Walking after incomplete spinal cord injury: Changes in muscle activations due to training with a robotic powered exoskeleton

In recent years, an increasing number of clinical centres have started including powered exoskeleton-assisted gait training to SCI patients' conventional therapy, but more evidence about the effects of this kind of therapy on gait patterns is needed. The goal of this study was to investigate: (1) the changes in muscle activations due to the use of the exoskeleton, (2) the changes in muscle activations and spatio temporal parameters after an exoskeleton-assisted gait training, both during unassisted and assisted gait. In the study, 3 incomplete SCI subjects underwent an exoskeleton assisted gait training and were assessed before and after the therapy. Changes in gait speed and endurance were evaluated using clinical metrics (10-MWT and 6-MWT), while spatio temporal and muscles activations changes were assessed using an electromyography (EMG) and a motion capture system. Clinical results showed an increase after training of endurance and gait speed as confirmed by the spatio temporal parameters (increment of the swing phase and reduction of the stride duration). As for the EMG data, small positive changes were observed in post training unassisted walking muscles activations of the three patients. As expected, changes due to training or to assistance were subject-dependent and varied in function of the initial residual abilities of the single individual.