Exoskeleton Treatment of Deconditioning Due to Limited Ambulation Caused by Illness or Injury

A safety and feasibility study of robotic exoskeleton training in deconditioned patients residing in a healthcare facility.

Study Overview

• Status: Completed
• Conditions: Debility Due to Disease
• Intervention / Treatment: Device: EksoGT with SmartAssist software

Detailed Description

Patients who are hospitalized for several weeks or months are at a higher risk of decline in physical condition and are also at a higher risk of rehospitalization within 30 days of discharge. A program incorporating robotic exoskeleton training may provide sufficient physical support and challenge for patients to maintain a higher level of physical condition than if they did not undergo exoskeleton training. The investigators aim to demonstrate that EksoGT robotic exoskeleton training can be performed safely with patients who have been hospitalized and are at risk of experiencing a further decline in their physical condition.

• Study Type: Interventional
• Enrollment (Actual): 15
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Connecticut
    • Wallingford, Connecticut, United States, 06492
      • Gaylord Specialty Healthcare
  • Illinois
    • Wheaton, Illinois, United States, 60187
      • Marianjoy Rehabilitation Hospital
  • Nebraska
    • Omaha, Nebraska, United States, 68104
      • Quality Living, Inc

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. A diagnosis of "deconditioned", defined as the loss of muscle tone and endurance due to chronic disease, immobility, or loss of function.
2. Adults 18 years and older (or as specified by state law).
3. Admitted into a hospital, long-term care facility, skilled nursing facility, or similar.
4. Sufficient upper extremity strength to use a front wheeled walker by manual muscle testing (minimum triceps strength bilaterally of 3/5, shoulder abduction and flexion/extension 4/5).
5. Screened and cleared by a physician for full weight-bearing exercise training.
6. Weigh 220 pounds (100kg) or less.
7. Between approximately 5'0" and 6'4" tall.
8. Standing hip width of approximately 18" or less.
9. Have near normal range of motion in hips, knees and ankles.

Exclusion Criteria:

1. Currently involved in another intervention study.
2. Transferred to the intensive care unit or isolation-room stay.
3. Currently on a ventilator or extracorporeal membrane oxygenation (ECMO) machine.
4. Currently have a ventricular assist device (VAD) or an automatic implantable cardioverter-defibrillator (AICD).
5. Advanced heart failure - ejection fraction of < 20%.
6. Documented cardiovascular risk from exercise.
7. Resting heart rate <50 bpm or >120 bpm.
8. Uncontrolled or new (within 24 hours) arrythmias.
9. Resting blood pressure below 90/70 or above 160/100.
10. Oxygen saturation (O2 sat) < 90% during rest.
11. Uncontrolled or severe orthostatic hypotension that limits standing tolerance.
12. Cardiac ischemia within 24 hours.
13. Unresolved or new (within 24 hours) deep vein thrombosis.
14. Concurrent severe neurological pathology/disease or stroke within 72 hours.
15. Open skin ulcerations on any body surfaces in contact with exoskeleton.
16. Acute fracture
17. Osteoporosis
18. Active heterotrophic ossification (HO) of the lower extremity, hip dysplasia, or hip/knee axis abnormalities.
19. Current chemotherapy
20. Inability to speak or understand the English language.
21. Inability to cooperate in tests/exercises.
22. Hip flexion contracture greater than ~17°.
23. Knee flexion contracture greater than 12°.
24. Unable to achieve neutral ankle dorsiflexion with passive stretch (neutral with max 12° knee flexion).
25. Cognitive impairments - unable to follow 2 step commands or to communicate pain or to stop session.
26. Pregnancy
27. Any reason the physician may deem as harmful to the participant to enroll or continue in the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Interventional Group; All participants will be included in the interventional group. Intervention will consist of walking exercise using the EksoGT exoskeleton for supported walking, running SmartAssist software.	Device: EksoGT with SmartAssist software; Intervention will consist of exercise using the EksoGT exoskeleton for supported walking. The EksoGT is a powered motorized orthosis intended to enable individuals who are experiencing muscular or neurological conditions affecting their lower extremities to perform ambulatory functions such as gait training.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants Who Experience an Adverse Event During Time of Treatment	The primary endpoint is safety defined as the number of participants experiencing an adverse event per overall during the study period.	2 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Participants Who Experience an Adverse Event During Time of Treatment That Was Deemed "Definitely Device Related"	Count of number of participants who experienced any adverse event that was rated as definitely related to treatment with the Ekso device.	2 weeks

Collaborators and Investigators

• Sponsor: Ekso Bionics

Publications and helpful links

General Publications

• Hoyer EH, Friedman M, Lavezza A, Wagner-Kosmakos K, Lewis-Cherry R, Skolnik JL, Byers SP, Atanelov L, Colantuoni E, Brotman DJ, Needham DM. Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality-improvement project. J Hosp Med. 2016 May;11(5):341-7. doi: 10.1002/jhm.2546. Epub 2016 Feb 5.
• Thomas JI, Lane JV. A pilot study to explore the predictive validity of 4 measures of falls risk in frail elderly patients. Arch Phys Med Rehabil. 2005 Aug;86(8):1636-40. doi: 10.1016/j.apmr.2005.03.004.
• Hoyer EH, Needham DM, Miller J, Deutschendorf A, Friedman M, Brotman DJ. Functional status impairment is associated with unplanned readmissions. Arch Phys Med Rehabil. 2013 Oct;94(10):1951-8. doi: 10.1016/j.apmr.2013.05.028. Epub 2013 Jun 26.
• Hoyer EH, Needham DM, Atanelov L, Knox B, Friedman M, Brotman DJ. Association of impaired functional status at hospital discharge and subsequent rehospitalization. J Hosp Med. 2014 May;9(5):277-82. doi: 10.1002/jhm.2152. Epub 2014 Feb 26.
• Hoyer EH, Brotman DJ, Chan KS, Needham DM. Barriers to early mobility of hospitalized general medicine patients: survey development and results. Am J Phys Med Rehabil. 2015 Apr;94(4):304-12. doi: 10.1097/PHM.0000000000000185.

Study record dates

Study Major Dates

• Study Start (Actual): October 11, 2017
• Primary Completion (Actual): December 13, 2018
• Study Completion (Actual): December 13, 2018

Study Registration Dates

• First Submitted: November 3, 2017
• First Submitted That Met QC Criteria: November 22, 2017
• First Posted (Actual): November 28, 2017

Study Record Updates

• Last Update Posted (Actual): April 14, 2023
• Last Update Submitted That Met QC Criteria: April 13, 2023
• Last Verified: April 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Frailty
• Other Study ID Numbers: 107159

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: No