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Biomechanical differences between ablebodied and spinal cord injured individuals walking in an overground robotic exoskeleton

Hayes, Stephen Clive; White, Matthew; Wilcox, Christopher Richard James; White, Hollie Samantha Forbes; Vanicek, Natalie


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Dr Steve Hayes
Lecturer in Biomechanics & Strength and Conditioning

Matthew White

Christopher Richard James Wilcox

Hollie Samantha Forbes White


Background Robotic assisted gait training (RAGT) uses a powered exoskeleton to support an individual's body and move their limbs, with the aim of activating latent, pre-existing movement patterns stored in the lower spinal cord called central pattern generators (CPGs) to facilitate stepping. The parameters that directly stimulate the stepping CPGs (hip extension and ipsilateral foot unloading) should be targeted to maximise the rehabilitation benefits of these devices. Aim To compare the biomechanical profiles of individuals with a spinal cord injury (SCI) and able-bodied individuals inside the ReWalkTM powered exoskeleton and to contrast the users' profiles with the exoskeleton. Methods Eight able-bodied and four SCI individuals donned a ReWalkTM and walked along a 12- meter walkway, using elbow crutches. Whole-body kinematics of the users and the ReWalkTM were captured, along with GRF and temporal-spatial characteristics. Discreet kinematic values were analysed using a Kruskall-Wallis H and Dunn's post-hoc analysis. Upper-body differences, GRF and temporal-spatial characteristics were analysed using a Mann-Whitney U test (P<0.05). Results Walking speed ranged from 0.32-0.39m/s. Hip abduction, peak knee flexion and ankle dorsiflexion for both the SCI and able-bodied groups presented with significant differences to the ReWalkTM. The able-bodied group presented significant differences to the ReWalkTM for all kinematic variables except frontal plane hip ROM (P = 0.093,δ = -0.56). Sagittal plane pelvic and trunk ROM were significantly greater in the SCI vs. able-bodied (P = 0.004,δ = -1; P = 0.008,δ = -0.94, respectively). Posterior braking force was significantly greater in the SCI group (P = 0.004, δ = -1). Discussion The different trunk movements used by the SCI group and the capacity for the users' joint angles to exceed those of the device suggest that biomechanical profiles varied according to the user group. However, upright stepping with the ReWalkTM device delivered the appropriate afferent stimulus to activate CPGs as there were no differences in key biomechanical parameters between the two user groups.


Hayes, S. C., White, M., Wilcox, C. R. J., White, H. S. F., & Vanicek, N. (2022). Biomechanical differences between ablebodied and spinal cord injured individuals walking in an overground robotic exoskeleton. PLoS ONE, 17(1), Article e0262915.

Journal Article Type Article
Acceptance Date Jan 19, 2022
Online Publication Date Jan 27, 2022
Publication Date Jan 27, 2022
Deposit Date Jan 28, 2022
Publicly Available Date Jan 28, 2022
Journal PLoS ONE
Print ISSN 1932-6203
Electronic ISSN 1932-6203
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 17
Issue 1
Article Number e0262915
Public URL
Additional Information All relevant data are within the paper and its Supporting Information files:


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