Exoskeleton-assisted walking improves pulmonary function and walking parameters among individuals with spinal cord injury: a randomized controlled pilot study

Xiang, Xiao-Na; Zong, Hui-Yan; Ou, Yi; Yu, Xijie; Cheng, Hong; Du, Chunping; He, Hongchen

doi:10.1186/s12984-021-00880-w

Cited by 24 publications

(44 citation statements)

References 53 publications

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“…A number of bionic exoskeletons are now FDA approved for assisting walking after SCI, including Ekso TM , Rewalk TM , and Indego ® systems, as well as the implanted neuroprostheses, Parastep ® 1, which uses functional neuromuscular stimulation (FNS) to generate a majority of the muscular torque required to move and stabilize the lower extremities. These exoskeletal ambulation devices can significantly improve cardiovascular and psychological health [ 100 , 101 , 102 , 103 , 104 ]. However, unfortunately, there is no evidence to suggest that use of these devices can protect against or reverse SCI-induced bone loss.…”

Section: Discussionmentioning

confidence: 99%

Osteopenia in a Mouse Model of Spinal Cord Injury: Effects of Age, Sex and Motor Function

Hook

Falck²,

Dundumulla

et al. 2022

Biology

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After spinal cord injury (SCI), 80% of individuals are diagnosed with osteopenia or osteoporosis. The dramatic loss of bone after SCI increases the potential for fractures 100-fold, with post-fracture complications occurring in 54% of cases. With the age of new SCI injuries increasing, we hypothesized that a SCI-induced reduction in weight bearing could further exacerbate age-induced bone loss. To test this, young (2–3 months) and old (20–30 months) male and female mice were given a moderate spinal contusion injury (T9–T10), and recovery was assessed for 28 days (BMS, rearing counts, distance traveled). Tibial trabecular bone volume was measured after 28 days with ex vivo microCT. While BMS scores did not differ across groups, older subjects travelled less in the open field and there was a decrease in rearing with age and SCI. As expected, aging decreased trabecular bone volume and cortical thickness in both old male and female mice. SCI alone also reduced trabecular bone volume in young mice, but did not have an additional effect beyond the age-dependent decrease in trabecular and cortical bone volume seen in both sexes. Interestingly, both rearing and total activity correlated with decreased bone volume. These data underscore the importance of load and use on bone mass. While partial weight-bearing does not stabilize/reverse bone loss in humans, our data suggest that therapies that simulate complete loading may be effective after SCI.

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Section: Discussionmentioning

confidence: 99%

Osteopenia in a Mouse Model of Spinal Cord Injury: Effects of Age, Sex and Motor Function

Hook

Falck²,

Dundumulla

et al. 2022

Biology

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“…According to the physical activity guidelines, patients with SCIs should engage in at least 30 min of moderate-to vigorous-intensity aerobic exercise three times per week for cardiometabolic health benefits (Martin Ginis et al, 2018). Some studies reported that walking with WREs has numerous beneficial effects on pulmonary function (Xiang et al, 2021), bladder function (Chun et al, 2020), and sitting balance (Tsai et al, 2021). Habitual walking exercises using the WPAL three times a week for a long time may provide health benefits for patients with SCIs.…”

Section: Discussionmentioning

confidence: 99%

Wearable Power-Assist Locomotor for Gait Reconstruction in Patients With Spinal Cord Injury: A Retrospective Study

et al. 2022

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Wearable robotic exoskeletons (WREs) have been developed from orthoses as assistive devices for gait reconstruction in patients with spinal cord injury. They can solve some problems encountered with orthoses, such as difficulty in independent walking and standing up and high energy consumption during walking. The Wearable Power-Assist Locomotor (WPAL), a WRE, was developed based on a knee–ankle–foot orthosis with a single medial hip joint. The WPAL has been updated seven times during the period from the beginning of its development, in 2005, to 2020. The latest version, launched as a commercialized model in 2016, is available for medical facilities. In this retrospective study, which included updated results from previous reports, all data were extracted from development research records from July 2007 to December 2020. The records were as follows: patient characteristics [the number of participants, injury level, and the American Spinal Injury Association Impairment Scale (AIS) score], the total number of WPAL trials when aggregating the cases with all the versions or only the latest version of the WPAL, and maximum walking performance (functional ambulation category [FAC], distance, and time of continuous walking). Thirty-one patients participated in the development research. The levels of spinal cord injury were cervical (C5–C8), upper thoracic (T3–T6), lower thoracic (T7–T12), and lumbar (L1) in 10, 5, 15, and 1 of the patients, respectively. The numbers of patients with AIS scores of A, B, C, and D were 20, 7, 4, and 0, respectively. The total number of WPAL trials was 1,785, of which 1,009 were used the latest version of the WPAL. Twenty of the patients achieved an FAC score of 4 after an average of 9 (median 8, range 2–22) WPAL trials. The continuous walking distance and time improved with the WPAL were compared to the orthosis. We confirmed that the WPAL improves walking independence in people with a wide range of spinal cord injuries, such as cervical spinal cord injuries. Further refinement of the WPAL will enable its long-term use at home.

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“…As for the sample size calculated by G*power version 3.1.9.6 (HHU, German), a pilot study [29] was performed for determinizing the effect size (1.04) of primary outcome (FVC). It was calculated that at least 16 participants were required for each group according to a significance level of 0.05 and study power of 80%.…”

Section: Sample Sizementioning

confidence: 99%

Exoskeleton-Assisted Walking for Pulmonary and Exercise Performances of SCI Individuals

Xiang

Zhang

Zong

et al. 2023

IEEE Trans. Neural Syst. Rehabil. Eng.

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To determine whether exoskeletonassisted walking (EAW) improves pulmonary ventilation function, motor function and related body structure, and activities equivalently as the conventional exercise program for people with spinal cord injury (SCI). Methods: Forty participants (7 females and 33 males; age 37.1±12.0 years) with thoracic SCI were randomized into two groups and undertook 16 sessions of 50-60 min training (4 days/week). Participants in the EAW group received EAW trainings, such as assisted standing, walking, and climbing the stairs. The control group received a conventional exercise program. Outcomes were measured at baseline and upon completion of treatment. Results: After trainings, the EAW group improved more than the control group in the forced vital capacity (FVC, 0.53 L [0.01-1.06 L]), predicted FVC% (19.59 [6.63-32.54]) and forced expiratory volume in 1s (0.61 L [0.15-1.07 L]), basic activities of daily living (BADL) (19.75 [10.88-28.62]), and distal femoral cartilage. Participants in the EAW group completed 6minute walk test with median 17.3 meters while wearing the exoskeleton. There was no difference in trunk and lower extremity motor function, bone mineral density, and adverse events (P > 0.05). Conclusion: In people with lower thoracic neurological level of SCI, EAW training has potential benefits to facilitate pulmonary ventilation function, walking, BADL and thickness of cartilage comparing to a conventional excise program.Significance: This study provided more evidence for using EAW in clinic, and partly proved EAW had equivalent effects as conventional exercise program, which may combine with conventional exercise program for reducing burden of therapists in the future.

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Exoskeleton-assisted walking improves pulmonary function and walking parameters among individuals with spinal cord injury: a randomized controlled pilot study

Cited by 24 publications

References 53 publications

Osteopenia in a Mouse Model of Spinal Cord Injury: Effects of Age, Sex and Motor Function

Osteopenia in a Mouse Model of Spinal Cord Injury: Effects of Age, Sex and Motor Function

Wearable Power-Assist Locomotor for Gait Reconstruction in Patients With Spinal Cord Injury: A Retrospective Study

Exoskeleton-Assisted Walking for Pulmonary and Exercise Performances of SCI Individuals

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