Effect of using of a lower-extremity exoskeleton on disability of people with multiple sclerosis

Abstract

Background

Although ongoing exercise is known to reduce disability in people with multiple sclerosis (MS), participation in lower-extremity exercise programs can be limited by their existing mobility impairments. Lower-extremity exoskeletons could address this problem by facilitating home and community locomotion and enhancing exercise capability but little data is available on the potential of this technology for reducing disability of people with MS.

Methods

We evaluated the Keeogo™ exoskeleton for people with MS using an open-label randomised cross-over design. The trial design allowed us to quantify rehabilitation effects (tested without device) and training effects (tested with device) using functional outcomes: 6-minute walk test (6MWT), timed stair test (TST), and timed up-and-go (TUG). Baseline and post-study self-report instruments included Medical Outcomes Survey Short Form-36 (SF36), MS Walking Scale (MSWS), and others. Amount of home use was documented by daily activity log. Partial correlation analysis was used to explore the relationships between changes in functional outcomes and self-report disability, controlling for amount of home use of the device.

Results

Twenty-nine participants with MS completed the trial. Change scores for MSWS, SF36 physical function and SF36 emotional well-being correlated positively with changes in 6MWT which was explained by amount of home use.

Conclusions

The benefits in physical functioning and emotional well-being from using the exoskeleton at home were linked to amount of device usage. Low-profile robotic exoskeletons could be used to deliver facilitated exercise while assisting with locomotor activities of daily living, such as walking and stair climbing in the home and community environment.

IMPLICATIONS FOR REHABILITATION

• Exoskeletons for home use may have the potential to benefit people with MS in terms of physical functioning and emotional well-being.

• The benefits in physical functioning and emotional well-being appeared to be linked to amount of usage.

• Exoskeletons might be useful for delivering facilitated exercise while assisting with walking and stair climbing in the home.

Keywords:

• Health-related quality of life
• powered exoskeleton
• neurological disorder
• mobility assist
• ambulatory aid

Acknowledgements

The authors are indebted to the professional staff at the participating sites, and we wish to thank our research participants for their dedication and invaluable contributions.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Figure 1. Keeogo™ Dermoskeleton by B-Temia Inc., Quebec, Canada. The device is worn over regular clothing. Motors are located at the knees. The device is secured to the limbs with shank and thigh cuffs, and also suspended from the waist belt and chariot system that allows the hip to rotate freely. The thigh segment contains the artificial intelligence (AI) computer and inertial measurement unit (IMU). Sensors at the knee, hip and thigh allows the AI to know what both limbs are doing at all times [29].

Figure 2. Trial schema [29]: After enrolment (Visit 1) participants were allocated to sequences A or B. Stage I of the trial (Visits 2 and 3) was to quantify the immediate and naïve effects of Keeogo™ on functional performance testing. During Stage II of the trial, participants used Keeogo™ at home for 2 weeks (hW) and for 2-week without (hWO) Keeogo™. Clinical testing at Visit 4 and Visit 5 was used to quantify changes in functional performance resulting from home usage. Disability questionnaires were administered at Visit 1 and Visit 5.

Additional information

Funding

The trial was sponsored by B-Temia Inc., Quebec, Canada. The trial is registered at ClinicalTrials.gov: NCT02904382.