Effects of an Overground Walking Program With a Robotic Exoskeleton on Long-Term Manual Wheelchair Users With a Chronic Spinal Cord Injury: Protocol for a Self-Controlled Interventional Study

Abstract

Background In wheelchair users with a chronic spinal cord injury (WUSCI), prolonged nonactive sitting time and reduced physical activity—typically linked to this mode of mobility—contribute to the development or exacerbation of cardiorespiratory, musculoskeletal, and endocrine-metabolic health complications that are often linked to increased risks of chronic pain or psychological morbidity. Limited evidence suggests that engaging in a walking program with a wearable robotic exoskeleton may be a promising physical activity intervention to counter these detrimental health effects. Objective This study’s overall goals are as follows: (1) to determine the effects of a 16-week wearable robotic exoskeleton–assisted walking program on organic systems, functional capacities, and multifaceted psychosocial factors and (2) to determine self-reported satisfaction and perspectives with regard to the intervention and the device. Methods A total of 20 WUSCI, who have had their injuries for more than 18 months, will complete an overground wearable robotic exoskeleton–assisted walking program (34 sessions; 60 min/session) supervised by a physiotherapist over a 16-week period (one to three sessions/week). Data will be collected 1 month prior to the program, at the beginning, and at the end as well as 2 months after completing the program. Assessments will characterize sociodemographic characteristics; anthropometric parameters; sensorimotor impairments; pain; lower extremity range of motion and spasticity; wheelchair abilities; cardiorespiratory fitness; upper extremity strength; bone architecture and mineral density at the femur, tibia, and radius; total and regional body composition; health-related quality of life; and psychological health. Interviews and an online questionnaire will be conducted to measure users’ satisfaction levels and perspectives at the end of the program. Differences across measurement times will be verified using appropriate parametric or nonparametric analyses of variance for repeated measures. Results This study is currently underway with active recruitment in Montréal, Québec, Canada. Results are expected in the spring of 2021. Conclusions The results from this study will be essential to guide the development, implementation, and evaluation of future evidence-based wearable robotic exoskeleton–assisted walking programs offered in the community, and to initiate a reflection regarding the use of wearable robotic exoskeletons during initial rehabilitation following a spinal cord injury. Trial Registration ClinicalTrials.gov NCT03989752; https://clinicaltrials.gov/ct2/show/NCT03989752 International Registered Report Identifier (IRRID) DERR1-10.2196/19251

Effects of upper limb ergometer on pulmonary functions among spinal cord injury patients

“…Group-B received conventional treatment including deep breathing exercises: 10-15 repetitions twice a day, assistive Coughing: 5-6 repetitions twice a day [32], sustained stretching, splinting, bracing, ROM exercises [33], tilt table standing [34] and functional mobility exercises [35] i.e. ; (two sessions/day; 5 days/week).…”

Robotic Walking to Mitigate Bone Mineral Density Decline and Adverse Body Composition in Individuals With Incomplete Spinal Cord Injury

“…3 Resistance exercises, functional electrical stimulation-assisted exercises, and weight-bearing activities are suggested to promote bone health and density after SCI. 1,[6][7][8] The current global standard of care for SCI rehabilitation, activity-based training (ABT), 4,9 has been proposed as a vital therapy to prevent BMD decline by mechanically reloading the lower extremity and stimulating the osteogenic effects for bone mass deposit. 1,6,10 Subsequently, it has been hypothesized that robotic locomotor training (RLT) may also ameliorate the progressive loss of BMD in people with SCI, 3 as the weight-bearing activity stimulates and creates an ideal stress environment to promote physiologic bone remodeling.…”

“…3,11 However, as RLT is a relatively new rehabilitation technology, there is currently a lack of adequately powered studies, including randomized control trials (RCTs), addressing the influence of robotic walking on bone health in the SCI population. 2,8,12 In addition, there is a lack of published evidence-based guidelines defining the optimum time and frequency of weight-bearing activity required to maintain bone health during SCI rehabilitation. [13][14][15] Evidence for impact on BMD is somewhat mixed with descriptive evidence mainly suggesting benefits for early initiation of higher-dose standing programs.…”

“…Subsequently, it has been hypothesized that robotic locomotor training (RLT) may also ameliorate the progressive loss of BMD in people with SCI, 3 as the weight-bearing activity stimulates and creates an ideal stress environment to promote physiologic bone remodeling 3,11 . However, as RLT is a relatively new rehabilitation technology, there is currently a lack of adequately powered studies, including randomized control trials (RCTs), addressing the influence of robotic walking on bone health in the SCI population 2,8,12 . In addition, there is a lack of published evidence-based guidelines defining the optimum time and frequency of weight-bearing activity required to maintain bone health during SCI rehabilitation 13–15 .…”

“…Bone mineral density loss after SCI is partly caused by a decrease in mechanical loading as a result of reduced or complete loss of muscle function and weight-bearing activity 3 . Resistance exercises, functional electrical stimulation–assisted exercises, and weight-bearing activities are suggested to promote bone health and density after SCI 1,6–8 . The current global standard of care for SCI rehabilitation, activity-based training (ABT), 4,9 has been proposed as a vital therapy to prevent BMD decline by mechanically reloading the lower extremity and stimulating the osteogenic effects for bone mass deposit 1,6,10 …”