Neurological

Powered Exoskeleton Viable and Safe for Gait Training in Multiple Sclerosis

Among individuals with multiple sclerosis (MS) and serious walking constraints, it is viable and safe to gait train with a powered exoskeleton, according to research presented at the 2022 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) held June 1-4 , 2022 at National Harbor, Maryland.

MS often leads to limitations in walking. In the US, powered exoskeletons are used successfully in spinal cord injury and poststroke hemiparesis but not utilized in MS. In the current study, researchers sought to examine the use of powered exoskeletons for gait training, assessing practicality, safety, and clinical outcomes.

To accomplish this, they conducted a retrospective medical record review between June 2019 and July 2021 of 21 patients (56±10 years of age; 76% female; 81% progressive MS; 76% used a walker, and 33% a wheelchair as their primary means of indoor mobility) participating in 3 or more powered exoskeleton gait training sessions in the Cleveland Clinic neurorehabilitation program.

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Patients underwent a median of 11 sessions (interquartile range [IQR], 6-22) with mean steps per session 517.7±119.3 and walk-time per session 21±4 minutes. Walk time increased significantly compared to the first and last training sessions (P =.008) as did number of steps (P =.011) and programmed step length (P <.001). Clinical outcomes were not available for all patients. The Timed 25-Foot Walk showed no significant change though walking speed increased at least 20% in 3 of 15 patients. The Timed Up and Go test revealed a significant increase in time to complete (P =.029), and researchers said that 1 adverse event was reported in 5 patients.

Researchers concluded that, “gait training with a [powered exoskeleton] is safe and feasible in individuals with MS and severe walking limitations. A training progression was demonstrated between the beginning and end of treatment.” They noted a significant discrepancy in clinical outcomes between patients, first to last training session and suggested additional studies to honor training methodologies.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Bethoux F, Stallkamp Tidd S, Thompson N, Linder SM. Feasibility and outcomes of gait training with a powered exoskeleton in individuals with multiple sclerosis. Presented at: CMSC 2022 Annual Meeting; June 1-4, 2022; National Harbor, Maryland. Abstract REH03.

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