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Bach Baunsgaard C, Vig Nissen U, Katrin Brust A, Frotzler A, Ribeill C, Kalke YB, León N, Gómez B, Samuelsson K, Antepohl W, Holmström U, Marklund N, Glott T, Opheim A, Benito J, Murillo N, Nachtegaal J, Faber W, Biering-Sørensen F. Gait training after spinal cord injury: safety, feasibility and gait function following 8 weeks of training with the exoskeletons from Ekso Bionics. Spinal Cord 2017; 56:106-116. [PMID: 29105657 DOI: 10.1038/s41393-017-0013-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 08/15/2017] [Accepted: 08/15/2017] [Indexed: 12/13/2022]
Abstract
STUDY DESIGN Prospective quasi-experimental study, pre- and post-design. OBJECTIVES Assess safety, feasibility, training characteristics and changes in gait function for persons with spinal cord injury (SCI) using the robotic exoskeletons from Ekso Bionics. SETTING Nine European rehabilitation centres. METHODS Robotic exoskeleton gait training, three times weekly over 8 weeks. Time upright, time walking and steps in the device (training characteristics) were recorded longitudinally. Gait and neurological function were measured by 10 Metre Walk Test (10 MWT), Timed Up and Go (TUG), Berg Balance Scale (BBS), Walking Index for Spinal Cord Injury (WISCI) II and Lower Extremity Motor Score (LEMS). RESULTS Fifty-two participants completed the training protocol. Median age: 35.8 years (IQR 27.5-52.5), men/women: N = 36/16, neurological level of injury: C1-L2 and severity: AIS A-D (American Spinal Injury Association Impairment Scale). Time since injury (TSI) < 1 year, N = 25; > 1 year, N = 27. No serious adverse events occurred. Three participants dropped out following ankle swelling (overuse injury). Four participants sustained a Category II pressure ulcer at contact points with the device but completed the study and skin normalized. Training characteristics increased significantly for all subgroups. The number of participants with TSI < 1 year and gait function increased from 20 to 56% (P = 0.004) and 10MWT, TUG, BBS and LEMS results improved (P < 0.05). The number of participants with TSI > 1 year and gait function, increased from 41 to 44% and TUG and BBS results improved (P < 0.05). CONCLUSIONS Exoskeleton training was generally safe and feasible in a heterogeneous sample of persons with SCI. Results indicate potential benefits on gait function and balance.
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Affiliation(s)
- Carsten Bach Baunsgaard
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Ulla Vig Nissen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Natacha León
- Fundación Lesionado Medular (FLM), Madrid, Spain
| | - Belén Gómez
- Fundación Lesionado Medular (FLM), Madrid, Spain
| | - Kersti Samuelsson
- Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Wolfram Antepohl
- Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ulrika Holmström
- Spinal Cord Rehabilitation Unit, Uppsala University Hospital, Uppsala, Sweden
| | - Niklas Marklund
- Spinal Cord Rehabilitation Unit, Uppsala University Hospital, Uppsala, Sweden
| | - Thomas Glott
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | - Arve Opheim
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.,Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jesus Benito
- Institute Guttmann, Neurorehabilitation Hospital, Barcelona, Spain
| | - Narda Murillo
- Institute Guttmann, Neurorehabilitation Hospital, Barcelona, Spain
| | | | - Willemijn Faber
- Heliomare Rehabilitation Center, Wijk aan Zee, The Netherlands
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Nightingale EJ, Raymond J, Middleton JW, Crosbie J, Davis GM. Benefits of FES gait in a spinal cord injured population. Spinal Cord 2007; 45:646-57. [PMID: 17646840 DOI: 10.1038/sj.sc.3102101] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Review. OBJECTIVES This review article investigated the objective evidence of benefits derived from functional electrical stimulation (FES)-assisted gait for people with spinal cord injury (SCI). Both FES and gait have been proposed to promote not only augmented health and fitness, but specific ambulatory outcomes for individuals with neurological disabilities. However, due to small sample sizes and the lack of functionality of the intervention, it has not been widely used in clinical practice. This review assessed whether there is sufficient evidence to encourage a more widespread deployment of FES gait within the rehabilitation community. METHODS Hand searches and online data collection were performed in Medline and Science Direct. Specific search terms used included SCI/paralysis/paraplegia and tetraplegia with electrical stimulation/FES, gait and walking. RESULTS The searches generated 532 papers. Of these papers, 496 were excluded and 36 papers were included in the review. Many reported benefits were not carefully investigated, and small sample sizes or different methodologies resulted in insufficient evidence to draw definitive conclusions. CONCLUSIONS FES gait can enhance gait, muscle strength and cardiorespiratory fitness for people with SCI. However, these benefits are dependent on the nature of the injury and further research is required to generalize these results to the widespread population of SCI individuals. Proof of the functionality and further evidence of the benefits of FES gait will assist in FES gait gaining clinical acceptance.
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Affiliation(s)
- E J Nightingale
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
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Kottink AIR, Oostendorp LJM, Buurke JH, Nene AV, Hermens HJ, IJzerman MJ. The orthotic effect of functional electrical stimulation on the improvement of walking in stroke patients with a dropped foot: a systematic review. Artif Organs 2004; 28:577-86. [PMID: 15153151 DOI: 10.1111/j.1525-1594.2004.07310.x] [Citation(s) in RCA: 147] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Analysis of the available evidence on the improvement of walking in stroke patients with a dropped foot when using peroneus stimulation. METHODS A systematic review was performed to identify trials that investigated the orthotic effect of functional electrical stimulation (FES) on walking in stroke patients with a dropped foot. Two independent raters scored the methodological quality of the included articles. Walking speed and physiological cost index (PCI) were selected as the primary outcome measures. Studies that measured walking speed were pooled and a pooled difference including confidence interval was calculated. RESULTS Eight studies were included in the review, of which one was a randomized controlled trial. Methodological score ranged from 8 to 18 out of 19. Six studies measured walking speed. The pooled improvement in walking speed was 0.13 m/s (0.07-0.2) or 38% (22.18-53.8). CONCLUSIONS The present review suggests a positive orthotic effect of functional electrical stimulation on walking speed.
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Affiliation(s)
- Anke I R Kottink
- Roessingh Research and Development, PO Box 310, 7500 AH Enschede, the Netherlands.
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