Personal Exoskeleton or Manual Wheelchair: a Comparison of Performance and Satisfaction in Activities of Daily Living Among People With Spinal Cord Injuries, Using the SCED Methodology.

Condition(s) studied

Investigational drug(s) / intervention(s)

Carrying out tasks using the EVE exoskeleton and a manual wheelchair.: Each day (Monday to Friday), participants will have a 3½-hour session. During each session, tasks will need to be carried out using the EVE® exoskeleton and the manual wheelchair. The tasks have been grouped in pairs so that two tasks are carried out in succession. These task groups have been assigned a number, as follows: 1- Archery and retrieving a parcel 2- Making coffee and brushing teeth During a session, the participant will carry out one task group using both devices: the EVE® exoskeleton and the manual wheelchair. These devices have been assigned a letter, as follows: A- EVE® exoskeleton B- Manual wheelchair A random allocation will be used to determine the order of the parameters (B-wheelchair or A-EVE® exoskeleton), the time of day (morning or afternoon), and the task group to be performed in each session for each participant (1 or 2).

Study summary

Spinal cord injuries resulting in paraplegia affect patients' mobility and, consequently, their ability to participate in activities of daily living. In France, according to available sources, the number of people with a symptomatic spinal cord injury is estimated to be between 97,000 and 132,000, with an average age of 55. The incidence is estimated at 1,300 new cases per year.

Following initial treatment, patients' aim is to resume their daily activities. Engaging in these activities is associated with a better quality of life and is recognised as having a positive effect on health. Limitations in their ability to move around directly affect their participation in activities of daily living and, consequently, their quality of life.

To this end, mobility can be supported by a manual wheelchair (MW) or an electric wheelchair (EW); however, these aids do not enable patients to regain the ability to stand, which remains one of the main goals for people with spinal cord injuries.

Robotic exoskeletons can assist with standing and locomotion. To date, robotic exoskeletons have been used in rehabilitation centres. During the rehabilitation phase, these devices have proven to be usable and safe for a wide range of patients with spinal cord injuries. Motorised exoskeletons thus enable patients to perform tasks such as walking, standing upright, rotating, and carrying out dynamic balance exercises.

In the longer term, personal exoskeletons, used at home, could facilitate the performance of productive, domestic, social or recreational activities, such as those carried out on a daily basis by every individual.

Personal powered exoskeletons (PPEs) also appear to generate physiological and psychosocial benefits. Studies describe potential improvements in cardiovascular health, bladder and sphincter function, and a reduced risk of osteoporosis. After a few weeks of training with a motorised exoskeleton, patients report improvements in social functioning, mental health and sub-domains of general health perception on the SF36 Walk Wheel.

It should be noted that the ability to interact socially whilst standing is an important aspect of quality of life for patients with spinal cord injuries. Patients describe the pleasure of eye contact, of being able to walk with assistance, and an improvement in mood. The PPE would complement the wheelchair by enabling ambulation and participation in activities whilst standing.

Preserving upper limb function is a prerequisite for the widespread use of walking exoskeletons in everyday life. A self-supporting PPE, such as the EVE® device, which does not require the use of crutches, aims to enable users to stand up and walk whilst retaining the use of their upper limbs. This active balance control is a crucial function for achieving many functional skills in a domestic environment. One of the technological advantages of the self-balancing exoskeleton lies in the use of dynamics to eliminate the need for crutches, whilst ensuring walking safety.

The next step towards the development of personal exoskeletons for people with spinal cord injuries is to investigate the performance of activities of daily living whilst wearing an exoskeleton. To our knowledge, no such study has been carried out, and our work addresses a gap in the scientific literature by analysing the impact of using a self-propelled PPE on satisfaction and performance when carrying out activities of daily living.

The investigators hypothesise that the personal exoskeleton leads to greater satisfaction when carrying out the four tasks of daily living, compared with that achieved using a manual wheelchair.

In this context, the KER-EXHOME clinical trial, proposed by Dr Stéphanie LEPLAIDEUR (coordinator of this study), and led by the Kerpape Centre (sponsor), aims to compare, in participants with paraplegia, satisfaction and performance when carrying out activities of daily living and physical activities, using the EVE® device compared with a manual wheelchair.

Eligibility

Primary outcome measure(s)

• Compare satisfaction and performance when carrying out four activities of daily living using the EVE® exoskeleton, versus those carried out using a manual wheelchair, using the Canadian Occupational Performance Measure (COPM) — Intervention phase (Week 2 to 4) : Day 8, Day 9, Day 10, Day 11, Day 12, Day 15, Day 16, Day 17, Day 18, Day 19, Day 22, Day 23, Day 24, Day 25
  The Canadian Occupational Performance Measure (COPM) will be used to compare perceived satisfaction and performance when carrying out identified activities of daily living using either the EVE® exoskeleton or a manual wheelchair. Using the COPM, satisfaction and performance are assessed on a scale of 1 to 10 (1 = very poor performance and satisfaction, 10 = full performance and satisfaction). MCRO scores show a significant improvement between the start and end of treatment; in the SCI validation study, the average improvement reported is approximately 4.25 points (Performance) and 2.96 points (Satisfaction) between two measurement points. The MCRO will be carried out at the end of each session using one of the devices (wheelchair or exoskeleton). Two assessments must be carried out per half-day.

Trial sites (1)

More Centre Mutualiste de Rééducation et de Réadaptation Fonctionnelles de Kerpape trials in France

Other trials for the same condition