[Robot therapy with the H2 exoskeleton for gait rehabilitation in patients with incomplete spinal cord injry. A clinical experience]. / Terapia robótica con el exoesqueleto H2 en la rehabilitación de la marcha en pacientes con lesión medular incompleta. Una experiencia clínica.

BACKGROUND AND OBJECTIVE: Robotic exoskeletons have emerged as a promising tool in gait rehabilitation in patients with a spinal cord injury. The aim of this study was to assess the clinical applicability of a new robotic exoskeleton model (Exo H2) in the rehabilitation of people with incomplete spinal cord injury. MATERIAL AND METHODS: Exo H2 exoskeleton training was performed for 15 sessions in patients with incomplete subacute spinal cord injury. We analysed the appearance of undesirable events and the patient's perception of pain, fatigue and comfort. In addition, a pilot test was carried out on the possible effectiveness of the device by analysing gait characteristics before and after treatment measured by the 10mWT, the 6mWT, the TUG, the WISCI-II, and the impact on the SCIM III scale. RESULTS: Of a group of 8 patients recruited, we were able to analyse data from 4. No undesirable effects were reported. The VAS value was 2.28±1.55 for pain, 3.75±1.55 for fatigue and 4.17±1.68 for comfort. All values improved on the WISCI-I and the TUG and almost all in the 10MWT and in the 6MWT. CONCLUSIONS: The performance of the Exo H2 exoskeleton was robust during a clinical protocol for gait rehabilitation. The treatment was safe, without undesirable effects and with good patient tolerance. These results might justify the performance of clinical trials with an adequate sample size.

Shoulder joint kinetics during wheelchair propulsion on a treadmill at two different speeds in spinal cord injury patients.

STUDY DESIGN: Prospective study using biomechanics patient data. OBJECTIVES: To analyze shoulder joint kinetics while propelling a wheelchair placed on a treadmill and compare shoulder joint net forces and moments when changing the speed of wheelchair propulsion on the treadmill. SETTING: National Hospital for Spinal Cord Injury, Toledo, Spain. METHODS: Sixteen subjects with thoracic spinal cord injury participated. A kinematic analysis system consisting of four camcorders (Kinescan-IBV) and a kinetic device that registered the contact force of the hand on the pushrim (SMART(Wheel)) were used. The wheelchair was propelled at 3 and 4 km h(-1) without any ramp. An inverse dynamic model allowed shoulder joint net forces and moments to be calculated from the contact force of the hand on the pushrim and kinematic data. RESULTS: Increasing propulsion speed increased most of the temporal parameters of propulsion and pushrim kinetics and shoulder joint net forces and moments. Compared with other studies that used an ergometer or dynamometer at the same speed, the magnitude of the shoulder joint net forces and moments elicited by wheelchair propulsion on the treadmill were lower than obtained by wheelchair propulsion on other devices. CONCLUSION: Lower magnitude of shoulder joint forces and moments found on the treadmill may be due to the lower friction compared with the other devices reviewed. Shoulder joint forces and moments depended strongly on the propulsion speed, increasing in magnitude when speed increased from 3 to 4 km h(-1).

Comparative biomechanical gait analysis of patients with central cord syndrome walking with one crutch and two crutches.

BACKGROUND: Ambulatory people with central cord syndrome often require assistive devices. The selection of a suitable assistive device should be based on an objective assessment. Our objective in this study was to determine whether there was any difference in using two crutches over one crutch, considering that these patients have bilateral upper-limb involvement. METHODS: Kinematic gait analysis was conducted in 12 patients with central cord syndrome of more than one year of evolution and functional capacity for walking with one crutch or without crutches. Patients were asked to walk with one crutch and with two crutches at a freely chosen walking speed through a 10-m walkway. Three-dimensional kinematic equipment based on active markers was used to analyze temporospatial and articular parameters (maximum, minimum, and range of motion, ROM, throughout the cycle) FINDINGS: During two-crutch versus one-crutch walking, speed was lower (P=0041), stride time and step time were longer (P=0.004 and P=0.005) and there were fewer strides/minute and steps/minute (P=0.005 and P=0.006). The duration of the single support stance was longer during two-crutch walking (P=0.008). With respect to the articular parameters, both ankle ROMs (dorsi-plantar flexion P=0.003 and pronation-supination P=0.004) were greater with one-crutch walking than with two-crutch walking. INTERPRETATION: In patients with central cord syndrome capable of walking with one crutch or without crutches, walking with two crutches decreases speed, increases stride time and step time and improves stability by increasing single support, and diminishes ankle plantar flexion during swing phase.

Comparative study of pressure distribution at the user-cushion interface with different cushions in a population with spinal cord injury.

BACKGROUND: Few studies have offered comparative information on the mechanical characteristics of different wheelchair seat cushions. The objective of the present study was to compare the benefits of the wheelchair seat cushions most frequently used in a population of patients with spinal cord injury in terms of pressure distribution and contact surface at the user-cushion interface. METHODS: Each one of 48 patients with spinal cord injury was seated in his or her own wheelchair on the four models of cushions analyzed (low-profile air, high-profile air, dual-compartment air, and gel and firm foam), which were presented in randomized order. The pressure distribution readings and support surface area of the user-cushion interface were obtained with a matrix of piezocapacitive sensors. FINDINGS: The dual-compartment air cushion yielded lower readings for all pressure parameters analyzed (P(max), P(mean), P(sd), and P(isch)) than the other three cushion models (P<0.05). The best surface parameter results (S(tot), S>60 and %S>60) also were obtained with the dual-compartment air cushion (P<0.05). INTERPRETATION: In the sample analyzed, the dual-compartment air cushion was the cushion with the best pressure distribution and largest contact surface of the user-cushion interface compared to the other three cushions studied.