Effects of Ambulation Training Utilizing an Exoskeleton Robot on Subjects With Spinal Cord Injury

Study Overview
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Brief Summary
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The present study aims to investigate the effects of ReWalk exoskeleton robot training on various physiological and psychological parameters among subjects with spinal cord injury, including body composition and bone mineral mass, balance ability, bowel and bladder symptoms, severity of pain, psychological well-being, and quality of life. Ten patients with paraplegia caused by spinal cord injury will be recruited from the out-patient clinic of Department of Physical Medicine and Rehabilitation at the China Medical University hospital. All participants will undergo dual X-ray absorptiometry to evaluate the baseline bone mineral density. Eligible participants will then take ReWalk training sessions comprises of 3 x 1-hour sessions per week for 40 sessions. A comprehensive battery of outcome measures, including body composition and bone mineral mass, balance ability, bowel and bladder symptoms, severity of pain, psychological well-being, and quality of life, will be utilized for comparison after 40 sessions of ReWalk ambulation training.

Detailed Description
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The loss of upright mobility has a profound effect on the health and quality of life for individuals with a spinal cord injury (SCI). The ReWalk exoskeleton is an FDA-cleared, wearable, computer-controlled exoskeleton robot that enables subjects with SCI to stand and walk using crutches to keep balance. China Medical University Hospital is the second hospital in Taiwan to acquire this relatively new rehabilitation robot. ReWalk exoskeleton not only helps the patients with paraplegia regain their ability to walk, previous studies also suggest that restoration of upright mobility may help mitigate the physical and psychological decline routinely experienced by individuals with SCI. The present study aims to investigate the effects of ReWalk exoskeleton robot training on various physiological and psychological parameters among subjects with spinal cord injury, including body composition and bone mineral mass, balance ability, bowel and bladder symptoms, severity of pain, psychological well-being, and quality of life. Ten patients with paraplegia caused by spinal cord injury will be recruited from the out-patient clinic of Department of Physical Medicine and Rehabilitation at the China Medical University hospital. All participants will undergo dual X-ray absorptiometry to evaluate the baseline bone mineral density. Eligible participants will then take ReWalk training sessions comprises of 3 x 1-hour sessions per week for 40 sessions. The first 20 or so hours of training sessions focus on basic ReWalk skills, and the following training sessions focus on advanced ReWalk skills. A comprehensive battery of outcome measures, including body composition and bone mineral mass, balance ability, bowel and bladder symptoms, severity of pain, psychological well-being, and quality of life, will be utilized to obtain an in-depth overview and comparison of the treatment efficacy after 40 sessions of ReWalk ambulation training. The measures include: muscle strength measurements, Berg Balance Scale, modified Functional Reach Test, 10-Meters Walking Test, Timed Up and Go test, the Short Form-36 and Spinal Cord Injury-Quality Of Life questionnaires for health-related quality of life measurement. Dual X-ray absorptiometry will be used to measure the bone mineral density of the lumbar spine, the proximal femoral region and the distal forearms. It will also be used to estimate fat mass and lean body mass of the participants. All the outcome assessments, except for the Timed Up and Go and the 10-Metersr Walking Test, will be performed prior to the first training session and again at the end of the ReWalk ambulation training sessions. Descriptive data will be provided for all demographic parameters and with a mix-design ANOVA analysis employed to compare pre- and post-training conditions for all repeated outcome measures.

Official Title
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Evaluation of the Physiological and Psychological Effects of Ambulation Training Utilizing an Exoskeleton Robot on Subjects With Spinal Cord Injury

Conditions
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Spinal Cord Injuries

Intervention / Treatment
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* Device: Ambulation training utilizing an exoskeleton robot


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Between the age of 20-65 years old; Have paraplegia resulting from thoracic or lumbar spinal cord injury. At least 6 months after onset of the spinal cord injury Well motivated and willing to participate 40 hours of ReWalk ambulation training sessions. Exclusion Criteria: Have spinal cord injury neurologic level above T4 Height greater than 190 cm or lower than160 cm Weight greater than 100 kg Have osteoporosis (T-score < -2.5) Deep vein thrombosis Severe orthostatic hypotension precluding standing and walking training Pregnancy Cognitive impairments that would impact on the safe participation in the study Severe spasticity of lower limbs (Modified Ashworth Scale >3) Contracture of the ankle, or a knee flexion contracture greater than 10 degrees Musculoskeletal conditions that affected gait capacity Co-existence of other neurological diseases

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Exoskeleton robot ambulation training<br>Ambulation training utilizing an exoskeleton robot | Device: Ambulation training utilizing an exoskeleton robot<br>* Participants undergo 40 hours of ambulation training utilizing an exosksleton robot within 3 months.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| bone mineral density | bone mineral density of the lumbar spine, the proximal femoral region and the distal forearms, measured by dual X-ray absorptiometry | Change from baseline at 1 week after completion of 40 hours of ambulation training | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| SF-36 | SF-36 contains 36 items comprising eight subscales: physical functioning (PF), role limitations due to physical problems (RP), bodily pain, general health perceptions (GH), vitality (VT), social functioning (SF), role limitations due to emotional problems (RE), and mental health (MH). All subscales are transformed into a 0-100 scale, with 100 indicating the best status. | change from baseline at 1 week after completion of 40 hours of ambulation training | 
| Spinal Cord Injury-Quality of Life measurement system | The SCI-QOL consists of 19 item banks, including the SCI-Functional Index banks, and 3 fixed-length scales measuring physical, emotional, and social aspects of health-related QOL (HRQOL). A description of the score range (and which values are considered to be a better or worse outcome) is not included because it greatly exceeds the 999-character limitation allowed in the box of descrpition Emotional Health Domain: Positive Affect & Well-Being, Depression, Anxiety, Stigma, Resilience, Grief/Loss, Self-Esteem and Psychological Trauma Physical-Medical Health Domain: Skin/Pressure Ulcers Scale, Bladder Complications Scale, Bladder Management Difficulties, Bowel Management Difficulties, Pain Interference and Pain Behavior Scale. Social Participation Domain: Ability to Participate in Social Roles and Activities, Satisfaction with Social Roles and Activities, Independence. SCI-Functional Index banks: Basic Mobility, Ambulation, Fine Motor, Self-Care and Wheelchair activities. | change from baseline at 1 week after completion of 40 hours of ambulation training | 
| fat mass | fat mass measured by dual X-ray absorptiometry | change from baseline at 1 week after completion of ambulation training | 
| lean body mass | lean body mass measured by dual X-ray absorptiometry | change from baseline at 1 week after completion of 40 hours of ambulation training | 
| Berg Balance Scale | measuring sitting balance ability; minimum score: 0, maximu score 56; higher values represent a better outcome | change from baseline at 1 week after completion of 40 hours of ambulation training | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Exoskeleton Device, Rehabilitation, Body composition, Quality of Life