The Safety and Feasibility of Exoskeletal-Assisted Walking in Acute Rehabilitation After Spinal Cord Injury

Objective: To assess safety and feasibility for persons with acute spinal cord injury (SCI) using the robotic exoskeleton. Design: Case series observational study. Setting: A level-1 trauma center in Canada with both acute and tertiary inpatient SCI rehabilitation units. Participants: Eight male and 3 female (N=11) participants were recruited with a mean age of 41 years and with neurologic level of injury (C6-L2) and severity (American Spinal Injury Association Impairment Scale [AIS] A-D). The time since injury is a range of 3-15 weeks at the onset of training. Interventions: Up to 25 one-hour sessions of exoskeletal-assisted walking gait training, with participants less than 6 months from initial SCI. Main Outcome Measures: Cardiopulmonary outcomes including blood pressure, heart rate, and peripheral oxygen saturation; and perceived physical exertion using the Borg CR10 Scale were recorded. Gait parameters were measured by 6-minute walk test (6MWT) and 10-meter walk test (10MWT). Up Time, walk time, and number of steps were detailed longitudinally. Safety was assessed with regard to pain, falls, and skin integrity. Results: No serious adverse events occurred. Blood pressure decreased following initial sit to stand and increased during walking. Symptoms of hypotension were rare and improved with increased number of sessions. Perceived exertion was reported on average to be moderate (mean of 3.1). There was no significant increase in pain scores by Visual Analog Scale. On 6MWT, participants covered more distance (mean [m] +/- SD, 117.1 +/- 11.7) in session 25 compared to session 2 (mean [m] +/- SD, 47.6 +/- 6.6). On the 10MWT, all participants showed consistently improved gait speed; with participants traveling an average of 3.2 times faster during their last training session (mean [m/s] +/- SD, 0.40 +/- 0.04) in comparison to session 2 (mean [m/s] +/- SD, 0.12 +/- 0.01). Conclusions: Exoskeletal-assisted walking in acute rehabilitation (<6mo) following SCI appears to be both safe and feasible. (C) 2019 by the American Congress of Rehabilitation Medicine