Exoskeleton Information for patients Spinal Injuries
What is Ekso GT? Ekso GT is a robotic human-assisted exoskeleton that is designed as an assisted walking device for individuals with impaired walking ability due to neurological disorders such as Spinal Cord Injury. The fully weight-bearing walking pattern is achieved by the push of a button by trained therapists or the user s weight shift which triggers sensors to initiate the next step. How is the Ekso GT used? It assists people with motor incomplete spinal cord injuries to re-learn a normal walking pattern. It provides a means for people with a neck injury as high as C7 and below with complete paralysis to stand and walk. However, some preservation of hand grip strength is needed to manoeuvre the walking aid. Patient reported benefits of using the Ekso GT include reduction in muscle spasms, improvement in local circulation, improvement in balance, improvement in bladder and bowel function, and maintenance of bone health. What are the eligibility criteria? Anyone under the care of a Spinal Injuries consultant at the Princess Royal Spinal Injuries Unit, Sheffield. page 2 of 8
How do I get referred? If you are an inpatient: You can be referred through your named physiotherapist for an assessment. If appropriate, a signed medical release form will be obtained from your named consultant and the Ekso trained physiotherapist will arrange for an assessment. If you are an outpatient: You will be referred through an outpatient clinic appointment under your named consultant. If appropriate, your consultant will refer you to the Ekso trained physiotherapist for an assessment. What are the criteria for the use of Ekso GT? You will need to be able to fulfil all of the following criteria: Independently transfer from a wheelchair to a regular chair, ideally by completing a lift and shift manoeuvre or a standing pivot transfer Currently undertaking an active standing programme with a standing frame i.e. Oswestry Standing Frame, for longer than 15 minutes Sufficient upper limb function to be able to grasp and release objects in your hands Sufficient range of movement to tolerate sit to stand and walking Sufficient arm strength and sitting balance to assist with balance in standing with a frame and/or crutches Motor complete paralysis (Asia A/Asia B) C7 or below or incomplete motor paralysis (Asia C/Asia D) C2 or below Weigh 220 pounds (100 kilograms) or less page 3 of 8
Between 5 2 and 6 4 (157 to 188 cm) tall Standing hip width of 17.5 (44.45cm) or less. What are the conditions that would prevent me using the Ekso GT? Range of motion restrictions that would prevent you from achieving a walking pattern or a sit-to-stand movement. Spinal instability Unresolved clot in the leg i.e. deep vein thrombosis (DVT) Unable to tolerate standing for more than 15 minutes due to a drop in blood pressure or dizziness Significant osteoporosis that prevents safe standing. This is diagnosed by a DEXA scan Previous leg fractures less than 6 months ago Uncontrolled spasticity in your arms, abdomen or legs Uncontrolled Autonomic Dysreflexia (AD) Insufficient arm strength to assist with balance with frame or crutches Leg length discrepancy above recommended values set by Ekso Bionics. Skin problems i.e. pressure sores or fragile skin in areas in contact with the device Some conditions affecting memory and following instructions Pregnancy If you are unsure, speak to your consultant, physiotherapist or the Ekso trained physiotherapist for advice. page 4 of 8
What is the package of treatment? Initial assessment will include obtaining measurements of range of movement, strength, spasticity, and functional mobility; as well as measurements of your hips and lower limbs. It may involve a variable amount of treatment. The therapist will then assess body contact points with the suit, standing balance and, if appropriate, stepping with weight transference with spotters during the initial treatment sessions. Final assessment which will include measurements as above and completion of a feedback form. If you are an inpatient: You will be offered up to 3 one-hour sessions per week until your discharge from hospital or for 12 weeks, whichever is sooner. This will include putting on and taking off the Ekso GT suit, balance re-education and gait re-education. If you are an outpatient: You will be offered a 12 week programme of 60 minute sessions, although this can vary according to your needs. Treatment sessions can be negotiable and flexible to best meet your needs. However, this is dependent on the inpatient service demands. What do I wear? Wear something comfortable and breathable. Wear the same shoes worn for your initial assessment and each Ekso GT treatment session. If you have a catheter in situ, ensure the bag is emptied prior to each session. It is important that you check your skin closely after each Ekso GT session and report any markings from the suit to the therapist. page 5 of 8
Can I take images of myself in the Ekso GT? It is accepted that you may want to have photographs or videos taken of yourself in the Ekso GT. However, as the Ekso GT is used in a clinical environment where other patients and staff may be present, we would appreciate it if you refrain from sharing images or videos taken of yourself in the Ekso GT on social media sites. If you would like to take images of you in the Ekso GT, please speak to one of the Ekso trained therapists to assist. What happens if I cannot attend an Ekso GT session? We appreciate there may be times when you are unable to attend, for example due to illness or poor weather conditions for travel. However, it is your responsibility to inform the therapists if you are unable to attend so that an appointment may be offered to another client. This enables us to make the best use of the therapy timetable. The Ekso programme will require your full participation for best results. Please raise any concerns you might have about the programme with a member of the team at the earliest opportunity. page 6 of 8
What if I want to continue to use the Ekso GT after discharge from hospital? After completing the programme as an inpatient at the Spinal Injuries Unit, there is an opportunity to complete an outpatient programme. For further information regarding this service, please contact: Suk Wong, Senior Physiotherapist, Ekso Service 0114 271 5673 page 7 of 8
Images provided by Ekso Bionics Produced with support from Sheffield Hospitals Charity Working hard to fund improvements that make life better for patients and their families Please donate to help us do more www.sheffieldhospitalscharity.org.uk Registered Charity No 1059043 Alternative formats can be available on request. Please email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2017 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD8124-PIL3422 v2 Issue Date: April 2017. Review Date: April 2019