Can powered exoskeletons improve gait and balance in multiple sclerosis? A retrospective study

Abstract

Multiple sclerosis (MS) is a progressive neurologic disorder that can profoundly influence mobility, independence and quality of life. Gait dysfunction in MS is common, resulting in an increased risk of losing walking ability. Robotic exoskeletons have been developed to offer a new form of locomotor training. The aim of our study was to investigate the effectiveness of the powered exoskeleton (Ekso) in improving gait and balance in patients affected by MS. Twenty patients with MS (mean ± SD: age = 43.7 ± 10.3 years; 66.7% male) were enrolled in this retrospective study. They were divided into two groups, matched for demographic data (age and sex) and medical characteristics (disease duration and Expanded Disability Status Scale), but differing for the type of rehabilitation training performed. Group 1 [experimental group (EG)] received gait training with the Ekso device, whereas group 2 (control group) performed traditional gait training. Although both trainings led to a significant improvement in the ability to walk and balance, only in the EG a significant improvement in walking speed (10 Meter Walk test; P = 0.002), in person’s mobility (Timed Up and Go test; P = 0.002), and in the perception of mental well-being (MSQoL-M; P = 0.004), with a good usability and acceptance of the device, was found. Powered exoskeletons could be considered a valuable tool to improve functional outcomes and get the therapeutic goal in patients with MS.

Effect of robot-assisted gait training on quality of life and depression in neurological impairment: A systematic review and meta-analysis

“…A total of 13 interventional studies reported data on quality of life/physical health quality of life for both interventional and control groups. 12,15,17,34,41,54 Pooling these studies, intervention using an exoskeleton appeared to improve the quality of life/physical health quality of life of participants (adjusted Hedges’g 0.58, 95% CI 0.28, 0.88; Figure 4).…”

“…Of the 46 studies, 26 responded to the inclusion criteria and provided sufficient. All 31 references were included in the systematic review, 6,12,41 and 27 presented sufficient statistical data to be included in the quantitative meta-analysis (Figure 1). 6,12,18,21,29,32,41…”

“…The evaluations were performed on average after 7.6 weeks of training with only three studies proposing a longer duration of treatment (i.e. between 18 and 24 weeks 32,36,41 ). No study offered a follow-up after stopping rehabilitation treatment and it was, therefore, impossible to predict whether the positive effect persists.…”

“…Of the 46 studies, 26 responded to the inclusion criteria and provided sufficient. All 31 references were included in the systematic review, 6,12,41 and den Brave et al…”

“…27 presented sufficient statistical data to be included in the quantitative meta-analysis (Figure 1). 6,12,18,21,29,32,41 The characteristics of the included studies have been summarised in Table S1 (Supplementary material). Seventeen RCTs and 14 non-RCTs were included.…”