Hybrid 12-Month Exoskeleton Training with Percutaneous Epidural Stimulation After Spinal Cord Injury.

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Biomedical Engineering

Background:

• Exoskeleton-assisted walking (EAW) enhances ambulation and independence in chronic spinal cord injury (SCI).
• Spinal cord epidural stimulation (SCES) shows promise for promoting locomotor recovery in SCI.
• Combining EAW and SCES may offer synergistic benefits for motor function enhancement.

Purpose of the Study:

• To investigate the efficacy of a 12-month hybrid approach combining EAW with SCES for improving motor performance in individuals with chronic motor complete SCI.
• To compare the effects of EAW with SCES versus EAW alone, and to evaluate the impact of resistance training and delayed SCES.

Main Methods:

• Four males with chronic motor complete SCI received percutaneous SCES implantation.
• Participants underwent a 12-month intervention involving EAW with SCES, with varying phases of assistance modes (fixed vs. adaptive) and inclusion of resistance training.
• Exoskeleton performance data (steps, distance, speed, assistance levels) were collected weekly via the Ekso Pulse platform.

Main Results:

• Participants completed 85% of the 48-week study duration, with average EAW uptime of 46 minutes per session.
• Increased steps per minute, EAW distance, and speed were observed during adaptive assistance mode compared to fixed mode.
• The adaptive mode was associated with a reduced level of exoskeleton assistance.

Conclusions:

• Twelve months of hybrid EAW and SCES intervention led to significant improvements in walking speed and distance, particularly with adaptive assistance.
• The findings support the integration of exoskeletons with neuromodulation techniques like SCES for enhanced SCI rehabilitation.
• This hybrid approach holds potential for future therapeutic strategies aimed at maximizing motor recovery after SCI.