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Research

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Effects of Robotic Exoskeleton on Bone and General health in Complete Spinal Cord Injury

Spinal cord injuries (SCI) are associated with an accelerated bone loss that occurs primarily at regions below the neurological lesion. The extent of bone loss depends on the severity of motor impairment and individual with motor complete lesions tend to experience more bone loss than those with motor incomplete lesions. The rate of bone loss is in a rapid and linear pattern for 1-2 years post SCI and bone loss continues many years after the initial accident. Our work has focused on changes to the skeleton in individuals with acute and chronic motor SCI. Primarily due to the cortical thinning originating from the endosteal surface we have seen that the bone strength is reduced at approximately twice the rate of bone mass. Immobilization is common with SCI due to multiple complications such as decreased pulmonary function, systemic inflammation and loss of muscle mass.

Exoskeletons have been increasingly used in the medical field to assist many with debilitating illnesses. It could potentially be used greatly in the rehabilitation field much more than it is at present.  It greatly helps those in the ambulatory stage, especially those with (SCI) Spinal cord injuries. But some exoskeletons have difficulty delivering a proportional stimulus continuously which is one of the aims of the study.

The study aims to discover what the effects a regular exoskeleton-assisted gait has on the bone health as well as the effect it has on the general health of the participant.  The last aim is the quantify the kinematics, kinetics, and the loads on the lower limbs during ambulation while assisted by an exoskeleton. The study will take place at Worcester Polytechnic Institute (WPI) and Spaulding Rehabilitation Hospital Boston (SRH).

Throughout the study this primary idea will be assessed: The ambulatory and non-ambulatory clinical benefits of exoskeletal systems. The exoskeletons projected benefits are many and include, but are not limited to: helping military members regain mobility, improve general health and quality of life. It will help to inform the treatment of patient with SCI.

But with benefits there are also some foreseeable discomforts and risks, although they are very minimal to the average person. With the HR-pQCT imaging there is a minimal, yet still measurable amount of exposure to radiation. The normal exposure to radiation from the sun and other background sources on the average day is 0.006-0.007 mSv. Each time a HR-pQCT imaging is done it is slightly above that at 0.012 mSv. The overall exposure hits 0.036 mSv, which is well below the recommended maximum exposure of 1 mSv. Blood also needs to be taken for serum bio-markers of inflammation. Some discomfort is expected from this.

 

For the study there will be 15 participants that will be recruited.

Interested in participating?

 

You may be eligible if you have Complete Chronic Spinal Cord Injury and you satisfy all of the following:

 

  • Male or female between the ages of 20 and 40

  • Complete thoracic SCI (T3-T12)

  • At least 3 years post injury

  • Height between 158 and 188 cm (5’2” and 6’2”)

  • Weight is less than 100 kg (220 lbs)

  • No severe spasticity (Modified Ashworth Scale score less than 3 in both lower extremities

  • Sufficient upper body strength to complete sit to sit transfers

 

Possible reasons for exclusion:

 

  • Females who are pregnant

  • An initial blood pressure greater than 140/90 mmHg

  • Orthostatic hypotension with symptomatic fall in blood pressure greater than 30 mmHg when upright

  • Presence of an active grade 2 pressure ulcer or worse

  • History of previous  lower extremity bone fracture and/or metabolic bone disease

  • Presence of skin conditions that prevent wearing the device

  • History of cardiovascular diseases including significant arrhythmias, coronary disease and family history of arrhythmia or sudden cardiac death.

  • Presence of any medical problem that precludes full weight bearing and ambulation (e.g orthopedic injuries, pain, severe spasticity, lower extremity contractures)

  • Presence of cognitive and/or communicative disability (eg due to brain injury) that prevent them from following directions and learning (MMSE of less than 23)*

  • History of diabetes, renal disease, thyroid disorder or neurological disease (e.g stroke, peripheral neuropathy, myopathy,

  • Active treatment for epilepsy

  • Current use of medications potentially affecting bone health including bisphosphonates, androgenic steroids, estrogenic steroids, anti-epileptics, lithium, glucocorticoid use of more than 3 months and those who have received inhaled glucocorticoids

  • Use of a Thoraco-Lumbar Sacral Orthosis (TSLO) brace and subject not cleared by a physician to remove the TSLO while using the Ekso™

 

*MMSE stands for Mini-Mental State Exam