PTOTSLPRCTJournal of neuroengineering and rehabilitation2022

Effects of ATLAS 2030 gait exoskeleton on strength and range of motion in children with spinal muscular atrophy II: a case series.

C Cumplido-Trasmonte, J Ramos-Rojas, E Delgado-Castillejo and 9 others

PMID 35854321

WHAT IT FOUND

Three non-ambulatory children with SMA type II showed increased lower limb strength and range of motion after ten sessions with the ATLAS 2030 exoskeleton.

Hip extension and knee flexion improved most. Without a control group, these gains cannot be separated from natural variation or concurrent stretching.

Key findings

01Maximal isometric strength increased in all measured movements by the end of the study, with the greatest improvements seen in hip flexion, hip extension, and knee flexion.

02Range of motion at the hip increased by 12.6% and at the ankle by 34.1% from baseline to final assessment, while knee range of motion remained unchanged.

03Joint limitations (flexums) in hip extension, knee extension, and ankle dorsiflexion all improved compared to initial measurements.

STILL TO COME

How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs

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What it does not show

The study included only three participants with no control group, making it impossible to distinguish treatment effects from natural variability or regression to the mean. All participants received Spinraza (nusinersen) every four months, and the protocol included 15 minutes of lower limb stretching every session. The contribution of the exoskeleton cannot be separated from these concurrent interventions. The follow-up period was very short (one month), and the final assessment was only 48 hours after the last session, so it is unknown if any gains were sustained. The participants were young (5-6 years) and non-ambulatory, so results cannot be generalized to older children or those with different functional levels. The authors state that because medication did not change, the results are 'thought to be due to' the exoskeleton, but this is an assumption unsupported by the design.

Declared interests

Funded by the Consejería de Educación e Investigación de la Comunidad de Madrid and the Ministry of Science and Innovation. The device (ATLAS 2030) is manufactured by Marsi Bionics S.L., which is based in Madrid, Spain. The study was performed at Marsi Care research facilities.

The easy way to misread this

Do not interpret the strength and range of motion gains as proof that the ATLAS 2030 exoskeleton works. The study had only three participants, no control group, and included daily stretching and ongoing nusinersen treatment, so the specific contribution of the robotic device cannot be isolated from these other factors.

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