Assessment of In-Hospital Walking Velocity and Level of Assistance in a Powered Exoskeleton in Persons with Spinal Cord Injury

Abstract

Background: Individuals with spinal cord injury (SCI) often use a wheelchair for mobility due to paralysis. Powered exoskeletalassisted walking (EAW) provides a modality for walking overground with crutches. Little is known about the EAW velocities and level of assistance (LOA) needed for these devices. Objective: The primary aim was to evaluate EAW velocity, number of sessions, and LOA and the relationships among them. The secondary aims were to report on safety and the qualitative analysis of gait and posture during EAW in a hospital setting. Methods: Twelve individuals with SCI ≥1.5 years who were wheelchair users participated. They wore a powered exoskeleton (ReWalk; ReWalk Robotics, Inc., Marlborough, MA) with Lofstrand crutches to complete 10-meter (10MWT) and 6-minute (6MWT) walk tests. LOA was defined as modified independence (MI), supervision (S), minimal assistance (Min), and moderate assistance (Mod). Best effort EAW velocity, LOA, and observational gait analysis were recorded. Results: Seven of 12 participants ambulated ≥0.40 m/s. Five participants walked with MI, 3 with S, 3 with Min, and 1 with Mod. Significant inverse relationships were noted between LOA and EAW velocity for both 6MWT (Z value = 2.63, Rho = 0.79, P = .0086) and 10MWT (Z value = 2.62, Rho = 0.79, P = .0088). There were 13 episodes of mild skin abrasions. MI and S groups ambulated with 2-point alternating crutch pattern, whereas the Min and Mod groups favored 3-point crutch gait. Conclusion: Seven of 12 individuals studied were able to ambulate at EAW velocities ≥0.40 m/s, which is a velocity that may be conducive to outdoor activity-related community ambulation. The ReWalk is a safe device for in-hospital ambulation.

Training Persons with Spinal Cord Injury to Ambulate Using a Powered Exoskeleton

“…Trainer assistance affects performance; those who need a greater level of assistance walk slower than those who are more proficient and independent in using the system 18 . The three walking test measurements, although similar, provide different proficiency information.…”

“…These powered exoskeleton devices have been studied in persons with stroke 14,15 , persons with complete and incomplete SCI [16][17][18][19][20][21][22][23][24] , and other persons with disabilities causing reduced control of their lower extremities [25][26][27] . Although the devices differ, each one requires training and practice by the user for safe performance.…”

“…Other common contraindications may be treated and resolved, such as limited range of motion (ROM) 34 and pressure ulcers 35 . Each of the different powered exoskeleton may require different conditions for eligibility, such as ROM criteria, to be a candidate to use the device, most of which have been described [17][18][19]21,22,36 .…”

“…This program was developed for one device specifically, which is described by others [16][17][18] , but it addresses aspects and challenges that are common for staff trainers and persons with SCI who participate in exoskeletal-assisted walking programs which may use another powered exoskeleton. Certain aspects of this protocol are specific to the device used at the JJPVAMC.…”

Role of Gait Training in Recovery of Standing and Walking in Subjects with Spinal Cord Injury

“…Training protocol was being done on the different surfaces including sidewalk, grass, or stairs [56][57][58]. Yong et al used the training protocol with powered gait orthosis on the treadmill to increase confidence of SCI subjects and improvement of the walking speed on them [59]. While in using powered gait orthosis, Arazpour et al [60] performed upper extremity strengthening and lower extremity stretching as the main section of the training during orthotic gait rehabilitation.…”