Exoskeleton gait training to improve lower urinary tract function in people with motor-complete spinal cord injury: A randomized pilot trial
DOI:
https://doi.org/10.2340/16501977-2864Keywords:
spinal cord injury, exoskeleton device, pelvic floor, electromyography, lower urinary tract symptomsAbstract
Objective: The primary aim of this study was to determine the feasibility of delivering an exoskeleton-assisted walking intervention targeting lower urinary tract function in people with motor-complete spinal cord injury. Secondary aims were to deter-mine if exoskeleton walking activates the pelvic floor muscles, and compare 2 exoskeleton programmes regarding lower urinary tract function.
Design: Randomized pilot trial.
Subjects: Adults with motor-complete spinal cord injury at or above T10.
Methods: Participants were randomized to receive Ekso or Lokomat training. Feasibility outcomes included recruitment rate, adherence, and adverse events. Pelvic floor muscle electromyography was recorded during walking. Urodynamic studies, 3-day bladder diary, and Qualiveen-30 were administered pre- and post-training.
Results: Twelve people were screened and 6 people enrolled in the study. Two subjects withdrew from unrelated reasons. There was one adverse event. Pelvic floor muscle activity was greater in the Ekso group. Lower urinary tract function did not clearly change in either group.
Conclusion: This pilot study demonstrates the feasibility of delivering an exoskeleton training programme targeting lower urinary tract function.
Ekso-walking elicits pelvic floor muscle activity, but it remains unclear how locomotor training impacts lower urinary tract function.
Lay abstract
Some studies in people with spinal cord injury have report-ed improvements in urinary bladder health after gait therapy, but the mechanisms behind this are unclear. Strong pelvic floor muscles are crucial to urinary bladder health, and these muscles are normally active during walking. It is possible that the pelvic floor muscles are similarly engaged during exoskeleton-walking in people with spinal cord injury, and this could improve urinary bladder health. This study demonstrates that delivering an exoskeleton intervention to people with spinal cord injury for urinary bladder health is feasible. Participants were successfully recruited to a training programme, and any dropouts were because of issues unrelated to the study.
Furthermore, the study showed that the pelvic floor muscles are active while walking in 1 type of exoskeleton, but it remains unclear how exoskeleton-walking may help improve urinary bladder outcomes. Further research is needed to explore how exoskeleton interventions may engage the pelvic floor muscles and improve urinary bladder health outcomes for those with spinal cord injury.
Downloads
References
Taweel WA, Seyam R. Neurogenic bladder in spinal cord injury patients. Res Reports Urol 2015; 7: 85–99.
Simpson LA, Eng JJ, Hsieh JTC, Wolfe DL, Team SR. The health and life priorities of individuals with spinal cord injury: a systematic review. J Neurotrauma 2013; 29: 1548–1555.
Dumoulin C, Cacciari L, Hay-smith E. Pelvic floor muscle training versus no treatment , or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev 2018; (10): CD005654.
Godec C, Cass AS, Ayala GF. Bladder inhibition with functional electrical stimulation. Urology 1975; 6: 663–666.
Luginbuehl H, Naeff R, Zahnd A, Baeyens JP, Kuhn A, Radlinger L. Pelvic floor muscle electromyography during different running speeds: an exploratory and reliability study. Arch Gynecol Obstet 2016; 293: 117–124.
Zhou X, Willliams AM, Lam T. The effects of exercise-based interventions on urogential outcomes in individuals with spinal cord injury: a systematic review and meta-analysis. J Neurotrauma 2021; 38: 1225-1241.
Alamro RA, Chisholm AE, Williams AMM, Carpenter MG, Lam T. Overground walking with a robotic exoskeleton elicits trunk muscle activity in people with high-thoracic motor-complete spinal cord injury. J Neuroeng Rehabil 2018; 15: 1–11.
Williams AMM, Eginyan G, Deegan E, Chow M, Carpenter MG, Lam T. Residual innervation of the pelvic floor muscles in people with motor-complete spinal cord injury. J Neurotrauma 2020; 37: 2320–2331.
Eldridge SM, Chan CL, Campbell MJ, Bond CM, Hopewell S, Thabane L, et al. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ 2016; 355: i5239.
Schäfer W, Abrams P, Liao L, Mattiasson A, Pesce F, Spangberg A, et al. Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn 2002; 21: 261–274.
Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society. Urology 2003; 61: 37–49.
Costa P, Perrouin-Verbe B, Colvez A, Didier JP, Marquis P, Marrel A, et al. Quality of life in spinal cord injury patients with urinary difficulties. Eur Urol 2001; 39: 107–113.
Wolff J, Parker C, Borisoff J, Mortenson W Ben, Mattie J. A survey of stakeholder perspectives on exoskeleton technology. J Neuroeng Rehabil 2014; 11: 1–10.
Ho CH, Linsenmeyer TA, Millis SR. The reproducibility of urodynamic studies of neurogenic bladders in spinal cord injury. J Spinal Cord Med 2000; 23: 276–283.
Chou FH, Ho CH, Linsenmeyer TA. Normal ranges of variability for urodynamic studies of neurogenic bladders in spinal cord injury. J Spinal Cord Med 2006; 29: 26–31.
Published
How to Cite
License
Copyright (c) 2021 Alison M. M. Williams, Emily Deegan, Matthias Walter, Lynn Stothers, Tania Lam
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.
