Authors (including presenting author) :
Lau ACH, Lee JKY, Cheung KWS, Cheung EYY, Leung KKL
Affiliation :
Physiotherapy Department, Kowloon Hospital
Introduction :
Patients with spinal cord injury(SCI) is prone to developing osteoporosis and sarcopenia which the risk could be reduced by adequate weight-bearing exercise in standing position[1]. Conventional upright mobility training for SCI patients with no lower limb motor control relied on manual lifting by physiotherapists which limits training sustainability and imposed additional risk of injury to patients. The adoption of overground exoskeleton training(OET) provides standing and walking training to SCI patients which can potentially reduce physical demand to physiotherapists and maximize patient’s participation in lower limbs weight-bearing.
Objectives :
This study aims to evaluate the patients’ outcomes, experience and staff feedback with the implementation of new programme.
Methodology :
SCI patients attending Physiotherapy training in Kowloon Hospital with no lower limbs motor control were recruited. OET was conducted by one physiotherapist and one supporting staff. Real-time adjustment of hip and knee joints support from exoskeleton through computerized algorithm is equipped to ensure constant upright posture while maximizing patient’s own effort of support. Sufficient weight-shifting by active participation of the patients is required to initiate steps while assisted-as-needed assistance is provided for proper swing action.
Result & Outcome :
Ten SCI patients with mean age of 40.8±14.2 year-old were recruited during 2022-2024 with 600 sessions(60.0±57.3) delivered. The average walk-time was 1632.7±582.9minutes and the up-time was 1998.8±806.4minutes with 742.9±233.2steps per session. Patients demonstrated increased training time(walk-time:604.6±296.2 minutes vs 1632.7±582.9minutes,p<0.001, up-time:1515.8±664.2minutes vs 1998.8±806.4minutes,p=0.01), increased steps(122.4±111.8 vs 742.9±233.2,p<0.001), improved performance in 10-meter walk test(102.9±71.5s vs 41.8±32.8s,p=0.015), 6-minute walk test(23.1±10.6m vs 49.0±16.5m,p<0.001), Spinal Cord Independence Measure(57.7±18.9 vs 66.8±10.5,p=0.047) and rate of perceived exertion(5.7±1.9 vs 3.4±1.7,p<0.001). They reported positive Global Rate of Change scale after the training(5.2±1.5). There was no patient/therapist incidence reported. Overwhelming fruitful patients’ experience and physiotherapists’ feedback were observed.
The result suggests OET is a safe and manpower-saving regime to deliver upright mobility training for SCI patients with satisfactory improvements in cardiopulmonary and functional outcomes. This patient buy-in new programme focuses on safety enhancement in both patients and therapists without compromising treatment outcomes by advanced technology adoption. The automated exoskeleton support enables prevention of overstretching to lower limb joints and ligaments and strains of upper limb muscles during supported standing, minimizing injury to therapists for body weight support and avoid sacrificing quality of training due to fatigue.
