A team of researchers from Letterkenny Institute of Technology (LYIT) and ‘The No Barriers Foundation’ are examining the use of a state-of-the-art full lower limb powered exoskeleton (The EksoGT), on energy expenditure, muscular contraction and angular movement of the lower limbs, and quality of life within neurological rehabilitation. This research is a partnership led by LYIT researchers; (Mr. Damien Duddy, Mr. Rónán Doherty, Dr. James Connolly and Dr. Maria Faulkner) in association with ‘The No Barriers Foundation’ (Dr. Stephen McNally and Mr. Johnny Loughery). The EksoGT is often used in rehabilitation programmes to help individuals who have an impaired walking ability, due to neurological impairments such as spinal cord injury, stroke, multiple sclerosis etc, to walk over ground. The EksoGT enables the user to stand by supporting full body mass with hip and knee flexion and extension generated by motors in a sequence which enables the user to walk. 

For individuals with neurological impairments, the primary option for mobility is the wheelchair. Wheelchair propulsion alone may not result in an adequate amount of physical activity (energy expenditure) per day, which may lead to a sedentary lifestyle. Adopting a sedentary lifestyle can reduce cardiovascular fitness, muscular strength and quality of life, as well as leaving patients susceptible to a number of health conditions, such as cardiovascular and metabolic diseases.  

Previous research has highlighted that the use of an exoskeleton can potentially result in a number of psychological benefits. These benefits include improvements in mood, sleep quality, self-satisfaction and self-confidence, as well as a reduction in stress levels. Having the ability to stand upright in the exoskeleton and engage with other people at eye level, rather than looking up from a seated position resulted in an improvement in psychological and emotional state, whereby patients experienced social benefits and demonstrated an increased energy to interact with others.  

This novel study integrates the fields of sports science, data analysis, technology and physiotherapy. The study aims to assess the energy demands of walking with the exoskeleton, with an end goal of improving overall health and fitness among individuals with neurological impairments. An objective of this research is to examine energy expenditure using the Ganshorn power cube, during walking bouts with and without the use of the EksoGT.  A range of physiological and biomechanical parameters are assessed during both walking bouts. Shimmer 3 EMG sensors with an inbuilt Inertial Measurement Unit (IMU) assess muscle contraction and the angular movement of the lower limbs during each walking bout. Patient quality of life is assessed using the EQ-5D-5L questionnaire developed by Euroqol. 

Preliminary results indicate, treadmill walking using the EksoGT elevates energy expenditure, and other physiological responses to a greater degree than walking without the EksoGT, among an able-bodied population. The EMG and IMU data also suggest that muscle contraction and angular movement are higher when walking with the EksoGT in comparison to without. 

Therefore, incorporating the use of a powered exoskeleton into a rehabilitation programme may enable individuals with neurological impairments to achieve a greater cardiovascular response as well as increasing muscle activation/contraction of the lower limbs in comparison to wheelchair propulsion, whereby the majority of muscle mass recruited is located in the upper extremities. In turn, this may allow individuals with neurological impairments to increase their physical activity levels and achieve the many health benefits associated with exoskeleton gait training, for example; reduced muscular spasticity and pain, improved bowel and bladder function, increased bone density and lean body mass as well as an improvement in strength, balance, aerobic fitness and gait performance. The results may also enable clinicians to identify an appropriate amount of exercise to prescribe for patients using the EksoGT in order to elicit favourable cardiovascular adaptations and enhance patients walking ability. This in turn, may enhance overall health, reducing the risk of developing cardiovascular or metabolic diseases associated with a sedentary lifestyle, as well as enhancing both physical and mental health and improving quality of life.