Carsten Bach Baunsgaard , Ulla Vig Nissen, Anne Katrin Brust, Angela Frotzler, Cornelia Ribeill, Yorck-Bernhard Kalke, Natacha León, Belén Gómez, Kersti Samuelsson, Wolfram Antepohl, Ulrika Holmström, Niklas Marklund, Thomas Glott, Arve Opheim, Jesus Benito Penalva, Narda Murillo, Janneke Nachtegaal, Willemijn Faber, Fin Biering-Sørensen
Clinic for Spinal Cord Injuries, Rigshospitalet, 3100 Hornbaek, Denmark. E-mail: cb.baunsgaard@gmail.com
DOI: 10.2340/16501977-2372

Objective: To explore changes in pain, spasticity, range of motion, activities of daily living, bowel and lower urinary tract function and quality of life of individuals with spinal cord injury following robotic exoskeleton gait training.
Design: Prospective, observational, open-label multicentre study.
Methods: Three training sessions per week for 8 weeks using an Ekso™ GT robotic exoskeleton (EKSO Bionics). Included were individuals with recent (<1 year) or chronic (>1 year) injury, paraplegia and tetraplegia, complete and incomplete injury, men and women.
Results: Fifty-two participants completed the training protocol. Pain was reported by 52% of participants during the week prior to training and 17% during training, but no change occurred longitudinally. Spasticity decreased after a training session compared with before the training session (p < 0. 001), but not longitudinally. Chronically injured participants increased Spinal Cord Independence Measure (SCIM III) from 73 to 74 (p = 0. 008) and improved life satisfaction (p = 0. 036) over 8 weeks of training. Recently injured participants increased SCIM III from 62 to 70 (p < 0. 001), but no significant change occurred in life satisfaction. Range of motion, bowel and lower urinary function did not change over time.
Conclusion: Training seemed not to provoke new pain. Spasticity decreased after a single training session. SCIM III and quality of life increased longitudinally for subsets of participants.

This report from a European multicentre, prospective, observational, open-label, exploratory study examines the effects of gait training using an exoskeleton (Ekso Bionics) after spinal cord injury on spasticity, pain, range of motion, bowel and lower urinary tract function, activities of daily living and quality of life. Exoskeleton gait training seemed to be well-tolerated in spinal cord injury participants with neuropathic and nociceptive pain, but pain did not change during 8 weeks of training. Compared with testing prior to a single training session, spasticity decreased after training when calculating a sum-score for multiple lower extremity muscle groups. The results indicate a benefit in terms of independence measure SCIM III as well as quality of life over time. Bowel and lower urinary tract function did not change overall. Future studies could investigate these parameters compared with traditional gait training for spinal cord injury, as well as testing more intensive training protocols.