Effect of an exosuit on daily life gait performance in individuals with incomplete spinal cord injury

Individuals with incomplete spinal cord injury (iSCI) often have impaired gait capacity, limiting their gait performance in daily life. Exosuits, such as the Myosuit, may offer support to improve daily life gait performance. This study included a randomized controlled trial (RCT), a cross-sectional study, and an interview study. The RCT investigated the Myosuit’s effect on daily life gait performance and its usability. The cross-sectional study examined its effect on assisted gait capacity. The interview study evaluated user experiences.

In the RCT, 34 individuals with chronic iSCI were randomized to an intervention or control group. The intervention group received five Myosuit gait training sessions, followed by a 6-week home period using the device. The control group received four gait training sessions, followed by a 6-week home period without the device. Walking time per day was assessed at baseline and during weeks one, three, and six of the home period. Usability was assessed using the Dutch System Usability Scale (D-SUS) and Dutch version of the Quebec User Evaluation of Satisfaction with assistive Technology (D-QUEST). For the cross-sectional study, participants performed the 10-Meter Walk Test at preferred and maximum walking speed and the 6-Minute Walk Test (6MWT) under two conditions: with and without the Myosuit. Twelve participants who used the Myosuit at home took part in semi-structured interviews.

The RCT showed no significant group difference in walking time per day during the home period (estimate=9 minutes, robust standard error=8, p=0.23). The average D-SUS score was 56±21 and the D-QUEST score was 3.4±0.5. In the cross-sectional study, preferred walking speed was significantly lower with the exosuit compared to without (median difference: -0.03 m/s, p=0.002, r=-0.6). No significant differences were found for maximum walking speed (median difference: -0.04 m/s), walking distance during the 6MWT (median difference: -11 m), or perceived exertion during the 6MWT (median difference: 0, p=0.41). Interviews revealed five main themes: (1) Effects on physical functioning vary, (2) Usability is context-dependent, (3) Technical features need improvement, (4) The exosuit does not fully meet user expectations, and (5) Disadvantages outweigh the benefits for daily use.

In conclusion, Myosuit use in home and community settings did not improve daily life gait performance in individuals with iSCI. Limited usability and lack of improvement in assisted gait capacity may explain why gait performance did not improve.