Overground Robotic Exoskeletons for Early Mobility in Acute Care Therapy for Patients With Neurological Injuries

Purpose: Early mobility (EM) of patients with neurological injury in the acute care setting is recommended but faces practical challenges in delivery. The purpose of this development-of-concept study was to describe the incorporation of overground robotic exoskeleton early mobility (ORE-EM) into the physical therapy (PT) plan of care in the acute care setting for patients after stroke, spinal cord injury (SCI), and traumatic brain injury (TBI). Methods: Participants included patients with stroke, SCI, or TBI admitted to acute care hospital and (1) met ORE frame criteria, (2) required significant assistance for mobility, and (3) tolerated active or passive standing. Outcomes were safety (adverse events), tolerability [session metrics (up time, walk time, step count) and vital signs], and highest level of mobility achieved [Johns Hopkins Highest Level of Mobility (JH-HLM)] during usual care and ORE-EM sessions. Results: 11 patients (stroke = 4, SCI = 3, TBI = 4) completed 14 ORE-EM sessions (stroke = 6, SCI = 4, TBI = 4). One adverse event (a seizure) occurred during ORE-EM with a patient with TBI. ORE-EM session tolerability yielded up time = 12:05 (0-20:39), walk time = 7:16 (0-17:53), and step count = 180 (0-596). One patient with stroke was unable to stand due to orthostatic hypotension upon sitting. Otherwise, vitals during all ORE-EM sessions remained within normal limits. Patients achieved higher JH-HLM scores during ORE-EM [7 (4-8), than usual care EM sessions [4 (1-7)]. Conclusions: Use of ORE in the acute care setting may address known challenges to EM by reducing barriers to delivery without compromising patient safety to achieve the patients’ highest level of mobility.