The Ekso (Ekso Bionics) is a wearable exoskeleton that provides robotic support and
walking assistance for patients with lower extremity paralysis. Research suggests that
exoskeleton-assisted gait training is as effective as conventional gait training at
improving walking outcomes and balance during both the chronic and subacute period
following stroke (Goffredo et al., 2019; Molteni et al., 2017; Molteni et al., 2021; Nam
et al., 2019; Rojek, 2019).
Exoskeleton-assisted gait training during acute inpatient rehabilitation provides a means
for patients to actively participate in gait training during the early and most severe
stages of stroke recovery. Most acute inpatient rehabilitation facilities (IRFs) report a
feasibility of 5-8 Ekso sessions during inpatient stays and demonstrate significant
improvement from baseline (Nolan et al., 2020; Swank, 2020). Nolan et al. (2020)
demonstrated that stroke patients receiving Ekso ambulated 1640 feet more than patients
undergoing more conventional gait training techniques during inpatient rehabilitation,
suggesting that the exoskeleton may offer additional benefit during this phase of
recovery. Despite promising evidence, there have been no randomized controlled trials
within the IRF setting.
Because Ekso-gait training increases the number of steps patients can take, during acute
inpatient physical therapy (PT), the investigators hypothesize that patients who
participate in Ekso-gait training will demonstrate quicker improvements in balance, gait
speed, endurance and independence in functional ambulation during their stay in the IRF.
In this study, eligible patients admitted to Sunnyview Rehabilitation Hospital (SRH) for
rehabilitation following stroke will be randomized to receive conventional or Ekso-gait
training therapy. Meaningful clinical benchmarks for balance and walking will be assessed
using the Berg Balance Scale (BBS) (Alghadir, 2018; Moore, 2018), the 10 Meter Walk Test
(10MWT) (Bowden, 2008; Moore, 2018), the Six Minute Walk Test (6MWT) (Kubo et al., 2020;
Moore, 2018), and Functional Ambulation Category (FAC) (Mehrholz, 2007). Achieving these
benchmark scores are associated with several positive outcomes, including increased
ability to ambulate in the community and reduced risk of falling (Alghadir, 2018; Bowden,
2008; Kubo et al., 2020). The investigators also hypothesize that patients in the Ekso
cohort will report greater value/usefulness when compared to patients receiving standard
care.