Background: Individuals with spinal cord injury (SCI) often use a wheelchair for mobility due to paralysis. Powered exoskeletal-assisted walking (EAW) provides a modality for walking overground with crutches. Little is known about the EAW velocities and level of assistance (LOA) needed for these devices. Objective: The primary aim was to evaluate EAW velocity, number of sessions, and LOA and the relationships among them. The secondary aims were to report on safety and the qualitative analysis of gait and posture during EAW in a hospital setting. Methods: Twelve individuals with SCI ?1.5 years who were wheelchair users participated. They wore a powered exoskeleton (ReWalk; ReWalk Robotics, Inc., Marlborough, MA) with Lofstrand crutches to complete 10-meter (10MWT) and 6-minute (6MWT) walk tests. LOA was defined as modified independence (MI), supervision (S), minimal assistance (Min), and moderate assistance (Mod). Best effort EAW velocity, LOA, and observational gait analysis were recorded. Results: Seven of 12 participants ambulated ?0.40 m/s. Five participants walked with MI, 3 with S, 3 with Min, and 1 with Mod. Significant inverse relationships were noted between LOA and EAW velocity for both 6MWT (Z value = 2.63, Rho = 0.79, P = .0086) and 10MWT (Z value = 2.62, Rho = 0.79, P = .0088). There were 13 episodes of mild skin abrasions. MI and S groups ambulated with 2-point alternating crutch pattern, whereas the Min and Mod groups favored 3-point crutch gait. Conclusion: Seven of 12 individuals studied were able to ambulate at EAW velocities ?0.40 m/s, which is a velocity that may be conducive to outdoor activity-related community ambulation. The ReWalk is a safe device for in-hospital ambulation.
Vukobratovic M, Hristic D, Stojiljkovic Z. Development of active anthropomorphic exoskeletons. Med Biol Eng Comput. 1974;12(1):66–88.
,
Development of active anthropomorphic exoskeletons
, Med Biol Eng Comput.
, vol. 12
(pg. 66
-88
) Van Hedel HJA. Gait speed in relation to categories of functional ambulation after spinal cord injury. Neurorehabil Neural Repair. 2009;23(4):343–350.
,
Gait speed in relation to categories of functional ambulation after spinal cord injury
, Neurorehabil Neural Repair.
, vol. 23
(pg. 343
-350
) Clasey J, Janowiak A, Gater D. Relationship between regional bone density measurements and the time since injury in adults with spinal cord injuries. Arch Phys Med Rehabil. 2004;85(1):59–64.
,
Relationship between regional bone density measurements and the time since injury in adults with spinal cord injuries
, Arch Phys Med Rehabil.
, vol. 85
(pg. 59
-64
) Bauman W, Spungen A, Wang J, Pierson Jr R, Schwartz E. Continuous loss of bone during chronic immobilization: A monozygotic twin study. Osteoporos Int. 1999;10(2):123–127.
,
Continuous loss of bone during chronic immobilization: A monozygotic twin study
, Osteoporos Int.
, vol. 10
(pg. 123
-127
) Biering-Sorensen F, Bohr H, Schaadt O. Longitudinal study of bone mineral content in the lumbar spine, the forearm and the lower extremities after spinal cord injury. Eur J Clin Invest. 1990;20(3):330–335.
,
Longitudinal study of bone mineral content in the lumbar spine, the forearm and the lower extremities after spinal cord injury
, Eur J Clin Invest.
, vol. 20
(pg. 330
-335
) Spungen A, Wang J, Pierson R, Bauman W. Soft tissue body composition differences in monozygotic twins discordant for spinal cord injury. J Appl Physiol. 2000;88(4):1310–1315.
,
Soft tissue body composition differences in monozygotic twins discordant for spinal cord injury
, J Appl Physiol.
, vol. 88
(pg. 1310
-1315
) Maggioni M, Bertoli S, Margonato V, et al. Body composition assessment in spinal cord injury subjects. Acta Diabetologica. 2003;40:183–186.
,
Body composition assessment in spinal cord injury subjects
, Acta Diabetologica.
, vol. 40
(pg. 183
-186
) Spungen A, Adkins R, Stewart C, et al. Factors influencing body composition in persons with spinal cord injury: A cross-sectional study. J Appl Physiol. 2003;95(6):2398–2407.
,
Factors influencing body composition in persons with spinal cord injury: A cross-sectional study
, J Appl Physiol.
, vol. 95
(pg. 2398
-2407
) Wielopolski L, Ramirez L, Spungen A, et al. Measuring partial body potassium in the legs of patients with spinal cord injury: A new approach. J Appl Physiol. 2009;106(1):268.
,
Measuring partial body potassium in the legs of patients with spinal cord injury: A new approach
, J Appl Physiol.
, vol. 106
Bauman W, Spungen A, Zhong Y, et al. Depressed serum high density lipoprotein cholesterol levels in veterans with spinal cord injury. Paraplegia. 1992;30(10):697.
,
Depressed serum high density lipoprotein cholesterol levels in veterans with spinal cord injury
, Paraplegia.
, vol. 30
Bauman W, Spungen A. Coronary heart disease in individuals with spinal cord injury: Assessment of risk factors. Spinal Cord. 2008;46(7):466–476.
,
Coronary heart disease in individuals with spinal cord injury: Assessment of risk factors
, Spinal Cord.
, vol. 46
(pg. 466
-476
) Bauman W, Spungen A, Raza M, et al. Coronary artery disease: Metabolic risk factors and latent disease in individuals with paraplegia. Mt Sinai J Med. 1992;59(2):163.
,
Coronary artery disease: Metabolic risk factors and latent disease in individuals with paraplegia
, Mt Sinai J Med.
, vol. 59
Bauman W, Adkins R, Spungen A, Waters R. The effect of residual neurological deficit on oral glucose tolerance in persons with chronic spinal cord injury. Spinal Cord. 1999;37(11):765–771.
,
The effect of residual neurological deficit on oral glucose tolerance in persons with chronic spinal cord injury
, Spinal Cord.
, vol. 37
(pg. 765
-771
) Bauman W, Spungen A. Carbohydrate and lipid metabolism in chronic spinal cord injury. J Spinal Cord Med. 2001;24(4):266.
,
Carbohydrate and lipid metabolism in chronic spinal cord injury
, J Spinal Cord Med.
, vol. 24
pg. 266
Creasey G, Grill J, Korsten M. An implantable neuroprosthesis for restoring bladder and bowel control to patients with spinal cord injuries: A multicenter trial. Arch Phys Med Rehabil. 2001;82(11):1512–1519.
,
An implantable neuroprosthesis for restoring bladder and bowel control to patients with spinal cord injuries: A multicenter trial
, Arch Phys Med Rehabil.
, vol. 82
(pg. 1512
-1519
) Rajendran S, Reiser J, Bauman W, et al. Gastrointestinal transit after spinal cord injury: Effect of cisapride. Am J Gastroenterol. 1992;87(11):1614.
,
Gastrointestinal transit after spinal cord injury: Effect of cisapride
, Am J Gastroenterol.
, vol. 87
Tate DG, Kalpakjian CZ, Forchheimer MB. Quality of life issues in individuals with spinal cord injury. Arch Phys Med Rehabil. 2002;83(12, Suppl 1):s18–s25.
,
Quality of life issues in individuals with spinal cord injury
, Arch Phys Med Rehabil.
, vol. 83
(pg. s18
-s25
) Ditor D, Macdonald M, Kamath M, et al. The effects of body-weight supported treadmill training on cardiovascular regulation in individuals with motor-complete SCI. Spinal Cord. 2005; 43(11):664–673.
,
The effects of body-weight supported treadmill training on cardiovascular regulation in individuals with motor-complete SCI
, Spinal Cord.
, vol. 43
(pg. 664
-673
) Forrest G, Sisto S, Asselin P, et al. Locomotor training with incremental changes in velocity: Muscle and metabolic responses. Top Spinal Cord Inj Rehabil. 2008;14(1):16–22.
,
Locomotor training with incremental changes in velocity: Muscle and metabolic responses
, Top Spinal Cord Inj Rehabil.
, vol. 14
(pg. 16
-22
) Hicks A, Adams M, Ginis K, et al. Long-term body-weight-supported treadmill training and subsequent follow-up in persons with chronic SCI: Effects on functional walking ability and measures of subjective well-being. Spinal Cord. 2005;43(5):291–298.
,
Long-term body-weight-supported treadmill training and subsequent follow-up in persons with chronic SCI: Effects on functional walking ability and measures of subjective well-being
, Spinal Cord.
, vol. 43
(pg. 291
-298
) Shields RK, Schlechte J, Dudley-Javoroski S, et al. Bone mineral density after spinal cord injury: A reliable method for knee measurement. Arch Phys Med Rehabil. 2005;86(10):1969–1973.
,
Bone mineral density after spinal cord injury: A reliable method for knee measurement
, Arch Phys Med Rehabil.
, vol. 86
(pg. 1969
-1973
) Fineberg DB, Asselin P, Harel NY, et al. Vertical ground reaction force-based analysis of powered exoskeleton-assisted walking in persons with motor-complete paraplegia. J Spinal Cord Med. 2013;36(4):313–321.
,
Vertical ground reaction force-based analysis of powered exoskeleton-assisted walking in persons with motor-complete paraplegia
, J Spinal Cord Med.
, vol. 36
(pg. 313
-321
) Esquenazi A, Talaty M, Packel A, Saulino M. The ReWalk powered exoskeleton to restore ambulatory function to individuals with thoracic-level motor-complete spinal cord injury. Am J Phys Med Rehabil. 2012;91(11):911–921
,
The ReWalk powered exoskeleton to restore ambulatory function to individuals with thoracic-level motor-complete spinal cord injury
, Am J Phys Med Rehabil.
, vol. 91
(pg. 911
-921
) Zeilig G, Weingarden H, Zwecker M, Dudkiewicz I, Bloch A, Esquenazi A. Safety and tolerance of the ReWalk exoskeleton suit for ambulation by people with complete spinal cord injury: A pilot study. J Spinal Cord Med. 2012;35(2):96–101.
,
Safety and tolerance of the ReWalk exoskeleton suit for ambulation by people with complete spinal cord injury: A pilot study
, J Spinal Cord Med.
, vol. 35
(pg. 96
-101
) Perry J, Garrett M, Gronley JK, Mulroy SJ. Classification of walking handicap in the stroke population. Stroke. 1995;26:982–989.
,
Classification of walking handicap in the stroke population
, Stroke.
, vol. 26
(pg. 982
-989
) Fritz S, Lusardi, M. Walking speed: The sixth vital sign. J Geriatr Phys Ther. 2009; 32(2):46–49.
,
Walking speed: The sixth vital sign
, J Geriatr Phys Ther.
, vol. 32
(pg. 46
-49
) Kirtley C, Whittle MW, Jefferson RJ. Influence of walking speed on gait parameters. J Biomed Eng. 1985;7(4):282–288.
,
Influence of walking speed on gait parameters
, J Biomed Eng.
, vol. 7
(pg. 282
-288
) Webb, D. Maximum walking speed and lower limb length in hominids. Am J Phys Anthropol. 1996;101:515–525.
,
Maximum walking speed and lower limb length in hominids
, Am J Phys Anthropol.
, vol. 101
(pg. 515
-525
) Langhammer B, Lindmark B, Stanghelle J. The relation between gait velocity and static and dynamic balance in the early rehabilitation of patient with acute stroke. Adv Physiother. 2006;8:60–65.
,
The relation between gait velocity and static and dynamic balance in the early rehabilitation of patient with acute stroke
, Adv Physiother.
, vol. 8
(pg. 60
-65
) Requejo PS, Wahl DP, Bontrager EL, et al. Upper extremity kinetics during Lofstrand crutch-assisted gait. Med Eng Physics. 2005;27(1):19–29.
,
Upper extremity kinetics during Lofstrand crutch-assisted gait
, Med Eng Physics.
, vol. 27
(pg. 19
-29
)
This content is only available as a PDF.
