Background: Lower extremity robotic exoskeleton technology is being developed with the promise of affording people with spinal cord injury (SCI) the opportunity to stand and walk. The mobility benefits of exoskeleton-assisted walking can be realized immediately, however the cardiorespiratory and metabolic benefits of this technology have not been thoroughly investigated. Objective: The purpose of this pilot study was to evaluate the acute cardiorespiratory and metabolic responses associated with exoskeleton-assisted walking overground and to determine the degree to which these responses change at differing walking speeds. Methods: Five subjects (4 male, 1 female) with chronic SCI (AIS A) volunteered for the study. Expired gases were collected during maximal graded exercise testing and two, 6-minute bouts of exoskeleton-assisted walking overground. Outcome measures included peak oxygen consumption (V?O2peak), average oxygen consumption (V?O2avg), peak heart rate (HRpeak), walking economy, metabolic equivalent of tasks for SCI (METssci), walk speed, and walk distance. Results: Significant differences were observed between walk-1 and walk-2 for walk speed, total walk distance, V?O2avg, and METssci Exoskeleton-assisted walking resulted in %V?O2peak range of 51.5% to 63.2%. The metabolic cost of exoskeleton-assisted walking ranged from 3.5 to 4.3 METssci. Conclusion: Persons with motor-complete SCI may be limited in their capacity to perform physical exercise to the extent needed to improve health and fitness. Based on preliminary data, cardiorespiratory and metabolic demands of exoskeleton-assisted walking are consistent with activities performed at a moderate intensity.
Griffin T, Roberts T, Kram R. Metabolic cost of generating muscular force in human walking: Insights from load-carrying and speed experiments. J Appl Physiol. 2003;95:172–182.
,
Metabolic cost of generating muscular force in human walking: Insights from load-carrying and speed experiments
, J Appl Physiol.
, vol. 95
(pg. 172
-182
) Donelan J, Kram R, Kuo A. Mechanical work for step-to-step transitions is a major determinant of the metabolic cost of human walking. J Exper Biol. 2002;205:3717–3727.
,
Mechanical work for step-to-step transitions is a major determinant of the metabolic cost of human walking
, J Exper Biol.
, vol. 205
(pg. 3717
-3727
) Brooks G, Fahey T, White T, Baldwin K. Exercsie Physiology: Human Bioenergetics and Its Applications. 3rd ed. Montain View, CA: Mayfield Publishing Compnay; 2000.
,
Exercsie Physiology: Human Bioenergetics and Its Applications.
Ainsworth B, Haskell W, Hermann S, et al. 2011 compendium of physical activities. Med Sci Sports Exerc. 2011;43(8):1575–1581.
,
2011 compendium of physical activities
, Med Sci Sports Exerc.
, vol. 43
(pg. 1575
-1581
) Warburton D, Nicol C, Bredin S. Prescribing exercise as preventive therapy. Can Med Assoc J. 2006;174(7):961–974.
,
Prescribing exercise as preventive therapy
, Can Med Assoc J.
, vol. 174
(pg. 961
-974
) Oberg E. Physical activity prescription: Our best medicine. Integrative Med. 2007;6(5):18–22.
,
Physical activity prescription: Our best medicine
, Integrative Med.
, vol. 6
(pg. 18
-22
) American College of Sports Medicine. ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription. 7th ed. Philidelphia: Lippincott Williams & Wilkins; 2013.
,
ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription.
American Heart Association. The benefits of walking: Walking toward a healthier you. 2014. www.startwalkingnow.org. Accessed November 17, 2014. www.startwalkingnow.org.
West C, Bellantoni A, Krassioukov A. Cardiovascular dysfunction in individuals with incomplete spinal cord injury: A systematic review. Top Spinal Cord Inj Rehabil. 2013;19(4):267–278.
,
Cardiovascular dysfunction in individuals with incomplete spinal cord injury: A systematic review
, Top Spinal Cord Inj Rehabil.
, vol. 19
(pg. 267
-278
) Ravensbergen H, de Groot S, Post M, Slootman H, van der Woude L, Claydon V. Cardiovascular function after spinal cord injury: Prevalence and progression of dysfunction during inpatient rehabilitation and 5 years following discharge. Neurorehabil Neural Repair. 2014;28(3):219–229.
,
Cardiovascular function after spinal cord injury: Prevalence and progression of dysfunction during inpatient rehabilitation and 5 years following discharge
, Neurorehabil Neural Repair.
, vol. 28
(pg. 219
-229
) West C, Wong S, Krassioukov A. Autonomic cardiovascular control in Paralympic athletes with spinal cord injury. Med Sci Sports Exerc. 2014;46(1):60–68.
,
Autonomic cardiovascular control in Paralympic athletes with spinal cord injury
, Med Sci Sports Exerc.
, vol. 46
(pg. 60
-68
) Phillips W, Kiratli B, Sarkarti M, Weraarchakul G, Myers J, Franklin B. Effect of spinal cord injury on heart and cardiovascular fitness. Curr Problems Cardiol. 1998;23(11):641–716.
,
Effect of spinal cord injury on heart and cardiovascular fitness
, Curr Problems Cardiol.
, vol. 23
(pg. 641
-716
) Alekna V, Tamulaitiene M, Sinevicius T, Juocevicius A. Effect of weight-bearing activities on bone mineral density in spinal cord injured patients during the period of the first two years. Spinal Cord. 2008;46:727–732.
,
Effect of weight-bearing activities on bone mineral density in spinal cord injured patients during the period of the first two years
, Spinal Cord.
, vol. 46
(pg. 727
-732
) Tanhoffer R, Tanhoffer A, Raymond J, Hills A, Davis G. Exercise, energy expenditure and body composition in people with spinal cord injury. J Phys Act Health. 2014;11(7):1393–1400.
,
Exercise, energy expenditure and body composition in people with spinal cord injury
, J Phys Act Health.
, vol. 11
(pg. 1393
-1400
) Gorgey A, Dudley G. Skeletal muscle atrophy and increased intramuscualr fat after incomplete spinal cord injury. Spinal Cord. 2007;45:304–309.
,
Skeletal muscle atrophy and increased intramuscualr fat after incomplete spinal cord injury
, Spinal Cord.
, vol. 45
(pg. 304
-309
) Libin A, Tinsley E, Nash M, et al. Cardiometabolic risk clustering in spinal cord injury: Results of exploratory fatcor analysis. Top Spinal Cord Inj Rehabil. 2013;19(3):183–194.
,
Cardiometabolic risk clustering in spinal cord injury: Results of exploratory fatcor analysis
, Top Spinal Cord Inj Rehabil.
, vol. 19
(pg. 183
-194
) Sisto S, Evans N. Activity and fitness in spinal cord injury: Review and update. Curr Phys Med Rehabil Rep. 2014;2:147–157.
,
Activity and fitness in spinal cord injury: Review and update
, Curr Phys Med Rehabil Rep.
, vol. 2
(pg. 147
-157
) Nash M. Exercise as a health-promoting actvity following spinal cord injury. J Neurol Phys Ther. 2005;29(2):87–106.
,
Exercise as a health-promoting actvity following spinal cord injury
, J Neurol Phys Ther.
, vol. 29
(pg. 87
-106
) Kressler J, Nash M, Burns P, Field-Fote EC. Metabolic responses to 4 different body weight-supported locomotor training approaches in persons with incomplete spinal cord injury. Arch Phys Med Rehabil. 2013;94:1436–1442.
,
Metabolic responses to 4 different body weight-supported locomotor training approaches in persons with incomplete spinal cord injury
, Arch Phys Med Rehabil.
, vol. 94
(pg. 1436
-1442
) Collins E, Gater D, Kiratli J, Butler J, Hanson K, Langbein W. Energy cost of physical activities in persons with spinal cord injury. Med Sci Sports Exerc. 2010;42(4):691–700.
,
Energy cost of physical activities in persons with spinal cord injury
, Med Sci Sports Exerc.
, vol. 42
(pg. 691
-700
) Galea M. Spinal cord injury and physical activity: Preservation of the body. Spinal Cord. 2012;50: 344–351.
,
Spinal cord injury and physical activity: Preservation of the body
, Spinal Cord.
, vol. 50
(pg. 344
-351
) Cowan R, Nash M. Cardiovascular disease, SCI and exercise: Unique risks and focused countermeasures. Disabil Rehabil. 2010;32(26):2228–2236.
,
Cardiovascular disease, SCI and exercise: Unique risks and focused countermeasures
, Disabil Rehabil.
, vol. 32
(pg. 2228
-2236
) Jacobs P, Nash M. Exercise recommendations for people with spinal cord injury. Sports Med. 2004;34(11):727–751.
,
Exercise recommendations for people with spinal cord injury
, Sports Med.
, vol. 34
(pg. 727
-751
) Jacobs P, Nash M, Rusinowksi J. Circuit training provides cardiorespiratory and strength benefits in persons with paraplegia. Med Sci Sports Exerc. 2001;33:711–717.
,
Circuit training provides cardiorespiratory and strength benefits in persons with paraplegia
, Med Sci Sports Exerc.
, vol. 33
(pg. 711
-717
) Nash M, Cowan R, Kressler J. Evidence-based and heuristic approaches for customization of care in cardiometabolic syndrome after spinal cord injury. J Spinal Cord Med. 2012;35(5):278–292.
,
Evidence-based and heuristic approaches for customization of care in cardiometabolic syndrome after spinal cord injury
, J Spinal Cord Med.
, vol. 35
(pg. 278
-292
) Nash M, Jacobs P, Mendez A, Goldberg R. Circuit resistance training improves the atherogenic lipid profiles of persons with chronic paraplegia. J Spinal Cord Med 2001;24(1):2–9.
,
Circuit resistance training improves the atherogenic lipid profiles of persons with chronic paraplegia
, J Spinal Cord Med
, vol. 24
(pg. 2
-9
) Nash M, van de Ven L, Johnson B. Effects of resistance training on fitness attributes and upper-extremity pain in middle-aged men with paraplegia. Arch Phys Med Rehabil. 2007;88(1):70–75.
,
Effects of resistance training on fitness attributes and upper-extremity pain in middle-aged men with paraplegia
, Arch Phys Med Rehabil.
, vol. 88
(pg. 70
-75
) Dietz V, Harkema S. Locomotor activity in spinal cord-injured persons. J Appl Physiol. 2004;96(5):1954–1960.
,
Locomotor activity in spinal cord-injured persons
, J Appl Physiol.
, vol. 96
(pg. 1954
-1960
) Winchester P, McColl R, Querry R, et al. Changes in suprspinal activation patterns following robotic locomotor therapy in motor-incomplete spinal cord injury. Neurorehabil Neural Repair. 2005;19(4):313–324.
,
Changes in suprspinal activation patterns following robotic locomotor therapy in motor-incomplete spinal cord injury
, Neurorehabil Neural Repair.
, vol. 19
(pg. 313
-324
) Kressler J, Nash MS, Burns PA, Field-Fote EC. Metabolic responses to 4 different body weight-supported locomotor training approaches in persons with incomplete spinal cord injury. Arch Phys Med Rehabil. 2013;94(8):1436–1442.
,
Metabolic responses to 4 different body weight-supported locomotor training approaches in persons with incomplete spinal cord injury
, Arch Phys Med Rehabil.
, vol. 94
(pg. 1436
-1442
) Fenuta AM, Hicks AL. Metabolic demand and muscle activation during different forms of bodyweight supported locomotion in men with incomplete SCI. BioMed Res Int. 2014;2014:10.
,
Metabolic demand and muscle activation during different forms of bodyweight supported locomotion in men with incomplete SCI
, BioMed Res Int.
, vol. 2014
Hornby T, Kinnaird C, Holleran C, Rafferty M, Rodriguez K, Cain J. Kinematic, muscular, and metabolic responses during exoskeletal-, elliptical-, or therapist-assited stepping in people with incomplete spinal cord injury. Phys Ther. 2012;92(10):1278–1291.
,
Kinematic, muscular, and metabolic responses during exoskeletal-, elliptical-, or therapist-assited stepping in people with incomplete spinal cord injury
, Phys Ther.
, vol. 92
(pg. 1278
-1291
) Israel J, Campbell D, Kahn J, Hornby T. Metabolic costs and muscle activity patterns during robotic- and therapist-assisted treadmill walking in individuals with incomplete spinal cord injury. Phys Ther. 2006;86(11):1466–1478.
,
Metabolic costs and muscle activity patterns during robotic- and therapist-assisted treadmill walking in individuals with incomplete spinal cord injury
, Phys Ther.
, vol. 86
(pg. 1466
-1478
) Farris R, Quintero H, Murray S, Ha K, Hartigan C, Goldfarb M. A preliminary assessment of legged mobility provided by a lower limb exoskeleton for persons with paraplegia. IEEE Trans Neural Rehabil Eng. 2014;22(3):482–490.
,
A preliminary assessment of legged mobility provided by a lower limb exoskeleton for persons with paraplegia
, IEEE Trans Neural Rehabil Eng.
, vol. 22
(pg. 482
-490
) 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
) Ekso Bionics. What is Ekso ? http://www.eksobionics.com/ekso. Accessed November 21, 2014. http://www.eksobionics.com/ekso.
American Spinal Injury Association. International Standards for Neurological Classification of Spinal Cord Injury (revised 2011). Atlanta, GA: Author; 2011.
,
International Standards for Neurological Classification of Spinal Cord Injury (revised 2011).
Murray SA, Ha KH, Goldfarb M, eds. An assistive controller for a lower-limb exoskeleton for rehabilitation after stroke, and preliminary assessment thereof. Presented at: Engineering in Medicine and Biology Society (EMBC), 36th Annual International Conference of the IEEE; August 26–30, 2014.
,
An assistive controller for a lower-limb exoskeleton for rehabilitation after stroke, and preliminary assessment thereof
(pg. 26
-30
) ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: Guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111–117.
,
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: Guidelines for the six-minute walk test
, Am J Respir Crit Care Med.
, vol. 166
(pg. 111
-117
) Borg G. Borg’s Perceived Exertion and Pain Scales. Champaign, IL: Human Kinetics; 1998.
,
Borg’s Perceived Exertion and Pain Scales
Ferris D, Sawicki G, Daley M. A physiologist’s perspective on robotic exoskeletons for human locomotion. Int J Humanoid Robotics. 2007;4(3): 507–528.
,
A physiologist’s perspective on robotic exoskeletons for human locomotion
, Int J Humanoid Robotics.
, vol. 4
(pg. 507
-528
) Kressler J, Thomas C, Field-Fote E, et al. Understanding therapeutic benefits of overground bionic ambulation: Exploratory case series in persons with chronic, complete spinal cord injury. Arch Phys Med Rehabil. 2014;95(10):1878–1887.
,
Understanding therapeutic benefits of overground bionic ambulation: Exploratory case series in persons with chronic, complete spinal cord injury
, Arch Phys Med Rehabil.
, vol. 95
(pg. 1878
-1887
) Lam T, Noonan V, Eng J, Team SR. A systematic review of functional ambulation outcome measures in spinal cord injury. Spinal Cord. 2008;46(4): 246–254.
,
A systematic review of functional ambulation outcome measures in spinal cord injury
, Spinal Cord.
, vol. 46
(pg. 246
-254
) Jack L, Purcell M, Allan D, Hunt K. The metabolic cost of passive walking during robotics-assisted treadmill exercise. Technol Health Care. 2011;19(1):21–27.
,
The metabolic cost of passive walking during robotics-assisted treadmill exercise
, Technol Health Care.
, vol. 19
(pg. 21
-27
) Ainsworth B, Haskell W, Leon A, et al. Compendium of physical activities: Classification of energy costs of human physical activities. Med Sci Sports Exerc. 1993;25(1):71–80.
,
Compendium of physical activities: Classification of energy costs of human physical activities
, Med Sci Sports Exerc.
, vol. 25
(pg. 71
-80
) Garber C, Blissmer B, Deschenes M, et al. Quantity and quailty of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–1359.
,
Quantity and quailty of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for prescribing exercise
, Med Sci Sports Exerc.
, vol. 43
(pg. 1334
-1359
) 2008 Physical Activity Guidelines for Americans. Washington, DC: Physical Activity Guidelines Advisory Committee Report; 2008.
,
2008 Physical Activity Guidelines for Americans.
Nelson M, Rejeski W, Blair S, et al. Physical activity and public health in older adults: Recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1435–1445.
,
Physical activity and public health in older adults: Recommendation from the American College of Sports Medicine and the American Heart Association
, Med Sci Sports Exerc.
, vol. 39
(pg. 1435
-1445
) Conger S, Bassett D. A compendium of energy costs of physical activities for individuals who use manual wheelchairs. Adapted Phys Act Q. 2011;28: 310–325.
,
A compendium of energy costs of physical activities for individuals who use manual wheelchairs
, Adapted Phys Act Q.
, vol. 28
(pg. 310
-325
) Harness E, Astorino T. Acute energy cost of multimodal activity-based therapy in persons with spinal cord injury. J Spinal Cord Med. 2011;34(5):495–500.
,
Acute energy cost of multimodal activity-based therapy in persons with spinal cord injury
, J Spinal Cord Med.
, vol. 34
(pg. 495
-500
)
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