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Exoskeletal-Assisted Walking During Acute Inpatient Rehabilitation Leads to Motor and Functional Improvement in Persons With Spinal Cord Injury: A Pilot Study

Published:December 28, 2019DOI:https://doi.org/10.1016/j.apmr.2019.11.010

      Abstract

      Objective

      To explore the potential effects of incorporating exoskeletal-assisted walking (EAW) into spinal cord injury (SCI) acute inpatient rehabilitation (AIR) on facilitating functional and motor recovery when compared with standard of care AIR.

      Design

      A quasi-experimental design with a prospective intervention group (AIR with EAW) and a retrospective control group (AIR only).

      Setting

      SCI AIR facility.

      Participants

      Ten acute inpatient participants with SCI who were eligible for locomotor training were recruited in the intervention group. Twenty inpatients with SCI were identified as matched controls by reviewing an AIR database, Uniform Data System for Medical Rehabilitation, by an individual blinded to the study. Both groups (N=30) were matched based on etiology, paraplegia/tetraplegia, completeness of injury, age, and sex.

      Intervention

      EAW incorporated into SCI AIR.

      Main Outcome Measures

      FIM score, International Standards for Neurological Classification of Spinal Cord Injury Upper Extremity Motor Score and Lower Extremity Motor Scores (LEMS), and EAW session results, including adverse events, walking time, and steps.

      Results

      Changes from admission to discharge LEMS and FIM scores were significantly greater in the intervention group (LEMS change: 14.3±10.1; FIM change: 37.8±10.8) compared with the control group (LEMS change: 4.6±6.1; FIM change: 26.5±14.3; Mann-Whitney U tests: LEMS, P<.01 and FIM, P<.05). One adverse event (minor skin abrasion) occurred during 42 walking sessions. Participants on average achieved 31.5 minutes of up time and 18.2 minutes of walk time with 456 steps in one EAW session.

      Conclusions

      Incorporation of EAW into standard of care AIR is possible. AIR with incorporated EAW has the potential to facilitate functional and motor recovery compared with AIR without EAW.

      Keywords

      List of abbreviations:

      AIR (acute inpatient rehabilitation), ANCOVA (analysis of covariance), EAW (exoskeletal-assisted walking), EMR (electronic medical record), ISNCSCI (International Standards for Neurological Classification of Spinal Cord Injury), LEMS (Lower Extremity Motor Score), PT (physical therapy), SCI (spinal cord injury), UEMS (Upper Extremity Motor Score)
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