Evaluation of Robotic Exoskeletons Therapy for Gait Rehabilitation in Patients With Incomplete Spinal Cord Injury.
Study Details
Study Description
Brief Summary
The objective of the study is to assess the efficacy of the Exo-H2 robotic exoskeleton for walking rehabilitation of people with incomplete spinal cord injury.
Condition or Disease | Intervention/Treatment | Phase |
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N/A |
Detailed Description
The recovery of walking ability is a primary concern of rehabilitation programs for people who have suffered anincomplete spinal cord injury. Robotic therapy arises from the new concepts of neuroplasticity. One of the most novel contributions in this field is robotic exoskeletons. However, there is still not enough scientific evidence to support the clinical use of this technology.
The aim of this proposal is to assess the efficacy of a new model of robotic exoskeleton (Exo H2) developed by the CSIC with HNP involvement in the context of HYPER project (Consolider 2009 call) in gait rehabilitation for people with incomplete spinal cord injury. A multicenter study is proposed here, involving the National Hospital of Paraplegics and the Institut Guttmann. Two randomized groups of patients with subacute incomplete spinal cord injury will be defined. In one group, protocol gait rehabilitation based on the Exo H2 will be established and traditional gait therapy will be adapted for control group. Both groups of patients were assessed performing a physical exam including functional gait scales (10 MWT, 6MWT, WISCI II score, SCIM) and a biomechanical gait analysis with kinetic and kinematic techniques. Functional assessment will be carried out before intervention, at the end of the intervention and a follow up six weeks later.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Intervention Walking therapy with Exo-H2 exoskeleton |
Device: Walking therapy with Exo-H2 exoskeleton
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No Intervention: Control Group receiving conventional walking therapy without robotic exoskeleton |
Outcome Measures
Primary Outcome Measures
- Lower extremity motor score [Change from Baseline Lower Extremity Motor Score at 2 months]
This scale evaluate the ability and force of the patient when attepmting to contract five key lower limb muscles. It is manually measured by the therapist. Range from 0 (no contraction) to 5 (healthy function). The total score summs up the scores of all muscles. In healthy conditions is 50 points.
- Spasticity measured by Ashworth scale [Change from Baseline Ashworth Scale at 2 months]
Manual testing of muscle tone in response to manual mobilization of joints. Range from 0 (healthy response) to 4 (maximum muscle tone).
- Ten meters walking test [Change from Baseline Ten Meters Walking Test at 2 months]
This test measure walking velocity on covering ten meters walking in flat, straigth line.
- Six minutes walking test [Change from Baseline Six Minutes Walking Test at 2 months]
This test measure walking endurance by measuring the distance covered in six minutes of walking in flat, straigth line.
- Time Up-and-Go Test (TUG) [Change from Baseline TUG Test at 2 months]
This test measures the time to complete stand to sit, walk 3 meters and sitting back again.
- Walking Index for Spinal Cord Injury II (WISCI II) [Change from Baseline WISCI II Scale at 2 months]
WISCI II assess the amount of physical assistance needed, as well as devices required, for walking following paralysis that results from Spinal Cord Injury. The subject is observed by the trained personnel and the WISCI level is recorded on the scale of 0 to 20 at baseline (Baseline WISCI). The subject is observed again at the defined interval (Interval WISCI). The change in score is calculated by subtracting the baseline WISCI from the Interval WISCI, which equals the change in WISCI (Changed WISCI). If a group of subjects are enrolled, medians and means may be calculated.
- Questionnaire: Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) [Through study completion]
The purpose of the QUEST questionnaire is to evaluate how satisfied you are with your assistive device and the related services you experienced. The questionnaire consists of 12 satisfaction items. For each of the 12 items, rate your satisfaction with your assistive device and the related services you experienced by using the following scale of 1 to 5.
Secondary Outcome Measures
- Spinal Cord Independence Measure III (SCIM III) [Change from Baseline SCIM III scale at 2 months]
The SCIM is composed of 19 items that assess 3 domains.1) Self-care, 2) Respiration and sphincter management, 3) Mobility (9 items, scores range from 0-40). The total SCIM scores range from 0 to 100.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Incomplete Spinal Cord Syndrome, ASIA scale C or D
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enough strength in the upper extremities to handle a walker or crutches (triceps brachial muscle balance ≥ 3)
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Age between 16 and 70 y.o.
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Heigth: 1.6-1.9m
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Weigth less than 120Kg
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Stable medical condition between 6 weeks and 18 months since injury.
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Subjects must tolerate standing and be included in walking rehabilitation program in the center.
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Lower limb spasticity should be lower than 3 as measyred by Ashworth scale.
Exclusion Criteria:
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Cardiovascular diseases.
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Upper limb pathology of any kind.
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irreducible flexo or arthrodesis in lower limb joints, 2 or more osteoporotic fractures in the lower limbs in the last 2 years
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Uncontrolled epilepsy.
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Ulcers sores at the contact points with the exoskeleton.
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Refuse to participate.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
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1 | National Hospital for Paraplegics | Toledo | Spain | 45071 |
Sponsors and Collaborators
- Hospital Nacional de Parapléjicos de Toledo
- Institut Guttmann
Investigators
- Study Chair: Angel Gil-Agudo, PhD, MD, Head of Rehabilitation Department
Study Documents (Full-Text)
None provided.More Information
Publications
- Aach M, Cruciger O, Sczesny-Kaiser M, Höffken O, Meindl RCh, Tegenthoff M, Schwenkreis P, Sankai Y, Schildhauer TA. Voluntary driven exoskeleton as a new tool for rehabilitation in chronic spinal cord injury: a pilot study. Spine J. 2014 Dec 1;14(12):2847-53. doi: 10.1016/j.spinee.2014.03.042. Epub 2014 Apr 4.
- Chen G, Patten C. Treadmill training with harness support: selection of parameters for individuals with poststroke hemiparesis. J Rehabil Res Dev. 2006 Jul-Aug;43(4):485-98. Review.
- Colombo G, Joerg M, Schreier R, Dietz V. Treadmill training of paraplegic patients using a robotic orthosis. J Rehabil Res Dev. 2000 Nov-Dec;37(6):693-700.
- Ditunno J, Scivoletto G. Clinical relevance of gait research applied to clinical trials in spinal cord injury. Brain Res Bull. 2009 Jan 15;78(1):35-42. doi: 10.1016/j.brainresbull.2008.09.003. Epub 2008 Oct 9. Review.
- Ditunno PL, Patrick M, Stineman M, Ditunno JF. Who wants to walk? Preferences for recovery after SCI: a longitudinal and cross-sectional study. Spinal Cord. 2008 Jul;46(7):500-6. doi: 10.1038/sj.sc.3102172. Epub 2008 Jan 22.
- Esquenazi A, Packel A. Robotic-assisted gait training and restoration. Am J Phys Med Rehabil. 2012 Nov;91(11 Suppl 3):S217-27; quiz S228-31. doi: 10.1097/PHM.0b013e31826bce18.
- Jackson AB, Carnel CT, Ditunno JF, Read MS, Boninger ML, Schmeler MR, Williams SR, Donovan WH; Gait and Ambulation Subcommittee. Outcome measures for gait and ambulation in the spinal cord injury population. J Spinal Cord Med. 2008;31(5):487-99. Review.
- Kwakkel G, Kollen B, Lindeman E. Understanding the pattern of functional recovery after stroke: facts and theories. Restor Neurol Neurosci. 2004;22(3-5):281-99. Review.
- Mantone J. Getting a leg up? Rehab patients get an assist from devices such as HealthSouth's AutoAmbulator, but the robots' clinical benefits are still in doubt. Mod Healthc. 2006 Feb 13;36(7):58-60.
- Tefertiller C, Pharo B, Evans N, Winchester P. Efficacy of rehabilitation robotics for walking training in neurological disorders: a review. J Rehabil Res Dev. 2011;48(4):387-416. Review.
- Veneman JF, Kruidhof R, Hekman EE, Ekkelenkamp R, Van Asseldonk EH, van der Kooij H. Design and evaluation of the LOPES exoskeleton robot for interactive gait rehabilitation. IEEE Trans Neural Syst Rehabil Eng. 2007 Sep;15(3):379-86.
- Zeilig G, Weingarden H, Zwecker M, Dudkiewicz I, Bloch A, Esquenazi A. Safety and tolerance of the ReWalk™ exoskeleton suit for ambulation by people with complete spinal cord injury: a pilot study. J Spinal Cord Med. 2012 Mar;35(2):96-101. doi: 10.1179/2045772312Y.0000000003. Epub 2012 Feb 7.
- PI15/01437