<p>Effect of Gait Training Program with Mechanical Exoskeleton on Body Composition of Paraplegics</p>

Abstract

Purpose: To identify the effect of a 52-weeks gait training program with an exoskeletal body-powered gait orthosis on the body composition of paraplegics. Patients and Methods: Ten subjects with spinal cord injury at the thoracolumbar spine level for more than 2 years participated and were divided into exercise (n=5) and nonexercise (n=5) groups. A gait training program comprising stages 1-6 with customized exoskeletal body-powered gait orthosis was conducted for 52-weeks. A six-stage gait training program was conducted to manage the body composition and prevent obesity, and the changes in the body composition before and after the program were determined through bioelectrical impedance analysis. Results: No significant changes in weight, fat-free mass (kg), lean body mass (kg), and percent fat mass (%) are seen in the exercise group before and after the 52-weeks program. However, fat-free mass (pre = 47.3± 6.5, post = 44.3 ± 5.4, kg), lean body mass (pre = 45.2 ± 6.3, post = 42.3±5.2, kg), and percent fat mass (pre = 30.1 ± 12.1, post = 40.9 ± 9.1, kg) show significant changes (p < 0.05) in the nonexercise group. In the nonexercise group, among lean body mass changes over 52-weeks in the upper limbs (−31%), trunks (−9.7%), and lower limbs (−8.6%), upper limbs exhibit the most significant decrease (p < 0.05). Conclusion: The gait training program with exoskeletal body-powered gait orthosis has a positive effect on fat management in the whole body and lean body mass loss in paraplegics. Furthermore, it is effective in preventing continuous muscle loss and in maintaining health by reducing body fat. Body composition measurements with bioelectrical impedance analysis for paraplegics can be applied in various clinical areas and can be combined with various arbitration methods such as rehabilitation program.

Exoskeleton Training and Trans-Spinal Stimulation for Physical Activity Enhancement After Spinal Cord Injury (EXTra-SCI): An Exploratory Study

“…Another potential tool to help persons with SCI meet physical activity guidelines is powered robotic exoskeletons, the use of which has greatly expanded in recent years (16)(17)(18)(19)(20). Exoskeletons offer a unique opportunity for persons with SCI to experience standing and walking at a low metabolic cost (16,(21)(22)(23).…”

Physiotherapy using a free-standing robotic exoskeleton for patients with spinal cord injury: a feasibility study

“…Improvement in lean body mass has many health benefits [ 46 ]. Previous research, using a device requiring upper limb support, demonstrated that 52 weeks of training yielded positive changes to body composition [ 6 ]. A 2019 study found that for every percentage increase in lean body mass, there is a corresponding increase of 9% in the SCIM for tetraplegic patients [ 47 ].…”

“…Weight-bearing exercises such as sit to stand and locomotor training are essential functional components of therapy, necessary to strengthen or form new neural pathways and cortical adaptations [ 3 ], and maximise recovery in those with SCI [ 3 , 4 ]. Prolonged wheelchair use is known to lead to decreased bone mass and muscle mass and increased fat mass [ 5 , 6 ]. Weight-bearing exercise is important in the management of some of the secondary complications of SCI, such as decreased bone density, and bladder and bowel function [ 7 ].…”

“…All three devices have actuated hip and knee joints, but unpowered ankle joints, and require the user to support their weight with a walking aid, such as crutches or a walking frame. Clinical feasibility of these devices has been demonstrated [ 7 , 13 – 16 ], and research into clinical benefits suggests possible improvements in bladder and bowel function [ 14 , 15 , 17 – 19 ], pain [ 14 , 15 , 17 , 20 ], spasticity [ 14 , 15 , 20 , 21 ], bone density [ 22 ], lean body mass [ 23 ], muscle tone [ 6 , 15 , 17 ], and improved walking speed within the device [ 13 , 14 ]. Improvements in mood and mental state have also been reported [ 14 ].…”

Impact of rehabilitation on volumetric muscle loss in subjects with traumatic spinal cord injury: A systematic review

“…The inactivity-related VML, as in subjects suffering from SCI, might take advantage of physical exercise, isometric or cycle-ergometry functional electrical stimulation (FES), neuromuscular electrical stimulation (NMES), treadmill step-trained (Stp-T) or stand-trained (Std-T), body weight supported treadmill training (BWSTT), spinal magnetic stimulation, acrobatic exercises, testosterone replacement therapy, exoskeletal body-powered gait orthosis (EBPGO), and epidural spinal cord stimulation (eSCS) (Bustamante et al, 2016;Choi et al, 2020;Durán et al, 2001;Gao et al, 2017;Maher et al, 2017;Marquez-Chin & Popovic, 2020;McHugh et al, 2021;Mehrholz et al, 2017;Nightingale et al, 2018). The physical exercise efficacy seems to be related to its action on skeletal muscle tissue structure and neuroplasticity by the motor cortex activation (Fu et al, 2016;Jurkiewicz et al, 2007), and may result in resistance and cardiopulmonary conditioning improvement due to its neuroprotective and regenerative properties in people with SCI (Durán et al, 2001).…”