Exoskeleton-assisted walking improves pulmonary and exercise performances more than conventional exercise program in individuals with spinal cord injury: a randomised controlled study

QuestionIn people with spinal cord injury, does exoskeleton-assisted walking training improve pulmonary ventilation function, motor function and related body structure, walking, and activities of daily life equally comparing those with conventional exercise program? DesignRandomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. InterventionBoth groups undertook 16 sessions of 50-60min training (4 days/week, 4 weeks). Participants in the experimental group received EAW trainings using AIDER system, which assisted standing, walking, and climbing the stairs. The control group received a conventional exercise program which combined aerobic, resistance, flexibility and walking training. Outcome measuresThe primary outcome was the pulmonary function test. The secondary outcomes included: a 6-minute walk test with Borg scale (0 to 10) rating of exertion, 10-metre walk test, basic activities of daily living, trunk control test, lower extremity motor score, muscle tone of lower limb, bone mineral density, and distal femoral cartilage at baseline and upon completion of treatment. ResultsAfter 4 weeks of trainings, the experimental group improved more on the forced vital capacity (MD 0.53, 95%CI 0.01 to 1.06), predicted FVC% (MD 19.59, 95%CI 6.63 to 32.54) and forced expiratory volume in 1s (MD 0.61, 95%CI 0.15 to 1.07); BADL (MD 19.75, 95%CI 10.88 to 28.62); and distal femoral cartilage than the control group. Participants completed 6-minute walk test with median 17.3 meters while wearing the exoskeleton. There was no difference in trunk control test, lower extremity motor score, muscle tone, bone mineral density and adverse event. ConclusionsIn people with lower thoracic neurological level of spinal cord injury, exoskeleton-assisted walking training instead of a conventional excise program has potential benefits to facilitate pulmonary ventilation function, walking, basic activities of daily living and thickness of cartilage. Trial registrationChiCTR2000034623