Authors (including presenting author) :
Wong AFY(1), Chan SCN(1), Wong FPY(1), Koljonen PA(2), Tsang RCC(1), Wong YW(2), Cheung KMC(2)
Affiliation :
(1) Physiotherapy Department, MacLehose Medical Rehabilitation Centre, (2) Department of Orthopaedics and Traumatology, The University of Hong Kong
Introduction :
The advancement of medical robotic technology has enabled the evolution of gait training for patients with spinal cord injury (SCI) from stationary assistive systems, to ambulatory wearable robotic exoskeletons (WRE) that facilitate over-ground walking and gait training. However, the widespread clinical use of these new technologies is still hindered by the prohibitive cost and high level of training required for the operator. Since June 2018, The Department of Orthopaedics & Traumatology of The University of Hong Kong has begun utilizing a powered WRE (EksoGT) for rehabilitation of patients with SCI. This pilot program was funded by philanthropy and currently in its sixth month of operation at the Physiotherapy Department of MacLehose Medical Rehabilitation Centre.
Objectives :
This presentation aims to report the preliminary experience of using the WRE for gait training in a case series of patients with SCI, with discussion on the feasibility and safety of the WRE, short-term outcomes and patient perceived improvement after a course of training.
Methodology :
Patients with suitable neurological and physical conditions completed baseline testing before progressing to training. All patients completed a total of 10 one-hour sessions of over-ground gait training. Four physiotherapists completed a mandatory four-day certificate training programme to operate the EksoGT. Total stand-up time, walking time and number of steps were assessed in each session. Other outcomes included any adverse events and patient perceived improvement using a global rating scale.
Result & Outcome :
Five patients completed 10 sessions of training between Oct 2018 to Jan 2019. Neurological levels of injury ranged from C5 to T12. There were 3 AIS grade A patients, 1 grade B and 1 grade C. Over the course of 10 sessions, the mean changes in stand-up time, walking time and number of steps were: 814s (SD 495) (p=0.021), 1298s (SD 395) (p=0.002) and 818 (SD 170) (p<0.001) respectively. All patients rated their health status at least “moderately improved”. No adverse event was reported. To date, this is the first WRE introduced as a pilot programme within the Hospital Authority setting. Based on these preliminary data, the use of the EksoGT in selected patients with SCI appears safe, feasible and effective.
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