Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.
Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
J Neuroeng Rehabil. 2019 Nov 21;16(1):145. doi: 10.1186/s12984-019-0585-x.
Powered exoskeletons provide a way to stand and walk for people with severe spinal cord injury. Here, we used the ReWalk exoskeleton to determine the training dosage required for walking proficiency, the sensory and motor changes in the nervous system with training, and the functionality of the device in a home-like environment.
Participants with chronic (> 1 yr) motor complete or incomplete spinal cord injury, who were primarily wheelchair users, were trained to walk in the ReWalk for 12 weeks. Measures were taken before, during, immediately after, and 2-3 months after training. Measures included walking progression, sitting balance, skin sensation, spasticity, and strength of the corticospinal tracts.
Twelve participants were enrolled with 10 completing training. Training progression and walking ability: The progression in training indicated about 45 sessions to reach 80% of final performance in training. By the end of training, participants walked at speeds of 0.28-0.60 m/s, and distances of 0.74-1.97 km in 1 h. The effort of walking was about 3.3 times that for manual wheelchair propulsion. One non-walker with an incomplete injury became a walker without the ReWalk after training. Sensory and motor measures: Sitting balance was improved in some, as seen from the limits of stability and sway speed. Neuropathic pain showed no long term changes. Change in spasticity was mixed with suggestion of differences between those with high versus low spasticity prior to training. The strength of motor pathways from the brain to back extensor muscles remained unchanged. Adverse events: Minor adverse events were encountered by the participants and trainer (skin abrasions, non-injurious falls). Field testing: The majority of participants could walk on uneven surfaces outdoors. Some limitations were encountered in home-like environments.
For individuals with severe SCI, walking proficiency in the ReWalk requires about 45 sessions of training. The training was accompanied by functional improvements in some, especially in people with incomplete injuries.
NCT02322125 Registered 22 December 2014.
动力外骨骼为严重脊髓损伤患者提供了站立和行走的途径。在这里，我们使用 ReWalk 外骨骼来确定行走熟练度所需的训练剂量、训练过程中神经系统的感觉和运动变化，以及设备在家庭环境中的功能。
参与者为患有慢性（> 1 年）完全或不完全脊髓损伤的患者，主要为轮椅使用者，他们接受 ReWalk 训练 12 周。在训练前、训练中、训练后立即和训练后 2-3 个月进行测量。测量包括行走进展、坐姿平衡、皮肤感觉、痉挛和皮质脊髓束力量。
共纳入 12 名参与者，其中 10 名完成了训练。训练进展和行走能力：训练进展表明，大约需要 45 次训练才能达到 80%的最终训练表现。到训练结束时，参与者的行走速度为 0.28-0.60m/s，1 小时内的行走距离为 0.74-1.97km。行走的努力程度约为手动轮椅推进的 3.3 倍。一名不完全损伤的非行走者在训练后无需使用 ReWalk 即可行走。感觉和运动测量：一些人的坐姿平衡得到改善，表现为稳定极限和摆动速度。神经病理性疼痛没有长期变化。痉挛的变化是混合的，提示训练前高痉挛和低痉挛者之间存在差异。大脑到背部伸肌的运动通路的强度保持不变。不良事件：参与者和培训师遇到了一些轻微的不良事件（皮肤擦伤、非创伤性跌倒）。现场测试：大多数参与者可以在户外不平坦的表面行走。在家庭环境中遇到了一些限制。
对于严重脊髓损伤患者，在 ReWalk 中行走熟练度需要大约 45 次训练。在训练过程中，一些人，尤其是不完全损伤的人，功能得到了改善。
NCT02322125 于 2014 年 12 月 22 日注册。
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