Performance Attributes and User Progression While Using Ekso
Primary Purpose
Spinal Cord Injury
Status
Completed
Phase
Not Applicable
Locations
International
Study Type
Interventional
Intervention
Ekso
Sponsored by
About this trial
This is an interventional treatment trial for Spinal Cord Injury
Eligibility Criteria
Inclusion Criteria:
- Inpatient or outpatient from 15 through 65 years of age at time of entry into the trial
- Motor complete (ASIA Impairment Scale [AIS] A and B), with a neurological level of injury (NLI) between C7-L2 (inclusive), or motor incomplete (AIS C and D), NLI C1-L2 (inclusive), as determined by the International Standards for Neurological Classification of SCI (ISNCSCI)
- Greater than 30 days since SCI occurred
- Height from 157 - 188 centimeters (5'2" to 6'2") or for individuals who do not meet this criteria the following criteria may be used as assessed per the Ekso operating manual:
Max hip width= 16.5" or 42cm Upper leg length= 20" to 24⅛" or 51cm to 61.4cm Lower leg length= 19" to 25" or 48cm to 63.4cm
- Maximum weight of 100 kilograms (220 pounds)
- Sufficient upper extremity (UE) strength to use a front wheeled walker (FWW) either by manual muscle testing (MMT) (minimum triceps strength bilaterally of 3/5, shoulder abduction/adduction and flexion/extension 4/5) and/or by functional standing test with FWW. Participants with impaired hand function may use cuff grips.
Sufficient range of motion (ROM) to achieve a normal, reciprocal gait pattern, and normal sit to stand transitions.
- Hip extension greater than or equal to 5 degrees
- Knee extension greater than or equal to 5 degrees
- Ankle dorsiflexion greater than or equal to 0 degrees
- Demonstrate adequate trunk stability and upper extremity strength to utilize Ekso as evidenced by the ability to complete a level (or near level) surface wheelchair to mat transfer with minimal assistance.
- Medically stable and cleared by a physician for full weight bearing locomotor training including 15 minute standing frame trial to assess standing tolerance
Exclusion Criteria:
- Have trained in Ekso in the past except for one or two training/demonstration sessions
- Utilizing another robotic device for locomotor training
Any medical issue that in the opinion of the Investigator precludes full weight bearing locomotor training including but not limited to:
- Spinal instability (or spinal orthotic unless cleared by physician)
- Acute deep vein thrombosis (DVT) with activity restrictions
- Severe, recurrent autonomic dysreflexia (AD) requiring medical intervention
- Heterotopic ossification (HO) in the lower extremities resulting in ROM restrictions at the hips or knees
- Two or more pathological fractures in the last 48 months in a major weight bearing bone (femur or tibia) in the lower extremity
- Hip subluxation (x-rays will be obtained for individuals injured prior to 10 years of age)
- Any medical issue that in the opinion of the Investigator would affect participant safety either due to cognitive deficits/impulsivity, intolerance to mild exercise or other factors
- Any issue that in the opinion of the Investigator would confound results such as a concurrent neurological injury or disorder (other than SCI) or other factors
- Modified Ashworth Scale (MAS) = 4 in the majority of lower extremity joints (e.g. greater than or equal to four joint movements in bilateral lower extremities when testing hip flexion/extension, knee flexion/extension, ankle dorsi/plantar flexion)
- Skin integrity issues in areas that contact the device (including abdominal ostomies) or that would prohibit sitting
- Pregnancy
Sites / Locations
- Glostrup Hospital
- Universitats-und Rehabilitationskliniken
- Heliomare Revalidatie
- Sunnaas Sykehus HF
- Institut Guttmann, Neurorehabilitation Hospital
- Fundacion Lesionado Medular
- Clinical Department of Rehabilitation Medicine and Department of Medicine and Health Services
- Sinalenheten, Akademiska Sjukhuset
- Swiss Paraplegic Center (SPZ)
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
Ekso treatment
Arm Description
Outcomes
Primary Outcome Measures
Number of participants able to complete gait training progression using Ekso
To evaluate the performance attributes and user progression of participants with motor complete and incomplete spinal cord injury (SCI) while utilizing the Ekso robotic exoskeleton in an eight week over ground, locomotor program. The user will be trained with 1 person assisting without an overhead tether in multiple modes and levels of assist while maintaining safety. The following will indicate completion of training: number of Ekso sessions completed, ability to train in ProStep on or before session #24 without a tether, number of steps in device, time spent walking in device, and the duration of training sessions in each mode.
Secondary Outcome Measures
Cardiovascular Effect
The heart rate and blood pressure while sitting, at rest, and during activity will be taken to measure cardiovascular health changes. The perceived rate of exertion will also be used to determine cardiovascular effect.
Impact of Ekso Training on Spasticity
The impact of Ekso training on muscle spasticity will be measured using the Modified Ashworth Scale (MAS)
Mobility Progression
Impact of Ekso training on gait in participants who are ambulatory prior to Ekso training. Gait progression will be evaluated in individuals with motor incomplete SCI who are ambulatory outside of Ekso. They will utilize Timed Up and Go (TUG) to monitor mobility.
Impact of Ekso Training on Strength
The muscle strength of users will be analyzed to see if there is any gain in strength due to the Ekso training program.
Change in Bladder Function
Evaluate the function of bowel and bladder as impacted by Ekso training using Modified International SCI Lower Urinary Tract Basic Data Set
Functional Abilities
Functional abilities will be measured based on Spinal Cord Independence Measure II (SCIM II)
Change in Bowel Function
The effect of Ekso training on bowel function will be evaluated using Modified International SCI Bowel Function Basic Data Set
Quality of Life
The Quality of Life change due to Ekso training will be evaluated using the International SCI Quality of Life Basic Data Sheet
Balance
Impact of Ekso training on gait in participants who are ambulatory prior to Ekso training. Gait progression will be evaluated in individuals with motor incomplete SCI who are ambulatory outside of Ekso. They will utilize Berg Balance Scale (BBS) to measure balance.
Gait Speed
Impact of Ekso training on gait in participants who are ambulatory prior to Ekso training. Gait progression will be evaluated in individuals with motor incomplete SCI who are ambulatory outside of Ekso. They will utilize a 10 Meter Walk Test to analyze gait speed.
Gait Progression
Impact of Ekso training on gait in participants who are ambulatory prior to Ekso training. Gait progression will be evaluated in individuals with motor incomplete SCI who are ambulatory outside of Ekso. They will utilize the Walking Index for Spinal Cord Injury II (WISCI II) and note any changes in walking assistive device utilized.
Full Information
NCT ID
NCT02132702
First Posted
May 2, 2014
Last Updated
February 12, 2018
Sponsor
Ekso Bionics
Collaborators
Glostrup University Hospital, Copenhagen
1. Study Identification
Unique Protocol Identification Number
NCT02132702
Brief Title
Performance Attributes and User Progression While Using Ekso
Official Title
Performance Attributes and User Progression While Using Ekso Robotic Exoskeleton in an Eight Week, Over Ground, Locomotor Program in Individuals With Spinal Cord Injury
Study Type
Interventional
2. Study Status
Record Verification Date
February 2018
Overall Recruitment Status
Completed
Study Start Date
August 2014 (undefined)
Primary Completion Date
January 2017 (Actual)
Study Completion Date
January 2017 (Actual)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Ekso Bionics
Collaborators
Glostrup University Hospital, Copenhagen
4. Oversight
5. Study Description
Brief Summary
This study is to evaluate the performance attributes and user progression of participants with motor complete and incomplete spinal cord injury (SCI) while utilizing the Ekso robotic exoskeleton in an eight week over ground, locomotor program. We hypothesize an improvement in progression and overall health while using Ekso.
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Spinal Cord Injury
7. Study Design
Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
65 (Actual)
8. Arms, Groups, and Interventions
Arm Title
Ekso treatment
Arm Type
Experimental
Intervention Type
Device
Intervention Name(s)
Ekso
Primary Outcome Measure Information:
Title
Number of participants able to complete gait training progression using Ekso
Description
To evaluate the performance attributes and user progression of participants with motor complete and incomplete spinal cord injury (SCI) while utilizing the Ekso robotic exoskeleton in an eight week over ground, locomotor program. The user will be trained with 1 person assisting without an overhead tether in multiple modes and levels of assist while maintaining safety. The following will indicate completion of training: number of Ekso sessions completed, ability to train in ProStep on or before session #24 without a tether, number of steps in device, time spent walking in device, and the duration of training sessions in each mode.
Time Frame
baseline (1st session), session #1, session #12, session #24, followup at 12 weeks. Sessions occur 3x/week over an 8 week training period with a follow up visit at week 12.
Secondary Outcome Measure Information:
Title
Cardiovascular Effect
Description
The heart rate and blood pressure while sitting, at rest, and during activity will be taken to measure cardiovascular health changes. The perceived rate of exertion will also be used to determine cardiovascular effect.
Time Frame
baseline (1st session), session #1, session #12, session #24, followup at 12 weeks. Sessions occur 3x/week over an 8 week training period with a follow up visit at week 12.
Title
Impact of Ekso Training on Spasticity
Description
The impact of Ekso training on muscle spasticity will be measured using the Modified Ashworth Scale (MAS)
Time Frame
baseline (1st session), session #12, session #24, followup at 12 weeks. Sessions occur 3x/week over an 8 week training period with a follow up visit at week 12.
Title
Mobility Progression
Description
Impact of Ekso training on gait in participants who are ambulatory prior to Ekso training. Gait progression will be evaluated in individuals with motor incomplete SCI who are ambulatory outside of Ekso. They will utilize Timed Up and Go (TUG) to monitor mobility.
Time Frame
baseline (1st session), session #12, session #24, followup at 12 weeks. Sessions occur 3x/week over an 8 week training period with a follow up visit at week 12.
Title
Impact of Ekso Training on Strength
Description
The muscle strength of users will be analyzed to see if there is any gain in strength due to the Ekso training program.
Time Frame
baseline (1st session), after session #1, session #12, session #24, followup at 12 weeks. Sessions occur 3x/week over an 8 week training period with a follow up visit at week 12.
Title
Change in Bladder Function
Description
Evaluate the function of bowel and bladder as impacted by Ekso training using Modified International SCI Lower Urinary Tract Basic Data Set
Time Frame
baseline (1st session), after session #1, session #12, session #24, followup at 12 weeks. Sessions occur 3x/week over an 8 week training period with a follow up visit at week 12.
Title
Functional Abilities
Description
Functional abilities will be measured based on Spinal Cord Independence Measure II (SCIM II)
Time Frame
baseline, session #12, session #24, followup at 12 weeks. Sessions occur 3x/week over an 8 week training period with a follow up visit at week 12.
Title
Change in Bowel Function
Description
The effect of Ekso training on bowel function will be evaluated using Modified International SCI Bowel Function Basic Data Set
Time Frame
baseline (1st session), session #24, followup at 12 weeks. Sessions occur 3x/week over an 8 week training period with a follow up visit at week 12.
Title
Quality of Life
Description
The Quality of Life change due to Ekso training will be evaluated using the International SCI Quality of Life Basic Data Sheet
Time Frame
baseline (1st session),session #24, followup at 12 weeks. Sessions occur 3x/week over an 8 week training period with a follow up visit at week 12.
Title
Balance
Description
Impact of Ekso training on gait in participants who are ambulatory prior to Ekso training. Gait progression will be evaluated in individuals with motor incomplete SCI who are ambulatory outside of Ekso. They will utilize Berg Balance Scale (BBS) to measure balance.
Time Frame
baseline (1st session), session #12, session #24, followup at 12 weeks. Sessions occur 3x/week over an 8 week training period with a follow up visit at week 12.
Title
Gait Speed
Description
Impact of Ekso training on gait in participants who are ambulatory prior to Ekso training. Gait progression will be evaluated in individuals with motor incomplete SCI who are ambulatory outside of Ekso. They will utilize a 10 Meter Walk Test to analyze gait speed.
Time Frame
baseline (1st session), session #12, session #24, followup at 12 weeks. Sessions occur 3x/week over an 8 week training period with a follow up visit at week 12.
Title
Gait Progression
Description
Impact of Ekso training on gait in participants who are ambulatory prior to Ekso training. Gait progression will be evaluated in individuals with motor incomplete SCI who are ambulatory outside of Ekso. They will utilize the Walking Index for Spinal Cord Injury II (WISCI II) and note any changes in walking assistive device utilized.
Time Frame
baseline (1st session), session #12, session #24, followup at 12 weeks. Sessions occur 3x/week over an 8 week training period with a follow up visit at week 12.
10. Eligibility
Sex
All
Minimum Age & Unit of Time
15 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria:
Inpatient or outpatient from 15 through 65 years of age at time of entry into the trial
Motor complete (ASIA Impairment Scale [AIS] A and B), with a neurological level of injury (NLI) between C7-L2 (inclusive), or motor incomplete (AIS C and D), NLI C1-L2 (inclusive), as determined by the International Standards for Neurological Classification of SCI (ISNCSCI)
Greater than 30 days since SCI occurred
Height from 157 - 188 centimeters (5'2" to 6'2") or for individuals who do not meet this criteria the following criteria may be used as assessed per the Ekso operating manual:
Max hip width= 16.5" or 42cm Upper leg length= 20" to 24⅛" or 51cm to 61.4cm Lower leg length= 19" to 25" or 48cm to 63.4cm
Maximum weight of 100 kilograms (220 pounds)
Sufficient upper extremity (UE) strength to use a front wheeled walker (FWW) either by manual muscle testing (MMT) (minimum triceps strength bilaterally of 3/5, shoulder abduction/adduction and flexion/extension 4/5) and/or by functional standing test with FWW. Participants with impaired hand function may use cuff grips.
Sufficient range of motion (ROM) to achieve a normal, reciprocal gait pattern, and normal sit to stand transitions.
Hip extension greater than or equal to 5 degrees
Knee extension greater than or equal to 5 degrees
Ankle dorsiflexion greater than or equal to 0 degrees
Demonstrate adequate trunk stability and upper extremity strength to utilize Ekso as evidenced by the ability to complete a level (or near level) surface wheelchair to mat transfer with minimal assistance.
Medically stable and cleared by a physician for full weight bearing locomotor training including 15 minute standing frame trial to assess standing tolerance
Exclusion Criteria:
Have trained in Ekso in the past except for one or two training/demonstration sessions
Utilizing another robotic device for locomotor training
Any medical issue that in the opinion of the Investigator precludes full weight bearing locomotor training including but not limited to:
Spinal instability (or spinal orthotic unless cleared by physician)
Acute deep vein thrombosis (DVT) with activity restrictions
Severe, recurrent autonomic dysreflexia (AD) requiring medical intervention
Heterotopic ossification (HO) in the lower extremities resulting in ROM restrictions at the hips or knees
Two or more pathological fractures in the last 48 months in a major weight bearing bone (femur or tibia) in the lower extremity
Hip subluxation (x-rays will be obtained for individuals injured prior to 10 years of age)
Any medical issue that in the opinion of the Investigator would affect participant safety either due to cognitive deficits/impulsivity, intolerance to mild exercise or other factors
Any issue that in the opinion of the Investigator would confound results such as a concurrent neurological injury or disorder (other than SCI) or other factors
Modified Ashworth Scale (MAS) = 4 in the majority of lower extremity joints (e.g. greater than or equal to four joint movements in bilateral lower extremities when testing hip flexion/extension, knee flexion/extension, ankle dorsi/plantar flexion)
Skin integrity issues in areas that contact the device (including abdominal ostomies) or that would prohibit sitting
Pregnancy
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Fin Biering-Sorensen, MD
Organizational Affiliation
Glostrup University Hospital, Copenhagen
Official's Role
Principal Investigator
Facility Information:
Facility Name
Glostrup Hospital
City
Hornbaek
Country
Denmark
Facility Name
Universitats-und Rehabilitationskliniken
City
Ulm
Country
Germany
Facility Name
Heliomare Revalidatie
City
Wijk aan Zee
Country
Netherlands
Facility Name
Sunnaas Sykehus HF
City
Oslo
Country
Norway
Facility Name
Institut Guttmann, Neurorehabilitation Hospital
City
Barcelona
Country
Spain
Facility Name
Fundacion Lesionado Medular
City
Madrid
Country
Spain
Facility Name
Clinical Department of Rehabilitation Medicine and Department of Medicine and Health Services
City
Linkoping
Country
Sweden
Facility Name
Sinalenheten, Akademiska Sjukhuset
City
Uppsala
Country
Sweden
Facility Name
Swiss Paraplegic Center (SPZ)
City
Nottwil
Country
Switzerland
12. IPD Sharing Statement
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Performance Attributes and User Progression While Using Ekso
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