Study supports the potential for exoskeleton-assisted walking to induce changes in neuroplasticity of lower and upper limbs for individuals with motor complete and incomplete spinal cord injury.

Kessler Foundation researchers have recently published findings of a study examining the effects of exoskeleton-assisted walking on gait parameters and neuromuscular activity in able-bodied individuals and individuals with spinal cord injury (SCI).

The article titled, "Neuromechanical adaptations during a robotic powered exoskeleton assisted walking session," was published in the Journal of Spinal Cord Medicine.

The authors are Arvind Ramanujam, Erica Garbarini, Rakesh Pilkar, and Gail Forrest of Kessler Foundation, and Pierre Asselin and Christopher M. Cirnigliaro of the James J. Peters VA Medical Center. This is the first original research journal article published by Kessler Foundation researchers in the field of robotic exoskeleton training.

In the U.S., robotic exoskeletons are being used for rehabilitation and community use by individuals with SCI. Scientists at Kessler Foundation are interested in evaluating the effects of exoskeleton-assisted walking on locomotion, as well as the changes in neuromuscular profiles. In this study, researchers measured the effects of exoskeleton-assisted walking under the “Max Assist” condition during a single session on gait parameters, including the 3-D kinematics of ankle, knee and hip motion, and muscle activation patterns in four individuals with SCI and four able-bodied individuals. The “Max Assist” setting provides the participant with maximum amount of motor assistance to the lower limbs while walking through a predefined walking pattern. For the able-bodied group, data were also collected during overground non-exoskeleton-assisted walking. Participants walked in robotic devices from Ekso Bionics (Richmond, CA).

“For the participants with SCI during a single testing session, we identified specific patterns of muscle firing in the legs that suggest a neuromuscular training response may exist for individuals who complete repeated training bouts of walking using the powered exoskeleton,” said Arvind Ramanujam, MS, Senior Engineer in Human Performance & Engineering Research at Kessler Foundation. “For the able-bodied individuals, when comparing walking with and without using the exoskeleton, we saw major differences in muscle activation patterns and walking speed,” he added. “Our data show that longitudinal studies are definitely needed using different settings for powered exoskeleton training. The number of participants needs to be increased to more accurately evaluate the potential of powered exoskeletons to improve recovery of gait after a spinal cord injury.

“Understanding how robotic exoskeletons modify locomotor function is fundamental to optimal use during rehabilitation to improve gait pattern, postural stability, and mobility,” said Gail Forrest, PT, PhD, Associate Director of Human Performance & Engineering Research at Kessler Foundation. “This study is an important step towards understanding the potential for exoskeleton-assisted walking to induce changes in neuroplasticity in individuals with motor complete and incomplete spinal cord injury.