Dynamics of independence and locomotor capabilities caused by powered exoskeleton-induced walk training in patients with severe chronic spinal cord injury

Objective. To evaluate the effectiveness of complex rehabilitation with walk training induced by powered exoskeleton ‘ExoAtlet’ for the patients with severe chronic paraplegias caused by thoracic or upper lumbar spine injuries.

Material and Methods. Design: prospective monocenter study. Fifty patients with severe  spinal cord injuries (ASIA: A – 36, B – 10, C – 4; Frankel: A – 24, B – 16, C – 10) from  6 months to 23 years after complicated thoracic or upper lumbar spine injury underwent two intensive courses of complex neurorehabilitation including 36 sessions/hours of powered exoskeleton-induced walk training. Three areas mostly important for the patients were chosen for the analysis: changes in patient independence (assessed by the SCIM III scale), locomotor capabilities (Hauser’s Ambulation Index and tetrapedal tests), and strength and sensitivity indicators (AIS scales). Testing was carried out before and one month after the end of the second course. The frequency of positive changes in each area and their dependence (ANOVA) on the completeness of the spinal cord injury and the duration of the injury were studied.

Results. The increase in independence was observed in 46/50 patients, including by 1–3 SCIM points in 14 (28 %), by 4–9 points in 20 (40 %), and by 10 points and above in 12 patients (24 %). Locomotor capabilities improved in 84 % of patients due to reducing test execution time and the need for care. Progress in sensitivity below the affected area by at least 1 point was detected in 80 % of patients (on average by 6 AIS points), including in 68% in tactile and in 54 % in pain sensitivity. The muscle strength gain was recorded in 7 (14%) patients with incomplete paraplegia (on average by 3.5 AIS points). Within the study group, it was found that the progress achieved in independence, locomotor capabilities and sensitivity did not depend on the completeness of the spinal cord injury as well as on the period after injury.

Conclusion. Rehabilitation with repeated intensive courses of powered exoskeleton-induced walk training increases independence, expands locomotor capabilities and improves sensitivity below the affected area in most patients with complete and incomplete spinal cord injury at different periods after injury.

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