EKSO Trial: Powered Exoskeleton for Ambulation in Subjects With SCI (EKSO)
This study seeks to test the safety and efficacy of the Esko device in SCI population and in populations with similar neurological weakness to the SCI population. The device can currently stand from a seated position, walk, and turn and sit down. Our hypothesis are as follows:
- Hypothesis 1: We hypothesize that the Ekso subject will significantly improve balance while wearing the device as noted by subject's ability to safely achieve standing balance for 30 sec without loss of balance.
- Hypothesis 2: We hypothesize that the Ekso subject will display improved ability to safely ambulate 10 meters to be assessed using the 10 meter walk test.
- Hypothesis 3: We hypothesize that the Ekso subject will display improved weight shift in both static and dynamic activities as determined by a trained physical therapist.
- Hypothesis 4: We hypothesize that the Ekso subject will verbalize improved success with training of the device as noted by subjective questionnaires that will be assessed following each training session.
|Spinal Cord Injuries or Similar Neurological Weakness||Device: Ekso exoskeleton||Phase 1|
|Study Design:||Intervention Model: Single Group Assignment
Masking: Open Label
|Official Title:||Investigational Study of the Ekso Powered Exoskeleton for Ambulation in Individuals With Spinal Cord Injury (or Similar Neurological Weakness)|
- Change in 6 Minute Walk Test from baseline in distance, RPE and oxygen uptake [ Time Frame: Testing Day 1 - 3 and follow up testing Week 6 and Week 12. ]The goal is to cover as much ground as possible over 6 minutes, the distance is measured with a measuring wheel. The instructions are "Walk continuously if possible, but do not be concerned if you need to slow down or stop to rest." At the end of 6 minutes the participant is asked to rate their exertion level on a Borg Scale of 6 - 20 points. The VO2 MAX data is collected during the test every 10 seconds
- Change in 10 meter walk test from baseline in gait speed [ Time Frame: Testing Day 1 - 3 and follow up testing Week 6 and Week 12 ]Measure the time in second for and individual to walk 10 meters. The test is performed using a "flying start," patient walks 10 meters (33 ft) and the time is measured when the leading foot crosses the start line and the finish line. The instructions are: " Please walk this distance as fast as you safely can when I say go."
- Ratio of number of steps/walking time [ Time Frame: Testing Day 1 - 3 and follow up testing Week 6 and Week 12. ]The data will be collected from the Ekso statistics mode [data provided by the machine]
- 2 Minute Walk Test [ Time Frame: Testing Day 1 and follow up testing Week 6 and Week 12 ]Individual walks for 2 minutes and the distance is measured, start timing when the individual is instructed to "Go,"stop timing at 2 minutes, assistive devices can be used and documented from test to test, if physical assistance and/or tethering is required it will be recorded as well. The test should be performed at the fastest safest speed possible.
- Walk time to stand time ratio on a particular assistive device [ Time Frame: Testing Day 1 and follow up testing Week 6 and Week 12 ]The data will be collected from the statistics section of the Ekso. As patients progress from a rolling walker assistive device to the forearm crutches the ratio will be collected and compared to the initial and then final sessions with that particular device.
- Psychosocial Impact of Assistive Device Scale (PIADS) [ Time Frame: Day 1- 3 after the first trial of the Ekso, follow up testing on Week 6 and Week 12 ]
The PIADS is a 26-item, self-report questionnaire designed to assess the effects of an assistive device on functional independence, well-being, and quality of life.
The PIADS can be used to assess the impact of any assistive device (AD), prosthesis or medical procedure. It can be used to evaluate the impact of ADs over time and to match the devices with consumers. With its excellent psychometric properties, the PIADS fills a missing link in the assessment of ADs as well as in the examination of their acceptance and abandonment.
|Study Start Date:||May 2012|
|Estimated Study Completion Date:||April 2017|
|Estimated Primary Completion Date:||April 2017 (Final data collection date for primary outcome measure)|
Experimental: Ekso Safety and Efficacy
Observational study on the first time use of a robotic exoskeleton.
Device: Ekso exoskeleton
The participants will receive 1 - 40 training sessions. The sessions will be 1 hour of device use including balance training, gait training and sit to and from stand training with rolling walker and/ or forearm crutches.
Other Name: Ekso by Eksobionics
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This is an investigational clinical study trialing the safety and efficacy of the Esko device in the SCI population. Participants with a variety of spinal cord injury diagnoses (e.g. motor complete/incomplete, paraplegia/ tetraplegia) or diagnoses presenting with similar neurological weakness will be included to best determine the criteria for using the Ekso device within this population. The Ekso is an anthropomorphic mobile exoskeleton that is intended for spinal cord injury rehabilitation and mobility. The device is used to drive the patient's lower extremity joints through a desired trajectory in order to obtain a user specified motion.
The device is electrically powered by two motors at the knee and hip joints of either leg of the user. The flexion and extension directions at the hip and knee are only actuated degrees of freedom on the device. The device is equipped with mechanical hard stops at the limits of healthy subject ranges of motion to prevent powering the joint of the user to a position that the joint cannot reach. The device operates using a number of sensors. Some of these sensors are dedicated to maintaining proper function of the mechanical system and some are devoted to determining the user intent while using the device. The user focused sensors are foot pressure sensors at the heel and toe of both feet to determine the forces between the user and the ground at those locations.
The control code in the device behaves by creating an internal estimate of the subject's current position and then coordinating the motion of the four actuated degrees of freedom to take the desired motion. The desired motion is specified through an attached user interface that can be used by the patient or a therapist. The device can currently stand from a seated position, walk, and turn and sit down. In actual operation the device is triggered by one of two modes. The first mode is used early in training where the therapist manually triggers the steps of the user using the graphical interface; for advanced users, the machine interprets their motions to determine when steps are desired and the therapist is only responsible for starting and stopping the motion.
Complete and incomplete SCI patients as well as patients with similar neurological weakness will be recruited from inpatient, day rehab and outpatient clinics. Participants will be scheduled from 1-40 sessions. The amount of sessions provided will be dependent upon compatibility with device, ability to tolerate device use and ability to safely ambulate using the device. A participant will continue with each phase of the study as deemed appropriate by research staff:
- A.Phase 1 (1-3 sessions): To determine if participant is compatible with device use. If participant is not compatible with device the study will stop here. If participant is compatible with device, subject will move into phase 2.
- B.Phase 2 (4-10 sessions): Assessment and training of participant with device to determine safety and efficacy of subject with device. If subject is unsafe with device or does not tolerate device well then the study will stop here. If participant is safe, comfortable and efficient with device, participant will move into phase 3.
- C.Phase 3 (11-40 sessions): Continued training with participant to determine functional ability of patient to use device within a lab or clinical environment.
All testing and training sessions will be under supervision of a licensed physical therapist. Manual assistance or cueing will be provided as necessary for safety and balance. Vital signs will be monitored before and after physical exertion. All subjects will be permitted to stop physical activity or rest at any time during the study. Adverse events will be recorded.
We anticipate this study will help to determine if the Ekso device is a feasible option to initiate ambulation in the motor complete SCI population, motor incomplete SCI population and other similar diagnostic populations unable to ambulate over ground. We do not foresee any potential pitfalls.
Please refer to this study by its ClinicalTrials.gov identifier: NCT01701388
|United States, Illinois|
|Rehabilitation Institute of Chicago|
|Chicago, Illinois, United States, 60611|
|Principal Investigator:||Arun Jayaraman, PhD||RIC/Northwestern|