Exoskeleton-Assisted Gait: A Case Series Exploring New Rehabilitation Perspectives in Degenerative Spinal Cord Injury

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Deambulazione Assistita da esoscheletro: una serie di casi che esplora nuove prospettive riabilitative nelle lesioni midollari degenerative

Autori

Martina Regazzetti [Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, Venice, Italy]

Marta Albani Rocchetti [Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, Venice, Italy]

Lazzaro Giovanni [IRCCS San Camillo Hospital, Venice, Italy]

Federico Sara [Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, Venice, Italy]

Cieslik Blazej [Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, Venice, Italy]

Kiper Pawel [Healthcare Innovation Technology Lab, IRCCS San Camillo Hospital, Venice, Italy]

Introduction to clinical case

Recovery following incomplete spinal cord injury (iSCI) remains challenging, with conventional rehabilitation often emphasizing compensation over functional restoration. As most new SCI cases preserve some motor or sensory pathways, there is increasing interest in therapies that harness neuroplasticity. Robotic exoskeletons provide a promising means to deliver task-specific, repetitive gait training that may promote adaptive neural reorganization. This case series investigates the effects of exoskeleton-assisted walking on motor performance and neuromuscular coordination in individuals with degenerative iSCI.

Methods

Two cooperative male patients (aged 77 and 74) with incomplete, non-traumatic SCI participated in a four-week intervention involving one hour of neuromotor physiotherapy followed by one hour of exoskeleton-assisted gait training, three times per week. Functional performance was assessed using the 10-Meter Walk Test. Gait quality and neuromuscular control were further evaluated via spatiotemporal gait analysis and dynamic surface electromyography (sEMG) during overground walking

Results

Subject A demonstrated a clinically meaningful increase in walking speed (+1.5 m/s), improved gait symmetry, and more phase-specific activation of key lower limb muscles, including the tibialis anterior, gastrocnemius, and quadriceps. Subject B showed stable walking speed with persistent asymmetries in sEMG patterns, marked by prolonged and compensatory muscle activity, indicating limited neuromuscular adaptation.

Discussion and clinical relevance

Given the small number of participants, the current data do not allow us to determine if training with the exoskeleton can improve motor performance during walking in terms of endurance and speed. More data are needed to define in greater detail the impact that using this device can have on walking. Additionally, it is essential to verify on a larger number of patients whether the observed trends are consistent and significant. Examining the specific mechanisms by which the exoskeleton influences muscle activity could provide valuable insights. Comprehensive research with larger cohorts and extended follow-up periods is crucial to fully understand and optimize the potential of exoskeleton-assisted rehabilitation for improving patient outcomes. These findings suggest that robotic exoskeleton training may serve as an effective rehabilitation tool for selected patients with degenerative iSCI. The observed differences in outcomes underscore the importance of individualized approaches and highlight the need for further research into factors influencing responsiveness to robotic interventions.

REFERENCES

  • Devivo MJ. Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal Cord. 2012 May;50(5):365-72. Epub 2012 Jan 24. PMID: 22270188.
  • Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, Johansen M, Jones L, Krassioukov A, Mulcahey MJ, Schmidt-Read M, Waring W. International standards for neurological classification of spinal cord injury. J Spinal Cord Med. 2011 Nov;34(6):535-46. PMID: 22330108
  • Gizzi, L., Nielsen, J. F., Felici, F., Ivanenko, Y. P., and Farina, D. (2011). Impulses of activation but not motor modules are preserved in the locomotion of subacute stroke patients. Neurophysiol. 106, 202–210.
  • Sczesny-Kaiser M, Trost R, Aach M, Schildhauer TA, Schwenkreis P, Tegenthoff M. A Randomized and Controlled Crossover Study Investigating the Improvement of Walking and Posture Functions in Chronic Stroke Patients Using HAL Exoskeleton – The HALESTRO Study. Front Neurosci. 2019 Mar 29;13:259. PMID: 30983953;

 

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