Retraining walking over ground in a powered exoskeleton after spinal cord injury: a prospective cohort study to examine functional gains and neuroplasticity.
Atif S Khan, Donna C Livingstone, Caitlin L Hurd and 5 others
PMID 31752911WHAT IT FOUND
With repeated powered exoskeleton training, people with severe spinal cord injury walked for about an hour each session, and some gained balance or strength.
Brain-to-spine signals did not change, and no control group means recovery cannot be proven.
Key findings
01Participants who stayed in training completed more than 40 sessions, averaging 51.5 ± 6.0 sessions, and by the end all participants walked about 1 hour each session.
02Some function improved: two of three participants with motor incomplete injuries improved arm and leg strength scores, and the distance people could lean in sitting increased by 4.5 ± 4.1 cm after training.
03Signals from the brain to back muscles did not change after training at rest or with background muscle contraction.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only 10 participants provided full data sets, so the study cannot show how many people would respond similarly. There was no control group, so spontaneous change or other unmeasured activity cannot be ruled out. The study was exploratory, and p values were not corrected for the many comparisons. Some participants changed medication or activity without reporting it, and others stopped concurrent activities during training. The device and fittings changed during the study, including ReWalk versions, footplates and knee brackets. Several outcomes lacked known meaningful change thresholds, including pain, spasticity, sensory thresholds and PCI. Safety required a trainer and spotter, and skin abrasions caused training breaks for five participants. Follow-up was only 2 to 3 months, so long-term retention is unknown.
Declared interests
Funding came from the Craig H. Neilsen Foundation and the Center for Large Data Research & Data Sharing in Rehabilitation. The supplied text does not list author conflicts of interest.
The easy way to misread this
Do not read the walking gains as proof that the exoskeleton caused neural recovery. The study had no control group, and signals from the brain to back muscles did not change after training.