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Mobility and Therapeutic Benefits Resulting From Exoskeleton Use in a Home and Community Setting (SC140121 Study 3)

Primary Purpose

Spinal Cord Injury

Status
Withdrawn
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Indego Exoskeleton
Sponsored by
Vanderbilt University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional health services research trial for Spinal Cord Injury

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Age 18 years or older.
  • Size and limb proportions capable of fitting in the exoskeletal device :
  • Height between 1.55 m (5 ft, 1 in) and 1.92 m (6 ft, 3 in).
  • Femur length between 37.5 cm (15 in) and 43.125 cm (17.25 in).
  • Body mass no greater than 114 kg (250 lb).
  • "Poorly ambulatory" individual, defined as a person with FIM Gait 2- 6, who may be able to walk short distances with or without braces or stability aid, or may be able to walk with assistance of one person, but whose primary means of mobility is a manual or power-operated wheelchair.
  • Sufficient upper extremity strength and coordination to balance using appropriate stability aids, such as a rolling walker or forearm crutches, during exoskeleton walking.
  • Neurological injury level (NLI) T3 to L5 (between and inclusive).
  • Chronic SCI: at least 6 months post-injury, and preferably post-injury more than 1 year.
  • Sufficient bone health for walking with full weight-bearing without undue risk of fracture, as determined by each subject's personal medical doctor, and approved by each site's medical supervisor.
  • Passive range of motion (PROM) at shoulders, trunk, upper extremities and lower extremities within functional limits for safe gait and use of appropriate assistive device/stability aid.
  • Skin intact where interfacing with robotic device.
  • MAS for spasticity score 3 or less in lower extremities.
  • Resting blood pressure and heart rate within established guidelines for locomotor training, specifically systolic 150 mmHg or less, diastolic 90 mmHg or less, heart rate 105 bpm or less.
  • Ability to tolerate an upright standing position for 20 min, passive or active, without being lightheaded or having a headache.
  • Availability and willingness of support person to be trained in accordance with the FDA training protocol for personal use of the exoskeleton, and who will assume responsibility for the support person role, which specifically includes providing ambulatory support during all exoskeletal walking.
  • Access to a wireless internet connection (for use of exoskeleton iPod device).
  • Willingness and ability to electronically send walking session reports from exoskeleton iPod to appointed site monitor following each walking session.

Exclusion Criteria:

  • Heterotopic ossification that, in the opinion of the site medical supervisor, would place the subject at undue risk for fracture.
  • Inability to follow instructions.
  • Colostomy bag.
  • Women who are pregnant or attempting to become pregnant during the course of the study. Note that a pregnancy test will be required and must be negative for all women prior to enrolling in the study, and will be additionally required and must be negative every four weeks during the course of the study protocol.
  • Any disease, concomitant injury, or condition that interferes with the performance or interpretation of the protocol- specified assessments.
  • Insufficient availability to complete study.
  • Any other issue which, in the opinion of the investigators or medical supervisor, make the subject unsuitable for study participation.

Sites / Locations

  • Tampa VA
  • Minnesota Mayo Clinic
  • Vanderbilt University Medical Center

Arms of the Study

Arm 1

Arm Type

Other

Arm Label

Interventional

Arm Description

Walking in an exoskeleton within the home and community.

Outcomes

Primary Outcome Measures

Ten meter walk test (10MWT)
Measure of mobility (specifically gait speed) while wearing exoskeleton. Scale 1 to 7 (1=total assistance and 7=independent)
Six minute walk test (6MWT)
Measure of gait speed over six minutes while wearing exoskeleton. Scale 1 to 7 (1=total assistance and 7=independent)
Walking Index for Spinal Cord Injury II (WISCI-II)
Assessment of physical assistance required during walking while wearing exoskeleton. Scale 0 to 20 (0= unable to participate and 20 Ambulates with no devices, no braces and no physical assistance.
Functional Independence Measures (FIM) gait score
Assessment of physical assistance required during walking while wearing exoskeleton. Scale 0 to 7 (0= activity does not occur and 7= complete independence

Secondary Outcome Measures

Timed Up and Go Test (TUG)
Measure of ability to stand, walk, turn, and sit while wearing exoskeleton. ≤ to 10 seconds to > 30 seconds (≤ 10 seconds=normal to > 30 predictive of requiring assistive device for ambulation and being dependent in ADLs
Borg Rating Scale of Perceived Exertion (RPE)
Measure of exertion required while using exoskeleton. Scale 6 to 20 (6= no exertion and 20 = maximal exertion
Modified Ashworth Score (MAS)
Measure of bone mineral density. Scale 0 to 4 (0=No increase in muscle tone and 4=Affected part(s) rigid in flexion or extension)
Bone Mineral Density
Measure of bone mineral density. Score -1 and above to -2.5 and below (-1.0 to +0.5= normal and -2.5 and below=osteoporosis)
Functional Reach
Measure of core strength. 0 to 3 (0= unable to reach 3=Reach > or = to 10 inches)
Manual Muscle Test (MMT)
Measure of muscle strength Scale 0 to 5 (0= No visible or palpable contraction and 5=Full ROM against gravity, maximul resistance
Ten Meter Walk Test without exoskeleton (10MWT)
Measure of walking speed without exoskeleton. Measure of mobility (specifically gait speed) while wearing exoskeleton. Scale 1 to 7 (1=total assistance and 7=independent)
Functional Independence Measures (FIM) gait score without exoskeleton
Measure of assistance required for walking without exoskeleton Scale 0 to 7 (0= activity does not occur and 7= complete independence
Walking Index for Spinal Cord Injury II (WISCI-II) score without exoskeleton
Measure of assistance required for walking without exoskeleton. Scale 0 to 20 (0= unable to participate and 20 Ambulates with no devices, no braces and no physical assistance.

Full Information

First Posted
October 8, 2019
Last Updated
November 5, 2020
Sponsor
Vanderbilt University
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1. Study Identification

Unique Protocol Identification Number
NCT04149769
Brief Title
Mobility and Therapeutic Benefits Resulting From Exoskeleton Use in a Home and Community Setting (SC140121 Study 3)
Official Title
Mobility and Therapeutic Benefits Resulting From Exoskeleton Use in a Home and Community Setting (SC140121 Study 3)
Study Type
Interventional

2. Study Status

Record Verification Date
November 2020
Overall Recruitment Status
Withdrawn
Why Stopped
COVID
Study Start Date
May 1, 2020 (Anticipated)
Primary Completion Date
June 30, 2020 (Anticipated)
Study Completion Date
December 31, 2020 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Vanderbilt University

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
Yes
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The proposed study is a pilot study intended to inform the hypothesis that regular walking in an exoskeleton within the home and community might offer health benefit, neurological recovery, and/or mobility benefit to the user. This exploratory pilot study is also intended to assess the level of compliance (i.e., exoskeleton use) among study participants by characterizing extent the device is used beyond the minimum required.
Detailed Description
Study 3 Outline Study 3 enrollment will be limited to 1 or 2 subjects at each site. Each subject will take home an exoskeleton for the 8-week duration of the treatment period. The subjects will be selected from the pool of poorly-ambulatory subjects previously enrolled in Studies 1 and/or 2, and as such will have prior experience walking in the exoskeleton. Note that study 3 will emply the exoskeleton as per existing FDA approval (510(k) number K171334); specifically, "to enable individuals with spinal cord injury at levels T3 to L5 to perform ambulatory functions [in the home and community] with supervision of a specially trained companion in accordance with the user assessment and training certification program." Use of the exoskeleton in the home and community (i.e., outside a clinical setting) is referred to as "personal use." So that this study complies with FDA approval for personal use, subjects selected for enrollment in Study 3, along with each subject's designated support person, will be trained and certified for personal use in accordance with the manufacturer's FDA-approved personal use training program.

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
Health Services Research
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
Poorly-ambulatory subjects previously enrolled in Studies 1 and/or 2, and as such will have prior experience walking in the exoskeleton.
Masking
None (Open Label)
Allocation
N/A
Enrollment
0 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Interventional
Arm Type
Other
Arm Description
Walking in an exoskeleton within the home and community.
Intervention Type
Device
Intervention Name(s)
Indego Exoskeleton
Intervention Description
Regular dosing of Indego Exoskeleton walking.
Primary Outcome Measure Information:
Title
Ten meter walk test (10MWT)
Description
Measure of mobility (specifically gait speed) while wearing exoskeleton. Scale 1 to 7 (1=total assistance and 7=independent)
Time Frame
18 weeks
Title
Six minute walk test (6MWT)
Description
Measure of gait speed over six minutes while wearing exoskeleton. Scale 1 to 7 (1=total assistance and 7=independent)
Time Frame
18 weeks
Title
Walking Index for Spinal Cord Injury II (WISCI-II)
Description
Assessment of physical assistance required during walking while wearing exoskeleton. Scale 0 to 20 (0= unable to participate and 20 Ambulates with no devices, no braces and no physical assistance.
Time Frame
18 weeks
Title
Functional Independence Measures (FIM) gait score
Description
Assessment of physical assistance required during walking while wearing exoskeleton. Scale 0 to 7 (0= activity does not occur and 7= complete independence
Time Frame
18 weeks
Secondary Outcome Measure Information:
Title
Timed Up and Go Test (TUG)
Description
Measure of ability to stand, walk, turn, and sit while wearing exoskeleton. ≤ to 10 seconds to > 30 seconds (≤ 10 seconds=normal to > 30 predictive of requiring assistive device for ambulation and being dependent in ADLs
Time Frame
18 weeks
Title
Borg Rating Scale of Perceived Exertion (RPE)
Description
Measure of exertion required while using exoskeleton. Scale 6 to 20 (6= no exertion and 20 = maximal exertion
Time Frame
18 weeks
Title
Modified Ashworth Score (MAS)
Description
Measure of bone mineral density. Scale 0 to 4 (0=No increase in muscle tone and 4=Affected part(s) rigid in flexion or extension)
Time Frame
18 weeks
Title
Bone Mineral Density
Description
Measure of bone mineral density. Score -1 and above to -2.5 and below (-1.0 to +0.5= normal and -2.5 and below=osteoporosis)
Time Frame
18 weeks
Title
Functional Reach
Description
Measure of core strength. 0 to 3 (0= unable to reach 3=Reach > or = to 10 inches)
Time Frame
18 weeks
Title
Manual Muscle Test (MMT)
Description
Measure of muscle strength Scale 0 to 5 (0= No visible or palpable contraction and 5=Full ROM against gravity, maximul resistance
Time Frame
18 weeks
Title
Ten Meter Walk Test without exoskeleton (10MWT)
Description
Measure of walking speed without exoskeleton. Measure of mobility (specifically gait speed) while wearing exoskeleton. Scale 1 to 7 (1=total assistance and 7=independent)
Time Frame
18 weeks
Title
Functional Independence Measures (FIM) gait score without exoskeleton
Description
Measure of assistance required for walking without exoskeleton Scale 0 to 7 (0= activity does not occur and 7= complete independence
Time Frame
18 weeks
Title
Walking Index for Spinal Cord Injury II (WISCI-II) score without exoskeleton
Description
Measure of assistance required for walking without exoskeleton. Scale 0 to 20 (0= unable to participate and 20 Ambulates with no devices, no braces and no physical assistance.
Time Frame
18 weeks
Other Pre-specified Outcome Measures:
Title
Spinal Cord Injury Spasticity Evaluation Tool (SCI-SET)
Description
Survey of severity of spasticity. Score -3 to +3 ( -3 (extremely problematic) to +3 (extremely helpful).
Time Frame
18 weeks
Title
Self-Report Survey
Description
Survey of pain, spasticity, bowel and bladder function, and quality of life. Pain 0 to 5 (0=no pain and 5 =severe pain. Overall level of pain -3 to 3 (-3 =decreased and 3 =increased) Spasticity 0 to 5 (0= No spasticity and 5 Severe spasticity) Overall level of spasticity -3 to 3 (-3 =decreased and 3 =increased) Changes in bowel habits -3 to 3 (-3 worse and 3=better) Changes in bladder habits -3 to 3 (-3 worse and 3=better) Changes in mood -3 to 3 (-3 worse and 3=better)
Time Frame
18 weeks
Title
American Spinal Injury Association (ASIA) Impairment Scale
Description
Measure of neurological injury level and classification. Scale A to E (A= complete and E= normal)
Time Frame
18 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Age 18 years or older. Size and limb proportions capable of fitting in the exoskeletal device : Height between 1.55 m (5 ft, 1 in) and 1.92 m (6 ft, 3 in). Femur length between 37.5 cm (15 in) and 43.125 cm (17.25 in). Body mass no greater than 114 kg (250 lb). "Poorly ambulatory" individual, defined as a person with FIM Gait 2- 6, who may be able to walk short distances with or without braces or stability aid, or may be able to walk with assistance of one person, but whose primary means of mobility is a manual or power-operated wheelchair. Sufficient upper extremity strength and coordination to balance using appropriate stability aids, such as a rolling walker or forearm crutches, during exoskeleton walking. Neurological injury level (NLI) T3 to L5 (between and inclusive). Chronic SCI: at least 6 months post-injury, and preferably post-injury more than 1 year. Sufficient bone health for walking with full weight-bearing without undue risk of fracture, as determined by each subject's personal medical doctor, and approved by each site's medical supervisor. Passive range of motion (PROM) at shoulders, trunk, upper extremities and lower extremities within functional limits for safe gait and use of appropriate assistive device/stability aid. Skin intact where interfacing with robotic device. MAS for spasticity score 3 or less in lower extremities. Resting blood pressure and heart rate within established guidelines for locomotor training, specifically systolic 150 mmHg or less, diastolic 90 mmHg or less, heart rate 105 bpm or less. Ability to tolerate an upright standing position for 20 min, passive or active, without being lightheaded or having a headache. Availability and willingness of support person to be trained in accordance with the FDA training protocol for personal use of the exoskeleton, and who will assume responsibility for the support person role, which specifically includes providing ambulatory support during all exoskeletal walking. Access to a wireless internet connection (for use of exoskeleton iPod device). Willingness and ability to electronically send walking session reports from exoskeleton iPod to appointed site monitor following each walking session. Exclusion Criteria: Heterotopic ossification that, in the opinion of the site medical supervisor, would place the subject at undue risk for fracture. Inability to follow instructions. Colostomy bag. Women who are pregnant or attempting to become pregnant during the course of the study. Note that a pregnancy test will be required and must be negative for all women prior to enrolling in the study, and will be additionally required and must be negative every four weeks during the course of the study protocol. Any disease, concomitant injury, or condition that interferes with the performance or interpretation of the protocol- specified assessments. Insufficient availability to complete study. Any other issue which, in the opinion of the investigators or medical supervisor, make the subject unsuitable for study participation.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Michael Goldfarb, PhD
Organizational Affiliation
Vanderbilt University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Tampa VA
City
Tampa
State/Province
Florida
ZIP/Postal Code
33637
Country
United States
Facility Name
Minnesota Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Facility Name
Vanderbilt University Medical Center
City
Nashville
State/Province
Tennessee
ZIP/Postal Code
37212
Country
United States

12. IPD Sharing Statement

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Mobility and Therapeutic Benefits Resulting From Exoskeleton Use in a Home and Community Setting (SC140121 Study 3)

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