Overground Bionic Ambulation – Walking in an Exoskeleton

April 2015 – A couple years ago these battery-powered, external bodysuits designed to artificially walk people living with paralysis were launched onto the market; henceforth known as bionic exoskeletons.  They were cool devices designed by amazing engineers.

The question, however, was “what are they good for?”

  • Rehabilitation?
  • Exercise?
  • Mobility device?

Miami Project clinical researchers launched a pilot study to try to answer that question and the results were recently published in a peer-reviewed journal: Understanding Therapeutic Benefits of Overground Bionic Ambulation: Exploratory Case Series in Persons With Chronic, Complete Spinal Cord Injury (2014) Jochen Kressler, PhD, Christine K. Thomas, PhD, Edelle C. Field-Fote, PT, PhD, FAPTA, Justin Sanchez, PhD, Eva Widerström-Noga, DDS, PhD, Deena C. Cilien, BS, Katie Gant, MS, Kelly Ginnety, MS, Hernan Gonzalez, BS, Adriana Martinez, BS, Kimberly D. Anderson, PhD, Mark S. Nash, PhD, FACSM. Archives of Physical Medicine and Rehabilitation

Three people with chronic, complete thoracic spinal cord injury (SCI) walked in the exoskeleton 3 days/week for 6 weeks.  The research team evaluated changes in walking speeds and distances, energy expenditure, exercise conditioning effects, neuromuscular and cortical activity patterns, spasticity and pain severity before and after the 6 week intervention.  While walking in the device, participants with motor-complete SCI were able to achieve walking speeds and distances similar to those observed in persons with motor-incomplete SCI not using the device. The energy expenditure required for walking in the device was low, similar to walking in persons without disability, and exercise conditioning effects were negligible.  Participants with less leg spasticity walked longer during training, however walking in the device did not change or improve leg muscle activity. Additionally, there was no change in brain cortical activity patterns.  However, all participants reported an average reduction in pain severity over the 6 week study period.

Conclusions from this pilot study suggest that walking in an exoskeleton has no rehabilitation or exercise benefits.  However, it is good way to improve functional mobility.  The really important benefit is the reduction in neuropathic pain, a consequence of SCI that impacts many people and is very difficult to treat.