Foundational Ingredients of Robotic Gait Training for People With Spinal Cord Injury During Inpatient Therapy (FIRST)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Spinal cord injury (SCI) due to trauma is estimated to affect 288,000 - 500,000 Americans, with about 17,700 new cases annually. Recovery of walking is a primary rehabilitation goal for patients and encouraged by therapists due to its relationship to quality of life, impact on health, psychological profile, and social participation after SCI. Recent technological advances with exoskeleton devices specifically for gait training may yield better walking recovery outcomes compared with usual care intervention approaches, such as body-weight support treadmill training (BWSTT) and overground gait training with braces, yet limited evidence exists for those with SCI.
Aim 1: Use a Community-Based Participatory Research approach to develop an robotic gait training (RGT) program that meets the unique needs of people after incomplete SCI during inpatient rehabilitation. This will be achieved by establishing and engaging an Advisory Board of key stakeholders to review evidence-based literature, advise the research team on the unique aspects and goals of inpatient rehabilitation for people with SCI, review the RGT, and make recommendations for amendments to the RGT program based on our interim and final outcomes of the study over the funding period.
Aim 2: Prospectively examine the efficacy of RGT compared to usual care gait training during inpatient rehabilitation in people with incomplete SCI.
Aim 3: Compare the intensity of RGT and usual care gait training during inpatient rehabilitation.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Texas
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Dallas, Texas, United States, 75246
- Baylor Scott & White Institute for Rehabilitation
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- 16 - 85 Years of Age
- All types of incomplete Spinal Cord Injury (SCI) (traumatic and non-traumatic)
- Acute/Subacute phase of recovery
- Medically stable as deemed by physician
- Undergoing medical care and inpatient rehabilitation at BSW
- Both genders and all races and ethnicities
- Meet the Ekso robotic exoskeleton frame limitations
- Continence of or a program for bladder and bowel management
Exclusion Criteria
- Moderate to Severe Traumatic Brain Injury (TBI)
- Degenerative diagnoses
- Wound located in proximity to the exoskeleton frame
- Severe osteoporosis/-penia as shown with dual energy x-ray absorptiometry (DXA)
- Pre-morbid developmental disability, significant psychological diagnosis, or other cognitive impairment
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
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Experimental: Robotic Gait Training
Patients in the Robotic Gait Training (RGT) group will receive 90 minutes per week of RGT once patients are deemed clinically appropriate as defined by being able to tolerate standing for 15 minutes without orthostatic intolerance.
The duration of treatment will span the patient's length of stay in inpatient rehabilitation.
The Ekso Bionics Ekso GT™ robotic exoskeleton will be used for RGT.
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Participants will wear an exoskeleton suit and receive robotic gait training with a physical therapist for 90 minutes each week.
Robot gait training will include standing and walking activities while wearing the The Ekso Bionics Ekso GT™ robotic exoskeleton.
Participants will be asked to complete questionnaires about walking and function.
They will also be asked to wear a watch measuring their heart rate monitor.
Other Names:
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Active Comparator: Usual Care Gait Training
Usual Care (UC) gait training including body weight-supported treadmill training (BWSTT) and conventional overground walking.
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Participants receive usual care gait training with a physical therapist for 90 minutes each week.
Usual care gait training includes standard gait training involving standing and walking activities such as conventional overground walking, body weight-supported treadmill training (BWSTT), overground body weight-supported overground system, and various assistive devices (e.g., BWSTT, overground with braces, walker, etc.).
Participants will be asked to complete questionnaires about walking and function.
They will also be asked to wear a watch measuring their heart rate monitor and number of steps.
Other Names:
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Walking Index for Spinal Cord Injury - II (WISCI-II)
Time Frame: Within one week before discharge
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WISCI-II defines the physical limitation for gait secondary to impairment at the person level and indicates the ability of a person to walk after SCI.
WISC-II rank orders the ability a person to walk on a scale of 0-20 with 0 representing no ability to stand or participate in assisted walking and 20 representing an ability to walk 10 meters with no devices, no braces, and no physical assistance.
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Within one week before discharge
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Gait speed via 10-Meter Walk Test (10MWT)
Time Frame: Within one week of admission before start of treatment; Within one week before discharge
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The 10MWT assesses gait speed (m/s) over a short duration.
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Within one week of admission before start of treatment; Within one week before discharge
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Spinal Cord Independence Measure (SCIM)
Time Frame: Within one week of admission before start of treatment; Within one week before discharge
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The SCIM assesses self-care management, respiration and sphincter management, and functional mobility after a SCI.
SCIM is composed of 19 items with total SCIM scores ranging from 0 (required assistance) to 100 (independence).
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Within one week of admission before start of treatment; Within one week before discharge
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Numerical Pain Rating Scale (NPRS)
Time Frame: Within one week of admission before start of treatment; Within one week before discharge
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Pain is a significant problem in many individuals with SCI.
A 0-10 Point Numerical Pain Rating Scale (NRS) is recommended as the outcome measure for pain intensity after SCI during acute and subacute phases.
Pain severity can be categorized into 3 distinct groups as relates to pain interference: 1-3 (mild), 4-7 (moderate), 8-10 (severe).
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Within one week of admission before start of treatment; Within one week before discharge
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Fatigue Severity Scale (FSS)
Time Frame: Within one week of admission before start of treatment; Within one week before discharge
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The Fatigue Severity Scale (FSS) is used to measure fatigue in neurologic disorders and measures the effects of fatigue on function. It is measure on the following scale:
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Within one week of admission before start of treatment; Within one week before discharge
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Penn Spasm Frequency Scale (PSFS)
Time Frame: Within one week of admission before start of treatment; Within one week before discharge
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The PSFS is a self-report measure to assess a patient's perception of spasticity frequency and severity following a SCI.
With excellent internal consistency (ICC = 0.90), the current version was modified from the original to include both frequency and severity.
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Within one week of admission before start of treatment; Within one week before discharge
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Patient Health Questionnaire - 9 (PHQ-9)
Time Frame: Within one week of admission before start of treatment; Within one week before discharge
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The PHQ-9 is a self-report measure to assess the presence and intensity of depressive symptoms.
For SCI, the PHQ-9 demonstrates excellent internal consistency (Chronbach's alpha = 0.87) and construct validity (r = 0.78).
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Within one week of admission before start of treatment; Within one week before discharge
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General Anxiety Disorder (GAD-7)
Time Frame: Within one week of admission before start of treatment; Within one week before discharge
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The GAD-7 is a self-report measure to assess the presence of anxiety. Each items is scored on the following scale: 0 - not at all
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Within one week of admission before start of treatment; Within one week before discharge
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International Spinal Cord Injury Quality of Life Basic Data Set
Time Frame: Within one week of admission before start of treatment; Within one week before discharge
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The International Spinal Cord Injury Quality of Life Basic Data Set is a three-item quality of life questionnaire suitable for SCI populations containing items assessing general life satisfaction, satisfaction with physical health, and satisfaction with psychological health.
Items are answered on a 10-point likert scale that ranges from 0 (completely dissatisfied) to 10 (very satisfied).
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Within one week of admission before start of treatment; Within one week before discharge
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Heart Rate (HR)
Time Frame: Immediately following every treatment until discharge, an average of 28 days
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Polar heart rate monitor (Polar® Unite) will provide data on the day, duration, and intensity (average and maximum) of gait training sessions for both RGT and UC.
Participants will be provided a Polar heart rate monitor to wear during each gait training session for the entire length of the study, and gait training session data will be collected weekly.
These monitors record beat to beat heart rates and store up to 16 sessions of heart rate data.
Each week study staff will upload participants' heart rate data using Polar's FlowLink technology via the Polarpersonaltrainer.com website.
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Immediately following every treatment until discharge, an average of 28 days
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Ratings of Perceived Exertion (RPE)
Time Frame: Immediately following every treatment session until discharge, an average of 28 days
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The Borg RPE is a 15-point scale with verbal descriptors to standardize perceived exertion across tasks and individuals.
Participants will be asked to provide a self-reported intensity level on the Borg Rating of Perceived Exertion Scale during RGT and UC gait training sessions.
A self-report of 12 to 14 on the RPE indicates moderate intensity.
The Borg RPE scale has been shown to be a valid measure of exercise intensity with weighted mean validity coefficient of 0.62 for HR.
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Immediately following every treatment session until discharge, an average of 28 days
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Number of Steps
Time Frame: Immediately following every treatment session until discharge, an average of 28 days
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The Ekso device records several data points for each session including number of steps, "Up" time (the amount of time spent standing in the device), "Walk" time (the amount of time spent walking in the device), and device assistance scores. While all of these data values will be recorded to describe each RGT session and tracked to monitor progression of the RGT intervention, the number of steps per session will be utilized as an indicator of RGT session intensity.42,91 We will consult our Consumer Advocates for recommendations on incorporating device scores such as "Up" time and "Walk" time as additional measures of intensity. Number of steps for the UC group will be collected via pedometer during each gait training session. The number of steps captured on the device will be recorded on the case report form after each gait training session. The watch will be reset before each use. |
Immediately following every treatment session until discharge, an average of 28 days
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Patient Perceptual Survey
Time Frame: Within one week before discharge
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This survey contains six open-ended questions assessing participant perception and satisfaction with treatment as well as asking participants to describe observable changes in functional activities.
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Within one week before discharge
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Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Seema Sikka, MD, Baylor Research Institute
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 020-483
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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