Incidental bilateral calcaneal fractures following overground walking with a wearable robotic exoskeleton in a wheelchair user with a chronic spinal cord injury: is zero risk possible?

Preliminary Assessment of Muscle Activity and Muscle Characteristics during Training with Powered Robotic Exoskeleton: A Repeated-Measures Study

“…While some studies have reported that at least 20 sessions or more training is required for subjects to independently use the robotic exoskeleton [9,14], some studies have suggested that independent walking using the robotic exoskeleton is possible even with 6-9 sessions of training [10,13]. Bass et al [12] suggested that it is required to identify a training period and method that could minimize the load on the upper extremities and shoulders in order to properly perform gait and functional movements using the robotic exoskeleton and to prevent musculoskeletal damage. In this study, subjects were instructed to perform functional training 3 times a week, and after 15 training sessions for 5 weeks in healthy adults, the muscle activity and muscle characteristics of the upper and lower extremities for performing functional movements were confirmed to be minimized.…”

“…In the past 10 years of research on gait training using various robotic exoskeletons for SCI patients, it has been reported that independent gait is possible with 8-20 training sessions [9][10][11][12][13][14]. As such, the robotic exoskeleton could enhance the walking ability of SCI patients, in particular, the possibility of independent activity through the robot exoskeleton in patients with complete sensorimotor SCI depends on whether it is possible to perform movements with only the upper extremity.…”

“…Since SCI patients have a different level of body function according to the type and level of injury, the training period required to use the robotic exoskeleton is different. Therefore, a standardized training protocol for the use of exoskeleton walking robots was inconsistent until the present [9][10][11][12][13][14]. In order to develop a standardized training protocol for SCI, it is preferentially necessary to establish a standard of a common minimum training period.…”

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

“…Total hip areal bone mineral density (aBMD), determined with dual-energy x-ray absorptiometry (DXA) scans performed at T 1 , is used to assign each participant to one of three training regimes based on lower extremity fracture risks [ 69 ]: (1) conservative (T-score ≤ –2.5; first session includes a maximum of 300 steps; number of steps progresses up to 10% every week), (2) moderate (–2.5 < T-score < –1.0; first session includes a maximum of 400 steps; number of steps progresses up to 15% every week), or (3) aggressive (T-score ≥ –1.0; first session includes a maximum of 500 steps; number of steps progresses up to 20% every week). Workload is further individualized depending on each participant’s level of proficiency and tolerance; it is progressively and safely increased by modifying walking parameters (eg, number of steps, speed, and duration) or reducing total resting time or level of assistance provided by the physiotherapist to maintain a moderate-to-vigorous training intensity (ie, rate of perceived exertion ≥3/10 on the Modified Borg Scale [ 70 ]).…”

“…Training parameters are recorded at the end of each session (eg, total standing time, total walking time, total number of steps, assistance provided, and rate of perceived exertion). Given the risks of adverse events inherently linked to the use of a wearable robotic exoskeleton [ 69 , 71 ], skin integrity at interface pressure points, particularly at the tibial tuberosity, and signs of inflammation at the ankle and knee joints before and after each training session, respectively, are assessed and any serious adverse events will be reported.…”