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Updated: Sep 27, 2026
Training Persons with Spinal Cord Injury to Ambulate Using a Powered Exoskeleton
Published on: June 16, 2016
Energy consumption of locomotion with orthosis versus Parastep-assisted gait: a single case study
R Spadone1, G Merati, E Bertocchi
1Centro di Bioingegneria, Fondazione Don C Gnocchi ONLUS IRCCS-Politecnico di Milano, Milano, Italy.
Study Design:
Single case study.
Objectives:
To evaluate the energy expenditure during ambulation with the Advanced Reciprocating Gait Orthosis (ARGO), with and without functional electrical stimulation (FES), and with the Parastep system in a single subject, in order to avoid the effect of inter-subject variability.
Setting:
The Centre of Sport Medicine and Bioengineering Centre 'Don C Gnocchi' Foundation ONLUS IRCCS, Milano, Italy.
Methods:
A single patient (lesion level T5-T6) was trained specifically for each walking system and was evaluated after each training period. The effects of FES on muscle conditioning, spasticity and bone density were also evaluated. The HR/VO2 relationship and the energy cost of locomotion were measured during wheelchair (WHCH) use, during locomotion with ARGO (with and without FES) and Parastep system at different speeds.
Results:
The following was observed at the end of the whole training: (a) circumferences of both lower limbs and quadriceps forces were increased, whereas fatigue index was slightly decreased, spasticity and bone density were unchanged; (b) compared to WHCH locomotion, the slope of HR/VO2 curves with ARGO was higher (slope difference=51.1 b 1O2(-1)), with ARGO+FES was similar (slope difference=-5.3 b 1O2(-1)) and with Parastep was smaller (slope difference=-55.6 b 1O2(-1)); (c) HR increased linearly with all locomotion systems, but did not rise above 125 bpm with Parastep; (d) the cost of locomotion was higher with Parastep than with ARGO (with and without FES), tested at each velocity; (e) Parastep appears to be easier to use for the subject.
Conclusions:
(a) FES can improve ambulation with orthosis, but the cost of locomotion remains very high; (b) the Parastep assisted gait elicits a higher energy expenditure than other orthoses, probably due to the lower speed of locomotion and to the high isometric effort of the stimulated muscles.
Sponsorship:
This work has been partially supported by the Italian Minister of Public Health (Ricerca Finalizzata IRCCS no ICS030.7/RF97.25).
