Complete Motor Paraplegia
Conditions
Keywords
exoskeleton, paraplegia, rehabilitation
Brief summary
The loss of standing and walking capabilities in a paraplegic person is most often the result of damage to the spinal cord, either traumatic (accidental) or pathological and has both a somatic and a psychological impact on the quality of life, the risk of depression, and the difficulty of socio-professional reintegration in a society that is not adapted to people with disabilities. A motorized mechanical exoskeleton is an external device intended to compensate for a muscular or neurological deficiency enabling paraplegics to stand and walk again. The Atalante exoskeleton, designed by Wandercraft company allows patients to stand upright and walk without the aid of crutches. This early study was the first clinical investigation of the Atalante exoskeleton performed early in the development. It was used to evaluate the device design concept with respect to initial clinical safety and device functionality and guided further device modifications.
Detailed description
The aim of this study was to test the use of the Atalante exoskeleton on 10 patients with complete motor paraplegia (ASIA A and B) with a level of injury between T6 and S1. In this multi-centric clinical trial, patients were asked to perform between 1 and 2 days of training with Atalante exoskeleton including device training and evaluations (up to 9 hours of training and 3 hours of evaluation per patient). The primary objective of this study was to assess patients' ability to walk straight- for 10 meters with the Atalante exoskeleton during 10-meters walk test (10MWT). Within-group differences between the Atalante exoskeleton and the usual walking aid used by the patient in the success rate of the 10MWT were compared by a McNemar test. The secondary objectives focused on performance evaluation with the Atalante exoskeleton. The assessments performed were: 1. Assessment of the superiority of the Atalante exoskeleton compared to the usual aid walking assistance used by the patient on the walking, verticalization (or sit-to-stand), static and dynamic balance ability 2. Assessment of the static and dynamic postural stability of the subject with the Atalante exoskeleton by observation of center of pressure displacement and velocity 3. Assessment of the perceived effort by the patient 4. Assessment of perceived safety by the patient 5. Assessment of the overall satisfaction of patients after using the exoskeleton 6. Comparison of the two types of walk on walking ability, perceived effort, and safety
Interventions
DEVICETest with Atalante exoskeleton in continuous walk type
The continuous walk is smoother and more physiologic than the push and swing walk
Sponsors
Wandercraft
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
DEVICE_FEASIBILITY
Masking
NONE
Intervention model description
Prospective, multicentric, comparative, randomized cross-over study
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Under 60 years of age * Daily and autonomous use of wheelchair * Paraplegia with level of injury between T6 and S1 * Patient unable to walk, neither during physiotherapy session nor in a daily routine * Patient with cognitive capacities: able to understand oral and/or written instructions, as well as instructions given by demonstration * Able to use their upper limbs * Can be verticalized * Patient with a health care insurance * Patient having given his/her written consent * Joints amplitudes compatible with the use of the exoskeleton: * Hip: Flexion\>115°; Extension\>15°; Abduction\>17°; Adduction \>10°; Medial rotation\>35°; Internal rotation\>10° * Knee: Flexion\>105°; Extension\> -5° * Ankle: Flexion\>0°; Extension\>9°; Supination\>18°; Pronation\>18°
Exclusion criteria
* Severe or complete deficiency of the upper limbs * Bad control of the trunk * Vestibular disorder (loss of balance, dizziness, …) when placed in the vertical position * Upper limbs involuntary shivers and/or movements * Pregnant women * A lower or upper limb amputated * Epilepsy * Patient carrying an active implantable medical device
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The primary objective of this study was to assess patients' ability to walk straight- for 10 meters with the Atalante exoskeleton during 10-meters walk test (10MWT). | Day 2 | Within-group differences between the Atalante exoskeleton and the usual walking aid used by the patient in the success rate of the 10MWT were compared by a McNemar test. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Assessment of the static and dynamic postural stability | Day 2 | Static balance test with measurement of center of pressure displacement |
| Assessment of the perceived effort by the patient | Day 2 | Evaluation of perceived effort by the patient through a Borg CR-10 scale |
| Assessment of the superiority of the Atalante exoskeleton compared to the usual aid | Day 2 | Evaluation of walking ability through a 10mWT |
| Assessment of the overall satisfaction of patients after using the exoskeleton | Day 2 | Assessment of the patient overall satisfaction through a 7-point Likert scale |
| Comparison of the two types of walk | Day 2 | Comparison of the two types of walk on walking ability through the 10mWT |
| Assessment of perceived safety by the patient | Day 2 | Evaluation of perceived safety by the patient through a 7-point Likert scale |
Countries
France
Outcome results
None listed