Recovering the ability to stand and walk independently can have numerous health benefits for people with spinal cord injury (SCI). Wearable exoskeletons are being considered as a promising alternative to conventional knee-ankle-foot orthoses (KAFOs) for gait training and assisting functional mobility. However, comparisons between these two types of devices in terms of gait biomechanics and energetics have been limited. Through a randomized, crossover clinical trial, this study compared the use of a knee-powered lower limb exoskeleton (the ABLE Exoskeleton) against passive orthoses, which are the current standard of care for verticalization and gait ambulation outside the clinical setting in people with SCI. Ten patients with SCI completed a 10-session gait training program with each device followed by user satisfaction questionnaires. Walking with the ABLE Exoskeleton improved gait kinematics compared to the KAFOs, providing a more physiological gait pattern with less compensatory movements (38% reduction of circumduction, 25% increase of step length, 29% improvement in weight shifting). However, participants did not exhibit significantly better results in walking performance for the standard clinical tests (Timed Up and Go, 10-m Walk Test, and 6-min Walk Test), nor significant reductions in energy consumption. These results suggest that providing powered assistance only on the knee joints is not enough to significantly reduce the energy consumption required by people with SCI to walk compared to passive orthoses. Active assistance on the hip or ankle joints seems necessary to achieve this outcome.

No abstract

La epicondilopatía lateral (EL) cursa con dolor en la cara externa del codo que aumenta con la extensión resistida de muñeca. El abordaje terapéutico incluye: corrección de los factores predisponentes, tratamiento médico y fisioterapéutico. Las ondas de choque (ESWT) son impulsos acústicos de alta energía que van a estimular las células para producir factores de regeneración. Han sido utilizadas previamente en el tratamiento de las tendinopatías crónicas de forma estática local; sin embargo, sin tratar los posibles trigger points asociados. El objetivo del presente estudio fue analizar la eficacia de las ESWT sobre el dolor y la incapacidad funcional en pacientes afectos de EL resistentes al tratamiento conservador (3-6 meses) y con dolor prolongado superior a 3 meses. La metodología utilizada ha seguido los criterios de la International Society for Medical Shockwave Treatment (ISMST) utilizando una ESWT radial-3.000 impulsos, frecuencias de 5-10 Hz y dosis de energía baja (0,03 a 0, 12 mJ/mm 2)-. La duración del tratamiento fue de 5 sesiones (1/semana). Se evaluó el dolor y la capacidad funcional mediante la escala visual analógica (EVA)

Wearable exoskeletons are emerging as a new tool for gait training. However, comparisons between exoskeletons and conventional orthoses in terms of safety and feasibility are scarce. This study assessed the safety, feasibility, usability, and learning process of using the ABLE Exoskeleton in people with spinal cord injury (SCI) while comparing it with knee-ankle-foot orthoses (KAFOs). In this randomized, crossover clinical trial, 10 patients with chronic complete SCI (T4-T12) conducted a 10-session training and assessment protocol with each device: KAFOs and the ABLE Exoskeleton. Outcomes on safety (adverse events), and feasibility and usability (level of assistance, donning/doffing, therapy activities) were recorded for both devices. Evaluation sessions included standard clinical tests (Timed Up and Go, 10-Meter Walk Test, and 6-Minute Walk Test) to assess gait performance. The therapy metrics (number of steps, distance, gait speed, and standing and walking time) were recorded at each session for the robotic device. Participants quickly learned how to use the ABLE Exoskeleton, showing improvements in all therapy metrics (p<0.05) and the 6-Minute Walk Test (p<0.05). The robotic device reported less adverse events than KAFOs (17 and 31, respectively). Total donning and doffing time was 43 seconds faster with the robotic device using comparable levels of assistance. The time to complete the therapy activities was very similar between devices. Overall, participants needed 1 to 4 training sessions to perform essential therapy activities (sit/stand transitions, walking 10 meters, turning around) with both devices using minimum assistance or less. The results of this study show that it is feasible and safe for people with motor complete paraplegia due to SCI (T4-T12) to use the ABLE Exoskeleton for gait training in a rehabilitation hospital setting. The ABLE Exoskeleton proved to be safer than KAFOs in terms of adverse events, and as practical and easy to use as the conventional orthoses.

Recovering the ability to stand and walk independently can have numerous health benefits for people with spinal cord injury (SCI). Wearable exoskeletons are being considered as a promising alternative to conventional knee-ankle-foot orthoses (KAFOs) for gait training and assisting functional mobility. However, comparisons between these two types of devices in terms of gait biomechanics and energetics have been limited. Through a randomized, crossover clinical trial, this study compared the use of a knee powered lower limb exoskeleton (the ABLE Exoskeleton) against passive orthoses (KAFOs), which are the current standard of care for verticalization and gait ambulation outside the clinical setting in people with SCI. Ten patients with SCI completed a 10-session gait training program with each device followed by user satisfaction questionnaires. Walking with the ABLE Exoskeleton improved gait kinematics compared to the KAFOs, providing a more physiological gait pattern with less compensatory movements (38% reduction of circumduction, 25% increase of step length, 29% improvement in weight shifting). However, participants did not exhibit significantly better results in walking performance for the standard clinical tests (Timed Up and Go, 10-Meter Walk Test, and 6-Minute Walk Test), nor significant reductions in energy consumption. These results suggest that providing powered assistance only on the knee joints is not enough to significantly reduce the energy consumption required by people with SCI to walk compared to passive orthoses. Active assistance on the hip or ankle joints seems necessary to achieve this outcome.