ORIGINAL ARTICLE   Free

European Journal of Physical and Rehabilitation Medicine 2018 October;54(5):745-51

DOI: 10.23736/S1973-9087.18.04819-0

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Training for mobility with exoskeleton robot in spinal cord injury patients: a pilot study

Patrizio SALE ¹ ✉, Emanuele F. RUSSO ², Alessandra SCARTON ³, Rocco S. CALABRÒ ⁴, Stefano MASIERO ¹, Serena FILONI ²

¹ Rehabilitation Unit, Department of Neurosciences, University of Padua, Padua, Italy; ² Padre Pio Foundation and Rehabilitation Centers, San Giovanni Rotondo, Foggia, Italy; ³ Invictus Rehabilitation Center, Ponte San Nicolò, Padua, Italy; ⁴ Bonino-Pulejo Neurologic Trauma Center and Institute for Research and Care, Messina, Italy

BACKGROUND: Wearable robots are people-oriented robots designed to be worn all day, thus helping in the daily activities. They can assist in walking, running, jumping higher or even lifting objects too heavy in normal conditions.
AIM: The aim of this report was to investigate the changes in gait pattern through 3D gait analysis of subjects with spinal cord injury (SCI) undergoing an adaptive training with a wearable exoskeletal device (ESD). The change in the quality of life was also investigate together with the possibility to wear these devices all day, to improve the mobility.
DESIGN: Prospective quasi-experimental study, pre- and post-design.
SETTING: Outpatient SCI patients.
POPULATION: On a voluntary basis, eight SCI patients who had never used any ESD device were recruited.
METHODS: Subjects underwent a three-dimensional gait analysis (3D GA) while wearing the ESD at baseline (inclusion) (T0) and after 20 sessions of training over an expected average of 5/6 weeks (T1). The secondary outcome measures were: Participant Satisfaction Questionnaire, 6-Minute Walking Test (6MWT), Borg Scale (the test was administered in indoor and outdoor conditions) and Timed Up-and-Go test (TUG). Spatiotemporal and kinematic parameters were assessed and their change from the beginning to the end of the training was the secondary outcome.
RESULTS: No dropouts were recorded during the training and all subjects were able to terminate the protocol (compliant subjects: N.=8). After the training, all person showed some significant improvements for TUG, 6MWT and 10 MWT (Z=-2.521; P=0.008) and for the spatiotemporal and kinematics parameters.
CONCLUSIONS: This paper confirms that the adaptive training with ESD is safe and feasible in a heterogeneous sample of persons with SCI, especially in ameliorating the interaction between the patients and the device with an improvement of spatiotemporal and kinematics parameters.
CLINICAL REHABILITATION IMPACT: Since the training has been proven safe and the hypothesis that the subjects with spinal cord injury improving their performance over time and being able to adapt at the use of device in full autonomy at home during all the activities of the daily living has strengthened.

KEY WORDS: Spinal cord injury - Gait - Neurological rehabilitation - Exoskeleton device - Wearable electronic devices - Robotics