Exoskeletal-assisted walking may improve seated balance in persons with chronic spinal cord injury: a pilot study

Abstract

Study design: Pre-post intervention.

Objective: To explore the potential effect of exoskeletal-assisted walking (EAW) on seated balance for persons with chronic motor complete spinal cord injury (SCI).

Setting: A SCI research center.

Methods: Eight participants who were over 18 years of age with chronic SCI and used a wheelchair for mobility were enrolled. Seven able-bodied participants were used for normal seated balance comparative values. Participants with chronic SCI received supervised EAW training using a powered exoskeleton (ReWalkTM) for a median 30 sessions (range from 7 to 90 sessions). Before and after EAW training, seated balance testing outcomes were collected using computerized dynamic posturography, providing measurements of endpoint excursion (EPE), maximal excursion (MXE), and directional control (DCL). Modified functional reach test (MFRT) and the sub-scales of physical functioning and role limitations due to physical health from the Short Form (36) Health Survey (SF-36) were used to identify changes in functional activities.

Results: After EAW training, seated balance significantly improved in total-direction EPE and MXE (P < 0.01 and P < 0.017 respectively). The results of MFRT and sub-scales of physical functioning and role limitations due to physical health improved after EAW training but were not statistically significant.

Conclusions: EAW training may have the potential to improve seated balance for persons with chronic motor complete SCI. Due to the limitations of the study, such as small sample size and lack of a control group, further studies are needed to clarify the effect of improving seated balance through EAW training.

Trial registration: ClinicalTrials.gov NCT01454570.

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1. Seated balance testing using a computerized dynamic posturography (SMART EquiTest, Natus®).

The participant sat upright without back support and with arms across chest. They were instructed to move the avatar on the screen to reach the directional targets by leaning the trunk. Study team members were close by as spotters in case of a fall.

Fig. 2. Modified functional reach test.

The procedure and setting for the modified functional reach test.

Fig. 3. Each participant’s results of seated balance tests.

Abbreviations: EPE endpoint excursion, MXE maximal excursion, DCL directional control, and MFRT modified functional reach test.

Fig. 4. Participants’ seated balance test results at pre- and post-EAW training compared with able-body participants’ seated balance test results.

Note: * sign means relatively large charges but not statistically significant. Abbreviations: F front, R right, B back, L left, EPE endpoint excursion, MXE maximal excursion, and DCL directional control.