Alison M.M. Williams, Emily Deegan, Matthias Walter, Lynn Stothers, Tania Lam
Kinesiology, University of British Columbia, Vancouver, Canada. E-mail: awilliams@icord.org
DOI: 10.2340/16501977-2864

Objective: The primary aim of this study was to determine the feasibility of delivering an exoskeleton-assisted walking intervention targeting lower urinary tract function in people with motor-complete spinal cord injury. Secondary aims were to determine if exoskeleton walking activates the pelvic floor muscles, and compare 2 exoskeleton programmes regarding lower urinary tract function.
Design: Randomized pilot trial.
Subjects: Adults with motor-complete spinal cord injury at or above T10.
Methods: Participants were randomized to receive Ekso or Lokomat training. Feasibility outcomes included recruitment rate, adherence, and adverse events. Pelvic floor muscle electromyography was recorded during walking. Urodynamic studies, 3-day bladder diary, and Qualiveen-30 were administered pre- and post-training.
Results: Twelve people were screened and 6 people enrolled in the study. Two subjects withdrew from unrelated reasons. There was one adverse event. Pelvic floor muscle activity was greater in the Ekso group. Lower urinary tract function did not clearly change in either group.
Conclusion: This pilot study demonstrates the feasibility of delivering an exoskeleton training programme targeting lower urinary tract function. Ekso-walking elicits pelvic floor muscle activity, but it remains unclear how locomotor training impacts lower urinary tract function.

Some studies in people with spinal cord injury have reported improvements in urinary bladder health after gait therapy, but the mechanisms behind this are unclear. Strong pelvic floor muscles are crucial to urinary bladder health, and these muscles are normally active during walking. It is possible that the pelvic floor muscles are similarly engaged during exoskeleton-walking in people with spinal cord injury, and this could improve urinary bladder health. This study demonstrates that delivering an exoskeleton intervention to people with spinal cord injury for urinary bladder health is feasible. Participants were successfully recruited to a training programme, and any dropouts were because of issues unrelated to the study. Furthermore, the study showed that the pelvic floor muscles are active while walking in 1 type of exoskeleton, but it remains unclear how exoskeleton-walking may help improve urinary bladder outcomes. Further research is needed to explore how exoskeleton interventions may engage the pelvic floor muscles and improve urinary bladder health outcomes for those with spinal cord injury.