Exoskeleton Training May Improve Level of Physical Activity After Spinal Cord Injury: A Case Series

Abstract

Objectives: To determine whether the use of a powered exoskeleton can improve parameters of physical activity as determined by walking time, stand up time, and number of steps in persons with spinal cord injury (SCI). Methods: Three men with complete (1 C5 AIS A and 2 T4 AIS A) and one man with incomplete (C5 AIS D) SCI participated in a clinical rehabilitation program. In the training program, the participants walked once weekly using a powered exoskeleton (Ekso) for approximately 1 hour over the course of 10 to 15 weeks. Walking time, stand up time, ratio of walking to stand up time, and number of steps were determined. Oxygen uptake (L/min), energy expenditure, and body composition were measured in one participant after training. Results: Over the course of 10 to 15 weeks, the maximum walking time increased from 12 to 57 minutes and the number of steps increased from 59 to 2,284 steps. At the end of the training, the 4 participants were able to exercise for 26 to 59 minutes. For one participant, oxygen uptake increased from 0.27 L/min during rest to 0.55 L/min during walking. Maximum walking speed was 0.24 m/s, and delta energy expenditure increased by 1.4 kcal/min during walking. Body composition showed a modest decrease in absolute fat mass in one participant. Conclusion: Exoskeleton training may improve parameters of physical activity after SCI by increasing the number of steps and walking time. Other benefits may include increasing energy expenditure and improving the profile of body composition.

Keywords: energy expenditure; exoskeleton; physical activity; spinal cord injury.

Figure 1.

Walking time, stand up time, steps, and walking time to stand up time in 4 participants with SCI over the course of 10 to 15 weeks of powered exoskeleton training.

Figure 2.

Energy expenditure in an individual with a T4 motor complete SCI during sitting rest (R), standing rest (SR), walking with walker (W), walking with crutches, standing recovery (SRe), and sitting rest (R) in week 12 of the exoskeleton training.