Robotic locomotor training in a low-resource setting: a randomized pilot and feasibility trial

Abstract

Purpose

Activity-based Training (ABT) represents the current standard of neurological rehabilitation. Robotic Locomotor Training (RLT), an innovative technique, aims to enhance rehabilitation outcomes. This study aimed to conduct a randomized pilot and feasibility trial of a locomotor training program within South Africa.

Materials and methods

Individuals with chronic traumatic motor incomplete tetraplegia (n = 16). Each intervention involved 60-minute sessions, 3x per week, for 24-weeks. Outcomes included feasibility measures and functional capacity.

Results

17 out of 110 individuals initiated the program (recruitment rate = 15.4%) and 16 completed the program (drop-out rate = 5.8%) and attended sessions (attendance rate = 93.9%). Both groups showed a significant increase in upper extremity motor score (MS) and abdominal strength post intervention. Only the RLT group showed a significant change in lower extremity MS, with a mean increase of 3.00 [0.00; 16.5] points over time. Distance walked in the Functional Ambulatory Inventory (SCI-FAI) increased significantly (p = 0.02) over time only for the RLT group.

Conclusions

Feasibility rates of the intervention and functional outcomes justify a subsequent powered RCT comparing RLT to ABT as an effective rehabilitation tool for potentially improving functional strength and walking capacity in people with incomplete SCI.

IMPLICATIONS FOR REHABILITATION

• Spinal cord injury causes severe limitations to functional capacity, independence, and quality of life.

• Robotic Locomotor Training is growing rehabilitation modality for people with spinal cord injury, but currently its effects on functional capacity are limited.

• In a relatively small sample, this study shows that large, randomized control trials are feasible within a low-income setting.

• The preliminary findings of this study show that 12 weeks of locomotor training can improve ambulatory function and functional strength in individuals with spinal cord injury.

Keywords:

• Spinal cord injuries
• rehabilitation
• robotics
• exoskeleton device
• exercise therapy
• gait
• muscle strength
• SCI-FAI

Acknowledgements

Tristan Naidoo from the University of Cape Town for his assistance with the statistical analyses. Dr. Jason Bantjes and Dr. Leslie Swartz for monitoring the psychological well-being of the participants involved in this trial. Dr. Ed Baalbergen for the health screening of the participants involved in the trial. A loaner exoskeleton was provided by Ekso Bionics for the duration of the study. Ekso Bionics were not involved in the conceptualisation, design, data analysis, interpretation, or dissemination of the study’s results.

Disclosure statement

The authors report there are no competing interests to declare.

Data availability statement

The data that support the findings of this study are available from the corresponding author, [YA], upon reasonable request.

Additional information

Funding

This work was supported by the National Research Foundation of South Africa Career Grant, University of Cape Town Development Grant [grant number 91421] and the Oppenheimer Memorial Trust [grant number 20523].