Evidence map›Paper›PMID 31752911›Full record

ArticleJournal of neuroengineering and rehabilitation2019

Retraining walking over ground in a powered exoskeleton after spinal cord injury: a prospective cohort study to examine functional gains and neuroplasticity.

Atif S Khan, Donna C Livingstone, Caitlin L Hurd, Jennifer Duchcherer, John E Misiaszek, Monica A Gorassini, Patricia J Manns, Jaynie F Yang

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of neuroengineering and rehabilitation, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02322125 (Restoring Walking With a Powered Exoskeleton After Complete and Sever Incomplete Spinal Cord Injury), which is not on this map. Cited by 30 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02322125 nacompletednot on this map

Restoring Walking With a Powered Exoskeleton After Complete and Sever Incomplete Spinal Cord Injury

TypeinterventionalSponsorUniversity of AlbertaRan2014 to 2018Enrolled12ConditionsSpinal Cord InjuryArmsReWalk
3 · Its place in the literature

Who cites it

30 citing papers in PubMed, 10 syntheses or guidelines pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Atif S KhanNeuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.
Donna C LivingstoneDepartment of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
Caitlin L HurdDepartment of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
Jennifer DuchchererBiomedical Engineering, University of Alberta, Edmonton, Alberta, Canada.
John E MisiaszekNeuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.
Monica A GorassiniNeuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.
Patricia J MannsDepartment of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
Jaynie F YangNeuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada. jaynie@ualberta.ca.ORCID 0000-0002-7507-8924

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPowered exoskeletons provide a way to stand and walk for people with severe spinal cord injury. Here, we used the ReWalk exoskeleton to determine the training dosage required for walking proficiency, the sensory and motor changes in the nervous system with training, and the functionality of the device in a home-like environment.

methodsParticipants with chronic (> 1 yr) motor complete or incomplete spinal cord injury, who were primarily wheelchair users, were trained to walk in the ReWalk for 12 weeks. Measures were taken before, during, immediately after, and 2-3 months after training. Measures included walking progression, sitting balance, skin sensation, spasticity, and strength of the corticospinal tracts.

resultsTwelve participants were enrolled with 10 completing training. Training progression and walking ability: The progression in training indicated about 45 sessions to reach 80% of final performance in training. By the end of training, participants walked at speeds of 0.28-0.60 m/s, and distances of 0.74-1.97 km in 1 h. The effort of walking was about 3.3 times that for manual wheelchair propulsion. One non-walker with an incomplete injury became a walker without the ReWalk after training. Sensory and motor measures: Sitting balance was improved in some, as seen from the limits of stability and sway speed. Neuropathic pain showed no long term changes. Change in spasticity was mixed with suggestion of differences between those with high versus low spasticity prior to training. The strength of motor pathways from the brain to back extensor muscles remained unchanged. Adverse events: Minor adverse events were encountered by the participants and trainer (skin abrasions, non-injurious falls). Field testing: The majority of participants could walk on uneven surfaces outdoors. Some limitations were encountered in home-like environments.

conclusionFor individuals with severe SCI, walking proficiency in the ReWalk requires about 45 sessions of training. The training was accompanied by functional improvements in some, especially in people with incomplete injuries.

trial registrationNCT02322125 Registered 22 December 2014.

Indexed as

Exoskeleton DeviceWalkingAdolescentAdultAgedCohort StudiesEnvironmentFemaleHumansMaleMiddle AgedMuscle SpasticityNeuronal PlasticityPainPostural BalanceProspective StudiesLocomotionNeuroplasticityPowered exoskeletonRehabilitationSpinal cord injuryWalking

Identifiers

PMID31752911
PMCPMC6868817

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.