Criteria of mastering the skills of walking in the exoskeleton in patients with consequences of spinal cord injuries

The problem of rehabilitation of patients with consequences of spinal cord injury by means of application of the exoskeleton is considered in this article for the first time in Russia. Authors of this article propose a new method of rehabilitation of this contingent of patients - walking in the exoskeleton. This method permits to enlarge considerably the contingent of the disabled people, otherwise to apply this device not only in patients with paraparesis of the lower extremities, but also in patients with complete paraplegia. Authors consider combination of training in the exoskeleton with transcutaneous electrical stimulation of the spinal cord to be one of the most effective methods of rehabilitation of such patients. Authors revealed distinctions of the biomechanical structure of walking in exoskeleton of healthy people and patients with the spinal cord injury, and, besides, they determined the method of application of transcutaneous electrical stimulation of the spinal cord in combination with training of walking in the exoskeleton. Pain and tactile sense increased in 4 from 6 patients after the intensive course of training in the exoskeleton in combination with transcutaneous electrical stimulation of the spinal cord. All 6 patients noted appearance of paresthesia in legs lower zone of anesthesia, appearance of sensation of the passive movements at the joints and “sense of the support”. It has been revealed that the following positive changes take place as a result of 10-days training of walking in the exoskeleton in combination with transcutaneous electrical stimulation of the spinal cord: growth of stability, increase of the support and push functions of the lower extremities, change of the form of the vertical component of the ground reaction force, decrease of the time of the support on crutches. For all this, in 2 of 6 patients improvement of walking takes place during the first trial session of walking in the exoskeleton in combination with transcutaneous electrical stimulation of the spinal cord, in particular, change of the temporal structure of the step (reduction of duration of the stance and double-support phases and increase of duration of the swing phase, diminution of duration of the support on crutches), inconsiderable increase of the amplitude of heel-strike and push-off. It is believed that even inconsiderable positive changes of the locomotor functions during the first session is a criterion of revealing the rehabilitation potential, and subsequently - of the rehabilitation prognosis.