Safety and Efficacy of At-Home Robotic Locomotion Therapy in Individuals with Chronic Incomplete Spinal Cord Injury: A Prospective, Pre-Post Intervention, Proof-of-Concept Study

Abstract

BackgroundThe compact Motorized orthosis for home rehabilitation of Gait (MoreGait) was developed for continuation of locomotion training at home. MoreGait generates afferent stimuli of walking with the user in a semi-supine position and provides feedback about deviations from the reference walking pattern.ObjectiveProspective, pre-post intervention, proof-of-concept study to test the feasibility of an unsupervised home-based application of five MoreGait prototypes in subjects with incomplete spinal cord injury (iSCI).MethodsTwenty-five (5 tetraplegia, 20 paraplegia) participants with chronic (mean time since injury: 5.8 ± 5.4 (standard deviation, SD) years) sensorimotor iSCI (7 ASIA Impairment Scale (AIS) C, 18 AIS D; Walking Index for Spinal Cord Injury (WISCI II): Interquartile range 9 to 16) completed the training (45 minutes / day, at least 4 days / week, 8 weeks). Baseline status was documented 4 and 2 weeks before and at training onset. Training effects were assessed after 4 and 8 weeks of therapy.ResultsAfter therapy, 9 of 25 study participants improved with respect to the dependency on walking aids assessed by the WISCI II. For all individuals, the short-distance walking velocity measured by the 10-Meter Walk Test showed significant improvements compared to baseline (100%) for both self-selected (Mean 139.4% ± 35.5% (SD)) and maximum (Mean 143.1% ± 40.6% (SD)) speed conditions as well as the endurance estimated with the six-minute walk test (Mean 166.6% ± 72.1% (SD)). One device-related adverse event (pressure sore on the big toe) occurred in over 800 training sessions.ConclusionsHome-based robotic locomotion training with MoreGait is feasible and safe. The magnitude of functional improvements achieved by MoreGait in individuals with iSCI is well within the range of complex locomotion robots used in hospitals. Thus, unsupervised MoreGait training potentially represents an option to prolong effective training aiming at recovery of locomotor function beyond in-patient rehabilitation.Trial RegistrationGerman Clinical Trials Register (DKRS) DRKS00005587

Pathophysiology, Classification and Comorbidities after Traumatic Spinal Cord Injury

“…However, the ISNCSCI does not test actual functions such as hand grasping and walking that are composites of multiple elements of sensorimotor control. Other outcome measures developed to assess these functions include the Graded Redefined Assessment of Strength, Sensation and Prehension (GRASSP) [ 98 ] for the upper extremity and the Walking Index for Spinal Cord Injury (WISCI/WISCI II) for assisted walking [ 99 ]. A composite of the ISNCSCI motor score and the SCIM, version 3 (SCIM-III), the Spinal Cord Ability Ruler (SCAR) has been proposed to linearize the assessments and create a measure of neurological and daily life function [ 100 ].…”

Non-invasive approaches to functional recovery after spinal cord injury: Therapeutic targets and multimodal device interventions

“…Primary challenges of chronic SCI are worsening disability, lack of spontaneous improvement below injury level, complications, and neuromuscular/musculoskeletal deterioration (Figure 1) (Adams and Hicks, 2005;Huie et al, 2017). Yet, compared to limited progress made in therapeutic management of acute SCI, there have been remarkable achievements in developing clinical rehabilitation therapies for chronic SCI (Gagnon et al, 2018;Rupp et al, 2015). This is attributable to newly gained understanding of neuroplastic mechanisms and their potentiators in both experimental and clinical settings, which led to breakthroughs in designing functional recovery strategies targeting the reactivation of the CPG circuitry (Behrman et al, 2006;Donati et al, 2016;Gill et al, 2018;Harkema et al, 2011;Hubscher et al, 2018).…”

Gerätegestützte Neurorehabilitation – was wird die Zukunft bringen?

“…Bei diesen liegt der Fokus der Rehabilitation auf der Verbesserung der Gehfunktion, da diese eine Voraussetzung für eine uneingeschränkte Partizipation im beruflichen wie privaten Leben darstellt [5]. Damit liegen die erreichten Verbesserungen in der gleichen Größenordnung wie die mit Großgeräten erzielbaren Erfolge [20]. Interessanterweise zeigte sich ein nahezu linearer Zuwachs der Gehgeschwindigkeit und -ausdauer innerhalb der 8 Wochen, sodass wahrscheinlich eine längere Trainingsdauer zu weiteren Verbesserungen geführt hätte.…”

“…Vor Kurzem konnte gezeigt werden, dass inkomplett Querschnittgelähmte mit einem "Stiff-Knee Gait"-ähnlichen Gangmuster durch visuelles, schrittphasenbezogenes Echtzeitfeedback der Abweichungen des Kniewinkels von der Norm ihr Gangmuster normalisieren konnten. Auch ohne Darbietung des Feedbacks kam es darüber hinaus über sechs Trainingseinheiten zu einer stetigen Normalisierung des Gangmusters [20].…”

“…Während über 1100 Trainingseinheiten kam es nur zu einer geräteassoziierten Nebenwirkung in Form eines Druckschadens an der Großzehe[20].…”