Walking with a powered robotic exoskeleton: subjective experience, spasticity and pain in Spinal Cord Injured persons

BACKGROUND: Powered robotic exoskeletons represent an emerging technology for the gait training of Spinal Cord Injured (SCI) persons. The analysis of the psychological and physical impact of such technology on the patient is crucial in terms of clinical appropriateness of such rehabilitation intervention for SCI persons. OBJECTIVE: To investigate the acceptability of overground robot-assisted walking and its effect on pain and spasticity. METHODS: Twenty-one SCI persons participated in a walking session assisted by a powered robotic exoskeleton. Pain assessed using a Numeric Rating Scale (NRS) and muscle spasticity, assessed as subjective perception using an NRS scale and as objective assessment using the Modified Ashworth scale and the Penn scale, were evaluated before and after the walking experience. Positive and negative sensations were investigated using a questionnaire. The patient’s global impression of change (PGIC) scale was administrated as well. RESULTS: After the walking session a significant decrease in the muscle spasticity and pain intensity was observed. The SCI persons recruited in this study reported (i) a global change after the walking session, (ii) high scores on the positive and (iii) low scores on the negative sensations, thus indicating a good acceptability of the robot-assisted walking. CONCLUSIONS: The overground robot-assisted walking is well accepted by SCI persons and has positive effects in terms of spasticity and pain reduction