion: a review , 1996, Spinal Cord.

[10]  Marcel P Dijkers,et al.  Time and Effort Required by Persons with Spinal Cord Injury to Learn to Use a Powered Exoskeleton for Assisted Walking. , 2015, Topics in spinal cord injury rehabilitation.

[11]  M Massucci,et al.  Walking with the Advanced Reciprocating Gait Orthosis (ARGO) in thoracic paraplegic patients: energy expenditure and cardiorespiratory performance , 1998, Spinal Cord.

[12]  H. Dickson,et al.  SCIM–Spinal Cord Independence Measure: a new disability scale for patients with spinal cord lesions , 1998, Spinal Cord.

[13]  Pierre Asselin,et al.  Assessment of In-Hospital Walking Velocity and Level of Assistance in a Powered Exoskeleton in Persons with Spinal Cord Injury. , 2015, Topics in spinal cord injury rehabilitation.

[14]  R K Jones,et al.  The physiological cost index of walking with mechanical and powered gait orthosis in patients with spinal cord injury , 2012, Spinal Cord.

[15]  A. Esquenazi,et al.  Safety and tolerance of the ReWalk™ exoskeleton suit for ambulation by people with complete spinal cord injury: A pilot study , 2012, The journal of spinal cord medicine.

[16]  Katie Gant,et al.  Understanding therapeutic benefits of overground bionic ambulation: exploratory case series in persons with chronic, complete spinal cord injury. , 2014, Archives of physical medicine and rehabilitation.

[17]  A. Esquenazi,et al.  The ReWalk Powered Exoskeleton to Restore Ambulatory Function to Individuals with Thoracic-Level Motor-Complete Spinal Cord Injury , 2012, American journal of physical medicine & rehabilitation.

[18]  T. Platz,et al.  REPAS, a summary rating scale for resistance to passive movement: Item selection, reliability and validity , 2008, Disability and rehabilitation.

[19]  M Akai,et al.  Effect of lesion level on the orthotic gait performance in individuals with complete paraplegia , 2006, Spinal Cord.

[20]  J. V. van Middendorp,et al.  Lower-limb exoskeletons for individuals with chronic spinal cord injury: findings from a feasibility study , 2016, Clinical rehabilitation.

[21]  Nene Av,et al.  Energy cost of paraplegic locomotion using the ParaWalker--electrical stimulation "hybrid" orthosis. , 1990 .

[22]  L Sykes,et al.  Objective measurement of use of the reciprocating gait orthosis (RGO) and the electrically augmented RGO in adult patients with spinal cord lesions , 1996, Prosthetics and orthotics international.

[23]  Clare Hartigan,et al.  Mobility Outcomes Following Five Training Sessions with a Powered Exoskeleton. , 2015, Topics in spinal cord injury rehabilitation.

[24]  A V Nene,et al.  Energy cost of paraplegic locomotion using the ParaWalker--electrical stimulation "hybrid" orthosis. , 1990, Archives of physical medicine and rehabilitation.

[25]  Energy expenditure and fatiguability in paraplegic ambulation using reciprocating gait orthosis and electric stimulation. , 1996, Disability and rehabilitation.