AUTHOR=Hohl Kristen , Smith Andrew C. , Macaluso Rebecca , Giffhorn Matthew , Prokup Sara , O’Dell Denise R. , Kleinschmidt Lina , Elliott Jim M. , Jayaraman Arun TITLE=Muscle adaptations in acute SCI following overground exoskeleton + FES training: A pilot study JOURNAL=Frontiers in Rehabilitation Sciences VOLUME=3 YEAR=2022 URL=https://www.frontiersin.org/journals/rehabilitation-sciences/articles/10.3389/fresc.2022.963771 DOI=10.3389/fresc.2022.963771 ISSN=2673-6861 ABSTRACT=Objective

To evaluate the combined effects of robotic exoskeleton and functional electrical stimulation (FES) training on muscle composition during over-ground gait training in persons with acute spinal cord injury (SCI).

Design

Randomized crossover pilot study.

Setting

Inpatient-rehabilitation Hospital.

Participants

Six individuals with acute SCI.

Intervention

Participants were randomized to either receive training with the Ekso® Bionics exoskeleton combined with FES in addition to standard-of-care or standard-of-care alone.

Outcome measures

The main outcome measures for the study were quantified using magnetic resonance imaging (MRI), specifically, lower extremity muscle volume and intramuscular adipose tissue (IMAT). Static balance and fall risk were assessed using the Berg Balance Scale.

Results

Significant improvements were observed in muscle volume in the exoskeleton intervention group when compared to only standard-of-care (p < 0.001). There was no significant difference between the groups in IMAT even though the intervention group saw a reduction in IMAT that trended towards statistical significance (p = 0.07). Static balance improved in both groups, with greater improvements seen in the intervention group.

Conclusions

Early intervention with robotic exoskeleton may contribute to improved muscle function measured using MRI in individuals with acute SCI.