Improving walking and inducing neuroplasticity after chronic SCI by training in the ReWalk exoskeleton

Recent developments in powered exoskeletons such as the ReWalk have shown promise to restore walking ability in people with severe spinal cord injury (SCI). Objective: Determine the effects of training in the ReWalk exoskeleton on walking function and neuroplasticity. Participants were individuals with complete or incomplete SCI, ≥1 yr postinjury, with arm strength to control forearm crutches, and who use the wheelchair as their primary mode of mobility. Training consisted of ~1 hr/day, 5 days/wk for 12 wks, progressing from sit-to-stand, stand-to-sit, balancing in standing, walking on smooth ground, turning while walking, to walking on uneven ground, ramps, curbs and stairs. Measurements were taken 2-3 times at baseline, then 6 and 12 weeks into training. Walking function included the maximum walking distance without a rest, the 10-m walk test, and the 6-min walk test (6MWT). Effort of walking was estimated with the physiological cost index (PCI) during the 6MWT. Postural stability was measured on a force platform, including the limits of stability (area enclosed by maximum leans in 8 directions) and postural sway with eyes open and closed. Plasticity in the motor pathways was determined by single-pulse, transcranial magnetic stimulation to induce motor evoked potentials in the paravertebral muscles. Spasticity was estimated with the Spinal Cord Assessment Tool for Spasticity and the cutaneomuscular reflex induced by stimulation of the posterior tibial nerve. Plasticity in sensory pathways was determined with the electrical sensory perceptual threshold. Pain was estimated weekly using the McGill Pain Questionnaire. A field test was conducted towards the end of training to determine the feasibility of the ReWalk for use in the home and community. Results: All participants were able to achieve over ground walking of ~1 km without a rest after ~50 sessions of training. Walking speeds ranged from 0.3 to 0.5 m/s in the ReWalk at the end of training. PCI was ❤ heart beats/m (HB/m) during the 6MWT (uninjured: 0.6 HB/m; with hip-knee-ankle-foot orthosis after complete SCI: ~14 HB/m). All participants showed dramatic improvements in postural stability. Some individuals showed plasticity in motor and sensory pathways, and reduction in pain and spasticity. Most participants could walk easily indoors and outdoors with the device, but stairs, curbs and other tasks were difficult. Conclusion: These preliminary results suggest ReWalk training enabled over ground ambulation for individuals with severe SCI, and generated useful neuroplasticity. We believe it is a good device to incorporate into the retraining of walking and balance after severe SCI.

Society for Neuroscience Chicago 2015 Spinal Cord Injury and Plasticity

Support: Spinal Cord Injury Treatment Centre (Northern Alberta) Society Alberta Paraplegic Foundation

Authors: *A. KHAN1, D. LIVINGSTONE2, J. MISIASZEK3, R. STEIN4, M. GORASSINI5, P. MANNS2, J. YANG2; 1Neurosci. and Mental Hlth. Inst., 2Physical Therapy, 3Occup. Therapy, 4Physiol., 5Biomed. Engin., Univ. of Alberta, Edmonton, AB, Canada

Disclosures: A. Khan: None. D. Livingstone: None. J. Misiaszek: None. R. Stein: None. M. Gorassini: None. P. Manns: None. J. Yang: None.

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