The WISE Trial - Walking Improvement for SCI With Exoskeleton (WISE)
Injuries, Spinal Cord
About this trial
This is an interventional treatment trial for Injuries, Spinal Cord focused on measuring Spinal Cord, Injury, Exoskeleton, Ekso, Rehabilitation
Eligibility Criteria
Inclusion Criteria:
- Motor incomplete paraplegia or tetraplegia
- Neurological level of injury (NLI) C1- approximately T10 (inclusive, for upper motor neuron injuries only), as determined by the International Standards for Neurological Classification of SCI (ISNCSCI)
- Sufficient diaphragmatic strength such that respiration is not compromised with exercise.
- Sufficient upper extremity strength to use a front wheeled walker either by manual muscle testing (minimum triceps strength bilaterally of 3/5, shoulder abduction/adduction and flexion/extension 4/5)
- AIS-C SCI & AIS-D SCI, as determined by the International Standards for Neurological Classification of SCI (ISNCSCI)
- Ambulates at <0.44 meters/second with or without physical assistance and assistance device
- WISCI ≥ 1
- 18 - 75 yrs, inclusive
- No current or history of other neurological conditions
- Screened and cleared by a physician
- Involved in standing program or must be able to tolerate at least 15 min upright
- Weigh 220 pounds (100kg) or less
- Be able to fit into the Ekso device
- Approximately between 5'0" and 6'4" tall
- Standing hip width of approximately 18" or less
- Have near normal range of motion in hips, knees and ankles
Exclusion Criteria:
- AIS-A SCI or AIS-B SCI
- Lower motor neuron injuries, as shown by absent reflexes during bilateral quadriceps and Achilles tendon taps
- < 3 months since previous intensive gait training regimen
- Already walking at self-selected ambulation speeds of at least 0.44 meter/second with or without assistance
- Currently involved in another intervention study
- Concurrent neurological disease
- Hip flexion contracture greater than ~17°
- Knee flexion contracture greater than 12°
- Unable to achieve neutral ankle dorsiflexion with passive stretch (neutral with max 12° knee flexion)
Leg length discrepancy
- Greater than 0.5" for upper leg
- Greater than 0.75" for lower leg
- Spinal instability
- Unresolved deep vein thrombosis
- Uncontrolled autonomic dysreflexia
- Severe muscular or skeletal pain
- Spasticity that prevents joint motion (severe stiffness or rigidity,) where both legs have a Modified Ashworth Score (MAS) score of 3 or higher for half or more of their proximal lower extremity muscles; proximal muscles include hip flexors/extensors/adductors and knee flexors/extensors.
- Open skin ulcerations on buttocks or other body surfaces in contact with exoskeleton or harness
- Pregnancy
- Cognitive impairments - unable to follow 2 steps commands and communicate for pain or to stop session
- Shoulder extension Range of Motion (ROM) < 50° excludes crutches during sit to stand or vice versa. (Walking with crutches permitted.)
- Participant requires the assistance of more than one therapist to transfer safely.
- Uncontrolled or severe orthostatic hypotension that limits standing tolerance; defined as sustained, symptomatic drops in systolic and diastolic blood pressure when moving from sitting to standing
- Active heterotrophic ossification (HO), hip dysplasia or hip/knee axis abnormalities
- Colostomy
- History of long bone fractures since the SCI, secondary to osteoporosis
- Unable to sustain current medication regimen
- Any reason the physician may deem as harmful to the participant to enroll or continue in the study
Sites / Locations
- Barrow Neurological Institute at St. Joseph's Hospital and Medical Center
- Gaylord Hospital
- Shirley Ryan AbilityLab
- Marianjoy Rehabilitation Hospital
- Kennedy Kruger Institute
- Rehabilitation Institute of Michigan
- Courage Kenny Research Center
- Kessler Foundation
- Burke Medical Research Institute
- TIRR Memorial Hermann Hospital
Arms of the Study
Arm 1
Arm 2
Arm 3
Experimental
Active Comparator
No Intervention
Group 1: Ekso GT Rehabilitation Therapy
Group 2: Active controls - BWSTT Therapy
Group 3: Passive controls
Participants in this group receive Ekso GT (gait training) PT therapy intervention 3 times per week for 12 weeks (36 sessions). Intervention: Ekso GT Rehabilitation therapy
Participants in this group receive a matched number of sessions of standard gait training using body-weight supported treadmill training and overground training. Intervention: Body Weight Supported Treadmill Training
Participants in this group continue with normal daily activities over 12 weeks.