title: Assessment of In-Hospital Walking Velocity and Level of Assistance in a Powered Exoskeleton in Persons with Spinal Cord Injury.
abstract: BACKGROUND
  Individuals with spinal cord injury (SCI) often use a wheelchair for mobility due to paralysis. Powered exoskeletal-assisted walking (EAW) provides a modality for walking overground with crutches. Little is known about the EAW velocities and level of assistance (LOA) needed for these devices.
  
  
  OBJECTIVE
  The primary aim was to evaluate EAW velocity, number of sessions, and LOA and the relationships among them. The secondary aims were to report on safety and the qualitative analysis of gait and posture during EAW in a hospital setting.
  
  
  METHODS
  Twelve individuals with SCI ≥ 1.5 years who were wheelchair users participated. They wore a powered exoskeleton (ReWalk; ReWalk Robotics, Inc., Marlborough, MA) with Lofstrand crutches to complete 10-meter (10 MWT) and 6-minute (6MWT) walk tests. LOA was defined as modified independence (MI), supervision (S), minimal assistance (Min), and moderate assistance (Mod). Best effort EAW velocity, LOA, and observational gait analysis were recorded.
  
  
  RESULTS
  Seven of 12 participants ambulated ≥ 0.40 m/s. Five participants walked with MI, 3 with S, 3 with Min, and 1 with Mod. Significant inverse relationships were noted between LOA and EAW velocity for both 6 MWT (Z value = 2.63, Rho = 0.79, P = .0086) and 10 MWT (Z value = 2.62, Rho = 0.79, P = .0088). There were 13 episodes of mild skin abrasions. MI and S groups ambulated with 2-point alternating crutch pattern, whereas the Min and Mod groups favored 3-point crutch gait.
  
  
  CONCLUSIONS
  Seven of 12 individuals studied were able to ambulate at EAW velocities ≥ 0.40 m/s, which is a velocity that may be conducive to outdoor activity-related community ambulation. The ReWalk is a safe device for in-hospital ambulation.
authors.affiliation: VA Rehabilitation Research & Development National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York.|Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Ajax
authors.initials: A
authors.lastname: Yang
authors.affiliation: VA Rehabilitation Research & Development National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York.
authors.forename: Pierre
authors.initials: P
authors.lastname: Asselin
authors.affiliation: VA Rehabilitation Research & Development National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York.
authors.forename: Steven
authors.initials: S
authors.lastname: Knezevic
authors.affiliation: VA Rehabilitation Research & Development National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York.|Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kornfeld
authors.affiliation: VA Rehabilitation Research & Development National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, New York.|Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.|Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Spungen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004867:Equipment Design; D000067190:Exoskeleton Device / Q000009:adverse effects; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000534:rehabilitation; D011187:Posture; D012449:Safety; D012867:Skin / Q000293:injuries; D013119:Spinal Cord Injuries / Q000451:nursing / Q000534:rehabilitation*; D016138:Walking; D055815:Young Adult
keywords: ReWalk; community ambulation; gait analysis; gait velocity; level of assistance; paralysis; powered exoskeleton; spinal cord injury