Exoskeleton-assisted Gait Training in Persons With Multiple Sclerosis: A Single-Group Pilot Study

Afzal, Taimoor; Tseng, Shih Chiao; Lincoln, John A.; Kern, Marcie; Francisco, Gerard E.; Chang, Shuo Hsiu

doi:10.1016/j.apmr.2019.10.192

Cited by 28 publications

(32 citation statements)

References 29 publications

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“…The primary novel results indicated that relative to CGT, 4-weeks of REAER was associated with large improvements in functional mobility, CPS, and RSFC between the thalamus and ventromedial prefrontal cortex in 10 PwMS based on effect size estimates. This is consistent with other preliminary work reporting on REAER-related benefits on aspects of mobility in persons with substantial MS disability (Afzal, et al, 2020;Berriozabalgoitia, et al, 2020;Drużbicki, et al, 2020;Kozlowski, et al, 2017;McGibbon, et al, 2021). Consistent with our a priori hypotheses, those improvements in thalamocortical RSFC were moderately associated with improvements in functional mobility and CPS based on effect size estimates.…”

Section: Discussionsupporting

confidence: 91%

“…RE assistance allows for the application of over-ground, walking-based ER at volumes that are necessary for realizing such functional adaptations in persons with substantial MS-related neurological disability . Such a hypothesis is supported by published evidence on the feasibility and initial efficacy of RE use on mobility and balance outcomes in persons with substantial MS disability (Berriozabalgoitia et al, 2020;Drużbicki et al, 2020;Afzal et al, 2020;McGibbon et al, 2021). In addition, our previous case-study reported that 4-weeks of RE-assisted ER (REAER) was associated with improved mobility as well as improved cognitive performance relative to CGT in 4 PwMS (Androwis et al, 2019).…”

Section: Introductionmentioning

confidence: 88%

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A pilot randomized controlled trial of robotic exoskeleton-assisted exercise rehabilitation in multiple sclerosis

Androwis

Sandroff

Niewrzol

et al. 2021

Multiple Sclerosis and Related Disorders

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Background: Co-occurring mobility and cognitive impairments are common, debilitating, and poorly-managed with pharmacological therapies in persons with multiple sclerosis (MS). Exercise rehabilitation (ER), particularly walking ER, has been suggested as one of the best approaches for managing these manifestations of MS. However, there is a focal lack of efficacy of ER on mobility and cognitive outcomes in persons with MS who present with substantial neurological disability. Such severe neurological disability oftentimes precludes the ability for participation in highly-intensive and repetitive ER that is necessary for eliciting adaptations in mobility and cognition. To address such a concern, robotic exoskeleton-assisted ER (REAER) might represent a promising intervention approach for managing co-occurring mobility and cognitive impairments in those with substantial MS disability who might not benefit from traditional ER. Methods: The current pilot single-blind, randomized controlled trial (RCT) compared the effects of 4-weeks of REAER with 4-weeks of conventional gait training (CGT) as a standard-of-care control condition on functional mobility (timed up-and-go; TUG), walking endurance (six-minute walk test; 6MWT), cognitive processing speed (CPS; Symbol Digit Modalities Test; SDMT), and brain connectivity (thalamocortical resting-state functional connectivity (RSFC) based on fMRI) outcomes in 10 persons with substantial MS-related neurological disability. Results: Overall, compared with CGT, 4-weeks of REAER was associated with large improvements in functional mobility (η p 2 =.38), CPS (η p 2 =.53), and RSFC between the thalamus and ventromedial prefrontal cortex (η p 2 =.72),but not walking endurance (η p 2 =.01). Further, changes in RSFC were moderately associated with changes in TUG, 6MWT, and SDMT performance, respectively, whereby increased thalamocortical RSFC was associated with improved functional mobility, walking endurance, and CPS (|ρ|>.36). Conclusion:The current pilot RCT provides initial support for REAER as an approach for improving functional mobility and CPS, perhaps based on adaptive and integrative central nervous system plasticity, namely increases in RSFC between the thalamus and ventromedial prefrontal cortex, in a small sample of persons with substantial MS disability. Such a pilot trial provides proof-of-concept data for the design and implementation of an appropriately-powered RCT of REAER in a larger sample of persons with MS who present with co-occurring impairments in both mobility and cognitive functioning.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 88%

A pilot randomized controlled trial of robotic exoskeleton-assisted exercise rehabilitation in multiple sclerosis

Androwis

Sandroff

Niewrzol

et al. 2021

Multiple Sclerosis and Related Disorders

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“…The design of the selected studies included case series/reports ( n = 7) [ 34 , 35 , 36 , 41 , 42 , 44 , 47 ], pilot studies ( n = 1) [ 28 ], prospective open label ( n = 1) [ 39 ], self-controlled feasibility ( n = 1) [ 31 ], longitudinal cohort ( n = 1) [ 40 ], prospective cohort ( n = 1) [ 38 ], randomised crossover trial ( n = 2) [ 37 , 43 ], open label prospective quasi-experimental ( n = 1) [ 30 ], prospective single group observational ( n = 1) [ 14 ], experimental ( n = 5) [ 22 , 29 , 32 , 33 , 45 ], cross sectional ( n = 1) [ 21 ] and comparative ( n = 1) [ 46 ] studies. The studies were conducted in the USA ( n = 13) [ 14 , 22 , 28 , 32 , 34 , 35 , 37 , 39 , 40 , 41 , 42 , 44 , 45 ], UK ( n = 2) [ 29 , 31 ], Canada ( n = 2) [ 21 , 38 ], Korea ( n = 2) [ 36 , 43 ], Italy ( n = 2) [ 33 , 47 ] and Australia ( n = 1) [ …”

Section: Resultsmentioning

confidence: 99%

“…The gender of participants was not disclosed by one study, the remaining studies ( n = 22) were comprised of 151 males and 65 females ( Table 1 ). The participants from n = 19 studies [ 14 , 21 , 22 , 29 , 30 , 31 , 33 , 34 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 47 ] were SCI patients, one study involved individuals with MS [ 28 ], another study consisted of stroke patients [ 37 ] and one study involved able-bodied participants [ 32 ]. One study involved patients with MS and stroke as well as healthy individuals [ 46 ].…”

Section: Resultsmentioning

confidence: 99%

“…The powered exoskeleton devices used throughout the selected studies included the EKSO ( n = 6) [ 28 , 30 , 35 , 40 , 41 , 44 ], Ekso GT ( n = 5) [ 21 , 30 , 33 , 42 , 45 ], ReWalk ( n = 6) [ 14 , 31 , 38 , 39 , 43 , 46 ], Indego ( n = 2) [ 22 , 34 ], Powered Gait Orthosis (PGO) ( n = 1) [ 29 ], Angelegs ( n = 1) [ 36 ], Hybrid Neuro-Prosthesis Exoskeleton ( n = 1) [ 32 ], SMA Exoskeleton ( n = 1) [ 37 ] and REX Bionics ( n = 1) [ 46 ]. Both the EKSO and Ekso GT were included in the intervention of one study [ 30 ].…”

Section: Resultsmentioning

confidence: 99%

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The Effects of Powered Exoskeleton Gait Training on Cardiovascular Function and Gait Performance: A Systematic Review

Duddy

Doherty

Connolly

et al. 2021

Sensors

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Patients with neurological impairments often experience physical deconditioning, resulting in reduced fitness and health. Powered exoskeleton training may be a successful method to combat physical deconditioning and its comorbidities, providing patients with a valuable and novel experience. This systematic review aimed to conduct a search of relevant literature, to examine the effects of powered exoskeleton training on cardiovascular function and gait performance. Two electronic database searches were performed (2 April 2020 to 12 February 2021) and manual reference list searches of relevant manuscripts were completed. Studies meeting the inclusion criteria were systematically reviewed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. n = 63 relevant titles were highlighed; two further titles were identified through manual reference list searches. Following analysis n = 23 studies were included. Data extraction details included; sample size, age, gender, injury, the exoskeleton used, intervention duration, weekly sessions, total sessions, session duration and outcome measures. Results indicated that exoskeleton gait training elevated energy expenditure greater than wheelchair propulsion and improved gait function. Patients exercised at a moderate-intensity. Powered exoskeletons may increase energy expenditure to a similar level as non-exoskeleton walking, which may improve cardiovascular function more effectively than wheelchair propulsion alone.

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The Effects of One Month of Lower Limb Powered Exoskeleton Gait Training Compared to the Conventional Gait Training on Treadmills in People with Multiple Sclerosis: A Pilot Study

Cavallo,

Gatti,

Pellino

et al. 2024

Engineering Methodologies for Medicine and Sports

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Exoskeleton-assisted Gait Training in Persons With Multiple Sclerosis: A Single-Group Pilot Study

Cited by 28 publications

References 29 publications

A pilot randomized controlled trial of robotic exoskeleton-assisted exercise rehabilitation in multiple sclerosis

A pilot randomized controlled trial of robotic exoskeleton-assisted exercise rehabilitation in multiple sclerosis

The Effects of Powered Exoskeleton Gait Training on Cardiovascular Function and Gait Performance: A Systematic Review

The Effects of One Month of Lower Limb Powered Exoskeleton Gait Training Compared to the Conventional Gait Training on Treadmills in People with Multiple Sclerosis: A Pilot Study

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