Background: Robotic mechanotherapy is considered as a promising area of physical rehabilitation of multiple sclerosis patients, while it ensures high training efficacy. Aim: To study the effect of physical training using with the ExoAtlet exoskeleton for lower extremities the functioning of patients with multiple sclerosis. Materials and methods: This was a prospective, open, uncontrolled, single center study. The rehabilitation course with the ExoAtlet exoskeleton included 43 patients (14 male and 29 female, aged from 28 to 59 years, mean age 43,5 ± 9,12 years) with remitting multiple sclerosis in remission (RMS-R) (n = 20) and secondary progressive course (VPRS) (n = 23), with the EDSS scores from 3 to 8. One of the inclusion criteria was the presence of motor paresis of the lower extremities. Training with the ExoAtlet exoskeleton was performed 5 days a week for two weeks. The neurological deficits and functioning were assessed with the Kurtzke expanded disability status scale (EDSS), the multiple sclerosis functional composite (MSFC) test, including the assessment of walking (Timed 25 Footwalk), of upper limb functions (9-Hole PegTest, 9-HPT), and of mental functioning (Symbol Digit Modalities Test, SDMT) before and after the rehabilitation course. Cognitive functions were assessed by the Montreal Cognitive Assessment (MoCA) scale. Results: The rehabilitation course resulted in a significant decrease of neurological deficiency by EDSS (by 0.26 score, 5%, p < 0.001). The MSFC test showed an improvement in all subtests: SDMT by 2 points, or 4.9% (p = 0.018), Timed 25-Footwalk by 3.2 seconds, or 19.6% (p < 0.001), 9-HPT for the dominant hand by 1.6 seconds, or 5% (p = 0.004), and for the non-dominant hand by 2.1 seconds, or 6.2% (p = 0.006). The improvement in the MoCA test after the rehabilitation course was 1.6 points, or 6% (p < 0.001). Conclusion: The study confirmed the positive effect of the exoskeleton in the lower extremities, such as restoration of the walking function in multiple sclerosis patients. There was a positive trend towards restoring of hand motor skills and cognitive functions.

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Aim. To study the efficiency of robotic mechanotherapy using the exoskeleton ExoAtlet on the functional state of patients with multiple sclerosis with impaired walking function. Materials and methods. This is a prospective, open, single-center study. The study included 53 patients with remitting course in remission and secondary progressive course, who had a neurological deficit level of 3 to 7 on the disability status scale (EDSS). To assess the severity of neurological deficits and functional state, we used the extended EDSS. Also we used the multiple sclerosis functional composite (MSFC) test, including the assessment of walking – Timed 25-Footwalk, the assessment of upper limb functions – 9-HolePegTest (9-HPT), the assessment of mental abilities – Symbol Digit Modalities Test (SDMT). Additionally, the preservation of cognitive functions was assessed by the Montreal Cognitive Assessment Scale (MoCA). Results. When assessing the level of disability on the EDSS scale, patients showed a statistically significant (p<0.02) decrease in this indicator by 0.22 points (4%). When studying the degree of impairment of the pyramidal function in patients, there was a decrease in indicator by 0.21 points (7%); p<0.01. The study of the SDMT subtest showed a statistically significant (p<0.02) improvement, the increase in the indicator was 2.3 points (4.3%). When evaluating other MSFC subtests, there was a statistically significant improvement in Timed 25-Footwalk subtest (p<0.001), 9-HPT on dominant (p<0.02) and non-dominant (p<0.02) hands. The improvement in Timed 25-Footwalk subtest score was 3.3 s (18.6%), in the 9-hole test on the dominant hand – 1.7 s (5.6%), on the non-dominant hand – 2.3 s (6.7%). When studying MoCa test, a statistically significant (p<0.001) improvement in cognitive functions after a course of rehabilitation was noted with a high degree of confidence, the improvement was 1.5 points (5.7%). Assessment of affective disorders in patients with multiple sclerosis showed a statistically significant decrease in the level of depression (p<0.02) on the HADS scale by 0.9 points (16.4%), and the level of anxiety (p<0.001) by 1.2 points (21.4%). Conclusion. During the study, data were obtained that showed the efficiency of robotic mechanotherapy using the exoskeleton for the lower extremities as a method of rehabilitation and the prospects for further study of this direction for restoring walking function in patients with MS in the presence of a motor deficit in the lower extremities.

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