- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06028529
Feasibility and Safety of a Portable Exoskeleton to Improve Mobility in Parkinson's Disease
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Currently, progressive resistance exercise training, high intensity treadmill training, balanced-based perturbation, and standard physical exercises are utilized to treat mobility deficits associated with PD; however, the effectiveness of these therapies is limited. This study proposes to investigate the utility of a portable exoskeleton for people with PD. The goal is to establish the safety of a lightweight portable exoskeleton, the Keeogo, for gait training and to preliminarily assess its potential efficacy for gait mobility and fall reduction. As the vast majority of PD patients eventually require assistive mobility devices, portable exoskeletons represents an avenue for increased, mobility, quality of life, and independence. Robotic-assist gait training (RAGT) has been extensively applied as a remarkable therapeutic modality, such that it is enabling highly motivated people with devastating neurologic injuries to regain independent ambulation. Despite the potential for this technology to transform the lives of people with PD, these devices are not being adequately investigated in people with movement disorders.
To establish preliminary safety and efficiency of the Keeogo exoskeleton for PD patients at various disease stages, the investigators will examine representative subjects in Hohen & Yahr stages II, III, IV, and V. Inclusion criteria are: 1) PD confirmed by a PADRECC movement disorder specialist using UK Brain Bank Criteria, 2) Modified H&Y stage II-V. Exclusion criteria are: 1) neurological, musculoskeletal, or other disorders unrelated to PD contributing to impairment of stance, gait, balance or coordination, 2) severe CHF, COPD, or those requiring nasal canula O2, 3) history of implantable cardiac device or ablative surgery, 4) moderate to severe cognitive impairment / dementia (Montreal Cognitive Assessment < 17/30), 5) symptomatic orthostatic hypotension with exertion, 6) feeding tube or associated port placement (PEG/J-PEG), 7) body height less than 5'1" or greater than 6'3" 8) body weight greater than 250 pounds, and 9) amputation of any portion of the lower limbs. Subjects will participate in a total of 30 minutes RAGT ambulation with the Keeogo twice per week for 6 weeks (12 sessions). Subjects may opt to utilize a platform rolling walker, rolling walker, bilateral Lofstrand crutches or a unilateral device, such as a cane or Lofstrand crutch, and will be maintained throughout the intervention.
To establish safety, the number and severity of AEs, such as falls, discomfort, skin or musculoskeletal injury, and orthostatic hypotensive episodes will be documented. Intervention efficacy will be measured pre- and post-donning of the Keeogo exoskeleton at bi-weekly intervention visits, and at a 6-week post-study visit. Walking capacity, including benefits on FoG, will be assessed with the Six Minute Walk Test (6MWT), balance and postural stability with the Berg Balance Scale (BBS), and disease severity with the Examination, Part III, of the Unified Parkinson's Disease Rating Scale (UPDRS). Additional assessments will include Berg Balance Scale (BBS), ascending and descending stair climb, PDQ39, The University of Alabama at Birmingham (UAB) Study of Aging Life-Space Assessment (LSA), and PD-Carer. As a primary end point for establishing efficacy, the 6MWT will be compared between end of training and baseline (with and without the exoskeleton), as well as at 6 and 12 weeks post-study as a durability assessment towards establishing a need for future assessment of in-home usage. These pilot investigations are expected to lay the groundwork for a large multi-center clinical study to establish ground exoskeletons as modern, standard of care devices to aid Veterans and other people with PD and other disabling movement disorders to maintain a more normal and productive life.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Rachel Sinclair, MPHA
- Phone Number: (804) 675-5931
- Email: rachel.sinclair@va.gov
Study Contact Backup
- Name: Mark S Baron, MD
- Phone Number: (804) 675-6700
- Email: mark.baron@va.gov
Study Locations
-
-
Virginia
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Richmond, Virginia, United States, 23249-0001
- Hunter Holmes McGuire VA Medical Center, Richmond, VA
-
Contact:
- Alyssa Huizar
- Phone Number: (804) 675-5151
- Email: alyssa.huizar@va.gov
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Principal Investigator:
- Mark S Baron, MD
-
Contact:
- Katrina Stumpf, MS
- Phone Number: 3720 804-675-5000
- Email: katrina.stumpf@va.gov
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- PD confirmed by a PADRECC movement disorder specialist using UK Brain Bank Criteria
- Modified H&Y stage II-V
Exclusion Criteria:
- neurological, musculoskeletal, or other disorders unrelated to PD contributing to impairment of stance, gait, balance or coordination
- severe CHF, COPD, or those requiring nasal canula O2
- history of implantable cardiac device or ablative surgery
- moderately-severe to severe cognitive impairment / dementia (Montreal Cognitive Assessment < 17/30)
- symptomatic orthostatic hypotension with exertion
- feeding tube or associated port placement (PEG/J-PEG)
- body height less than 5'1" or greater than 6'3"
- body weight greater than 250 pounds
- amputation of any portion of the lower limbs
- osteoporosis as defined by DEXA Scan T score < -2.5
- failure to meet B-Temia-established hip and knee flexion and extension manual muscle test (MMT) prerequisite screening parameters, which assure that individuals can adequately engage and walk against the resistive forces of the Keeogo
- inability to complete 20 minutes of walking with the exoskeleton (over a maximum period of one hour) at the initial screening/testing session
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Other
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Other: Feasibility and Safety
This is a feasibility study to assess the safety and potential utility of a lightweight ground exoskeleton (Keeogo, B-Temia, Inc.) to enhance mobility in people with Parkinson's disease (PD).
|
lightweight ground exoskeleton
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incidence of Falls While Wearing the Exoskeleton (Safety and Tolerability) Change
Time Frame: Through last training visit (weeks 1-6, 12 sessions)
|
Patients will be continuously supervised by a trained physical therapist and the expectation is that there will be no falls while wearing the device. All primary safety and tolerability measures will be separately assessed with consideration of H&Y staging (2-4; max. 5) and cognition (based on MOCA scores 0 = nl, max. 30). -Minimal attrition rate based on subjects being unable to complete the protocol. This could for example establish that the Keeogo device is not tolerated by more advanced (H&Y Stage 5) patients, but is acceptable for others. |
Through last training visit (weeks 1-6, 12 sessions)
|
Incidence of Attrition (Tolerability) Change
Time Frame: Through last training visit (weeks 1-6, 12 sessions)
|
The expectation is that there will be minimal attrition rate based on subjects being unable to complete the protocol.
In the case of attrition, patients will be interviewed for contributory sources.
|
Through last training visit (weeks 1-6, 12 sessions)
|
Incidence of Treatment-Emergent Adverse Events (Safety and Tolerability) Change
Time Frame: through last training visit (weeks 1-6, 12 sessions)
|
Patients will be questioned at the beginning of each session about potential AEs and any AEs observed during sessions by the therapists will be recorded at each training session.
The expectation is that there will be no uncorrected and unacceptable AEs as captured by regular structured interviews.
|
through last training visit (weeks 1-6, 12 sessions)
|
Six-minute Walk Test (Suitability as a Future Primary Efficacy Measure) Change
Time Frame: through last training visit (weeks 1-6, 12 sessions) and 6- and 12-wks post-training
|
The suitability of the 6MWT as a future primary clinical outcome measure (and our secondary measures) will be determined from the therapists' impression of ease and reliability of usage and from anticipated trends in scoring improvement.
The outcomes here from the 6MWT and secondary measures will be further used towards powering for a future clinical efficacy study, while accounting for preliminary defined influences of severity of PD (H&Y Staging) and cognition (MOCA scoring).
Additionally, 6- and 12-weeks post-training assessments will be used to preliminarily assess the durability of training effects.
|
through last training visit (weeks 1-6, 12 sessions) and 6- and 12-wks post-training
|
Patient Satisfaction
Time Frame: immediate post-training
|
All subjects will be interviewed for patient satisfaction with wearing and training with the exoskeleton.
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immediate post-training
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Motor examination (Part III) of the modified Unified Parkinson's Disease Rating Scale (Suitability as a Future Secondary Efficacy Measure)
Time Frame: immediate post-training, 6- and 12-wks post-training
|
Will assess the suitability of the modified UPDRS Part III (nl = 0, max.
128) as a future secondary clinical outcome measure.
Will be collected at baseline and end of training.
Additionally, 6- and 12-weeks post-training assessments will be used to preliminarily assess the durability of training effects.
|
immediate post-training, 6- and 12-wks post-training
|
Berg Balance Scale (Suitability as a Future Secondary Efficacy Measure)
Time Frame: immediate post-training, 6- and 12-wks post-training
|
Will assess the suitability of BBS (0 (worst) to 56 (best)) as a future secondary clinical outcome measure, focused on balance.
Additionally, 6- and 12-weeks post-training assessments will be used to preliminarily assess the durability of training effects.
|
immediate post-training, 6- and 12-wks post-training
|
Motion Detector Sensors (Suitability as a Future Secondary Efficacy Measure)
Time Frame: through last training visit (weeks 1-6, 12 sessions) and 6- and 12-wks post-training
|
Lightweight motion sensors will be attached to the exoskeleton on each leg to assess their suitability as future objective secondary clinical outcome measures of such gait parameters, as freezing of gait.
Will be collected at each training visit.
Additionally, 6- and 12-weeks post-training assessments will be used to preliminarily assess the durability of training effects.
|
through last training visit (weeks 1-6, 12 sessions) and 6- and 12-wks post-training
|
The University of Alabama at Birmingham Study of Aging Life-Space Assessment (Suitability as a Future Secondary Efficacy Measure)
Time Frame: immediate post-training, 6- and 12-wks post-training
|
Will assess the suitability of The UAB Study of Aging LSA (0 (worst) to 120 (best)) as a future secondary clinical outcome measure, focused on functional mobility.
Additionally, 6- and 12-weeks post-training assessments will be used to preliminarily assess the durability of training effects.
|
immediate post-training, 6- and 12-wks post-training
|
Collaborators and Investigators
Investigators
- Principal Investigator: Mark S Baron, MD, Hunter Holmes McGuire VA Medical Center, Richmond, VA
Study record dates
Study Major Dates
Study Start (Estimated)
Primary Completion (Estimated)
Study Completion (Estimated)
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
- N4387-P
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.
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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