Overground Robotic Exoskeleton Gait Training During Inpatient Rehabilitation for People with Polyneuropathy

Research Objectives: To describe the off-label use of overground robotic exoskeleton gait training (OEGT) for patients admitted to inpatient rehabilitation (IPR) with a diagnosis of polyneuropathy.

Design: Retrospective cohort study.

Setting: Large urban IPR hospital.

Participants: Convenience sample of patients admitted to IPR for polyneuropathy and receiving at least one OEGT session.

Interventions: OEGT with the EksoNR device.

Main Outcome Measures: Functional and mobility scores were compared at admission and discharge using the CARE tool scores for transfer bed-to-chair, walk 50 feet, and wheel 150 feet (score range: 0-6). The highest level of patient-reported pain (score range: 0-10) was collected from the patient’s medical record during each day of IPR and compared across OEGT vs. non-OEGT days. OEGT characteristics (number of sessions, time spent upright, time spent walking, step count) were recorded and compared from first session to final session. Analyses were conducted using Wilcoxon rank sum exact tests at a significance level of p < 0.05.

Results: Between June 2016 to August 2023, 13 patients with polyneuropathy (7 female, 6 male, median 59 years old [IQR: 53,63]) completed OEGT with a median number of 4 sessions (IQR: 2,8) over 39 days (IQR: 29, 46). Initial OEGT sessions had a median 8 minutes of up time (IQR: 6,13), 1.3 minutes walk time (IQR: 0.8,4.8), and 23 steps (IQR: 15,95). Final sessions had increased up time [21 minutes (IQR: 16, 23)], walk time [14.7 minutes (IQR: 11, 19)], and steps [404 (IQR: 343, 466)]. CARE score changes were observed from admit to discharge on transfer bed-to-chair [p < 0.01; admit=2 (IQR: 1,2), discharge=5 (IQR: 2,6)], walk 50 feet [p=0.04; admit=1 (IQR, 1,1), discharge=1 (IQR: 1,3)], (and wheel 150 feet [p < 0.01; admit=2 (IQR: 1, 3), discharge=6 (IQR: 4, 6)]. Median pain scores during IPR were 0 (IQR: 0, 5) and no significant differences (p = 0.50) were observed between OEGT (n=461) and non-OEGT days (n=65).

Conclusions: Our findings suggest the off-label use of OEGT was tolerable for patients with polyneuropathy and may contribute to improvements in function throughout IPR. Future research including non-OEGT controls would lend further support to our findings and aid in characterizing the optimal use of OEGT in this population.

Author(s) Disclosures: The authors have no conflicts of interest to disclose.