title: Time and Effort Required by Persons with Spinal Cord Injury to Learn to Use a Powered Exoskeleton for Assisted Walking.
abstract: BACKGROUND
  Powered exoskeletons have been demonstrated as being safe for persons with spinal cord injury (SCI), but little is known about how users learn to manage these devices.
  
  
  OBJECTIVE
  To quantify the time and effort required by persons with SCI to learn to use an exoskeleton for assisted walking.
  
  
  METHODS
  A convenience sample was enrolled to learn to use the first-generation Ekso powered exoskeleton to walk. Participants were given up to 24 weekly sessions of instruction. Data were collected on assistance level, walking distance and speed, heart rate, perceived exertion, and adverse events. Time and effort was quantified by the number of sessions required for participants to stand up, walk for 30 minutes, and sit down, initially with minimal and subsequently with contact guard assistance.
  
  
  RESULTS
  Of 22 enrolled participants, 9 screen-failed, and 7 had complete data. All of these 7 were men; 2 had tetraplegia and 5 had motor-complete injuries. Of these, 5 participants could stand, walk, and sit with contact guard or close supervision assistance, and 2 required minimal to moderate assistance. Walk times ranged from 28 to 94 minutes with average speeds ranging from 0.11 to 0.21 m/s. For all participants, heart rate changes and reported perceived exertion were consistent with light to moderate exercise.
  
  
  CONCLUSIONS
  This study provides preliminary evidence that persons with neurological weakness due to SCI can learn to walk with little or no assistance and light to somewhat hard perceived exertion using a powered exoskeleton. Persons with different severities of injury, including those with motor complete C7 tetraplegia and motor incomplete C4 tetraplegia, may be able to learn to use this device.
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York New York.
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Kozlowski
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York New York.
authors.forename: Thomas N
authors.initials: TN
authors.lastname: Bryce
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York New York.
authors.forename: Marcel P
authors.initials: MP
authors.lastname: Dijkers
mesh_terms: D000293:Adolescent; D000328:Adult; D000067190:Exoskeleton Device; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007858:Learning; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion / Q000502:physiology; D011782:Quadriplegia / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000534:rehabilitation*; D013997:Time Factors; D016138:Walking / Q000502:physiology*; D055815:Young Adult
keywords: adverse events; ambulation; assistive technology; exercise; exoskeleton; spinal cord injury; walking