Training Persons with Spinal Cord Injury to Ambulate Using a Powered Exoskeleton

被引:46
作者
Asselin, Pierre K. [1 ]
Avedissian, Manuel [1 ]
Knezevic, Steven [1 ]
Kornfeld, Stephen [2 ]
Spungen, Ann M. [1 ]
机构
[1] James J Peters VA Med Ctr, Dept Vet Affairs VA, Rehabil Res & Dev Natl Ctr Excellence Med Consequ, Bronx, NY 10468 USA
[2] James J Peters VA Med Ctr, Dept Vet Affairs VA, Spinal Cord Injury Serv, Bronx, NY 10468 USA
来源
JOVE-JOURNAL OF VISUALIZED EXPERIMENTS | 2016年 / 112期
关键词
Bioengineering; Issue; 112; 6MWT; ambulatory device; overground walking; paraplegia; powered exoskeleton; reciprocating gait orthosis; RGO; spinal cord injury; RECIPROCATING GAIT ORTHOSIS; PARAPLEGIC LOCOMOTION; ENERGY-COST; WALKING; REHABILITATION; CLASSIFICATION; PERFORMANCE; EXERCISE; MOBILITY; FRACTURE;
D O I
10.3791/54071
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment.
引用
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页数:17
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