Dataset Information

Effects on mobility training and de-adaptations in subjects with Spinal Cord Injury due to a Wearable Robot: a preliminary report.

ABSTRACT:

Background

Spinal cord injury (SCI) is a severe neurological disorder associated not only with ongoing medical complications but also with a significant loss of mobility and participation. The introduction of robotic technologies to recover lower limb function has been greatly employed in the rehabilitative practice. The aim of this preliminary report were to evaluate the efficacy, the feasibility and the changes in the mobility and in the de-adaptations of a new rehabilitative protocol for EKSO™ a robotic exoskeleton device in subjects with SCI disease with an impairment of lower limbs assessed by gait analysis and clinical outcomes.

Method

This is a pilot single case experimental A-B (pre-post) design study. Three cognitively intact voluntary participants with SCI and gait disorders were admitted. All subjects were submitted to a training program of robot walking sessions for 45 min daily over 20 sessions. The spatiotemporal parameters at the beginning (T0) and at the end of treatment (T1) were recorded. Other clinical assessments (6 min walking test and Timed Up and Go test) were acquired at T0 and T1.

Results

Robot training were feasible and acceptable and all participants completed the training sessions. All subjects showed improvements in gait spatiotemporal indexes (Mean velocity, Cadence, Step length and Step width) and in 6 min Walking Test (T0 versus T1).

Conclusions

Robot training is a feasible form of rehabilitation for people with SCI. Further investigation regarding long term effectiveness of robot training in time is necessary.

Trial registration

ClinicalTrials.gov NCT02065830.

SUBMITTER: Sale P

PROVIDER: S-EPMC4730780 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Publications

Effects on mobility training and de-adaptations in subjects with Spinal Cord Injury due to a Wearable Robot: a preliminary report.

Sale Patrizio P Russo Emanuele Francesco EF Russo Michele M Masiero Stefano S Piccione Francesco F Calabrò Rocco Salvatore RS Filoni Serena S

BMC neurology 20160128

<h4>Background</h4>Spinal cord injury (SCI) is a severe neurological disorder associated not only with ongoing medical complications but also with a significant loss of mobility and participation. The introduction of robotic technologies to recover lower limb function has been greatly employed in the rehabilitative practice. The aim of this preliminary report were to evaluate the efficacy, the feasibility and the changes in the mobility and in the de-adaptations of a new rehabilitative protocol ...[more]

PMID: 26818847

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Project description:BackgroundSpinal cord injury (SCI) is a serious clinical condition that impacts a patient's physical, psychological, and socio-economic status. The aim of this pilot study was to evaluate the effects of training with a newly developed powered wearable exoskeleton (Hyundai Medical Exoskeleton [H-MEX]) on functional mobility, physiological health, and quality of life in non-ambulatory SCI patients.MethodsParticipants received 60 minutes of walking training with a powered exoskeleton 3 times per week for 10 weeks (total 30 sessions). The 6-minute walking test (6MWT) and timed-up-and-go test (TUGT) were performed to assess ambulatory function. The physiological outcomes of interest after exoskeleton-assisted walking training were spasticity, pulmonary function, bone mineral density, colon transit time, and serum inflammatory markers. Effects of walking training on subjective outcomes were estimated by the Korean version of the Falls Efficacy Scale-International and the 36-Item Short-Form Health Survey version 2.ResultsTen participants finished 30 sessions of training and could ambulate independently. No severe adverse events were reported during the study. After training, the mean distance walked in the 6MWT (49.13 m) was significantly enhanced compared with baseline (20.65 m). The results of the TUGT also indicated a statistically significant improvement in the times required to stand up, walk 3 m and sit down. Although not statistically significant, clinically meaningful changes in some secondary physiological outcomes and/or quality of life were reported in some participants.ConclusionIn conclusion, this study demonstrated that the newly developed wearable exoskeleton, H-MEX is safe and feasible for non-ambulatory SCI patients, and may have potential to improve quality of life of patients by assisting bipedal ambulation. These results suggest that the H-MEX can be considered a beneficial device for chronic non-ambulatory SCI patients.Trial registrationClinicalTrials.gov Identifier: NCT04055610.

Project description:Robot-assisted gait training (RAGT) is a promising technique for improving the gait ability of elderly adults and patients with gait disorders by enabling high-intensive and task-specific training. Gait functions involve multiple brain regions and networks. Therefore, RAGT is expected to affect not just gait performance but also neuroplasticity and cognitive ability. The purpose of this preliminary study was to verify the feasibility of the proposed RAGT design and to assess and compare the effect sizes of various measurement variables, including physical, cognitive, and neuroimaging induced by RAGT. Twelve healthy adults without any neurological or musculoskeletal disorders participated in this study. All participants wore a wearable exoskeleton robot and underwent 10 RAGT sessions. Functional data related to physical and cognitive abilities and neuroimaging data obtained from a magnetic resonance imaging (MRI) scanner and a functional near-infrared spectroscopy (fNIRS) device were acquired before and after the training sessions to assess the effect sizes of variables affected by RAGT. All participants underwent 10 sessions of RAGT without any adverse incidents, and the feasibility of the proposed RAGT design, consisting of preferred speed walking, fast speed walking, inclined walking, and squats, was validated. Variables related to physical and cognitive abilities significantly improved, but those related to neuroplasticity did not. The effect size of physical ability was "very large," whereas that of cognitive ability was "medium-to-large." The effect sizes of functional and structural neuroplasticity showed "medium" and "very small," respectively. The effect size of the RAGT varied depending on the measured variables, with the effect size being the greatest for physical ability, followed by cognitive ability, functional neuroplasticity, and structural neuroplasticity. The proposed RAGT design affects cognitive and neuroplastic effects beyond the physical effect directly affected by RAGT. This study highlights that while RAGT can positively influence cognitive outcomes beyond physical benefits, more intensive interventions may be required to elicit significant neuroplastic changes. This preliminary study offers useful information for researchers interested in designing robot-assisted training by investigating the potential extent of neuroplastic effects. Trial registration: KCT0006738.

Project description:Robotic assistance is increasingly used in neurological rehabilitation for enhanced training. Furthermore, therapy robots have the potential for accurate assessment of motor function in order to diagnose the patient status, to measure therapy progress or to feedback the movement performance to the patient and therapist in real time. We investigated whether a set of robot-based assessments that encompasses kinematic, kinetic and timing metrics is applicable, safe, reliable and comparable to clinical metrics for measurement of arm motor function. Twenty-four healthy subjects and five patients after spinal cord injury underwent robot-based assessments using the exoskeleton robot ARMin. Five different tasks were performed with aid of a visual display. Ten kinematic, kinetic and timing assessment parameters were extracted on joint- and end-effector level (active and passive range of motion, cubic reaching volume, movement time, distance-path ratio, precision, smoothness, reaction time, joint torques and joint stiffness). For cubic volume, joint torques and the range of motion for most joints, good inter- and intra-rater reliability were found whereas precision, movement time, distance-path ratio and smoothness showed weak to moderate reliability. A comparison with clinical scores revealed good correlations between robot-based joint torques and the Manual Muscle Test. Reaction time and distance-path ratio showed good correlation with the "Graded and Redefined Assessment of Strength, Sensibility and Prehension" (GRASSP) and the Van Lieshout Test (VLT) for movements towards a predefined position in the center of the frontal plane. In conclusion, the therapy robot ARMin provides a comprehensive set of assessments that are applicable and safe. The first results with spinal cord injured patients and healthy subjects suggest that the measurements are widely reliable and comparable to clinical scales for arm motor function. The methods applied and results can serve as a basis for the future development of end-effector and exoskeleton-based robotic assessments.

Dataset Information

Effects on mobility training and de-adaptations in subjects with Spinal Cord Injury due to a Wearable Robot: a preliminary report.

Background

Method

Results

Conclusions

Trial registration

Publications

Effects on mobility training and de-adaptations in subjects with Spinal Cord Injury due to a Wearable Robot: a preliminary report.

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