Exploring Familiarization Phases to Establish Baseline Sessions in Lower Limb Exoskeleton Therapy for Neurological Patients.

Neurological disorders that cause paralysis, such as stroke, spinal cord injury, and multiple sclerosis, are prevalent worldwide and significantly impact society. Community-based exoskeleton services are designed to assist with the mobility and rehabilitation of individuals with these disorders by enhancing gait effectiveness. Accurate baseline data are essential for researchers to determine the effects of an intervention, particularly when assessing gait effectiveness. Establishing a reliable baseline ensures that any changes in gait and mobility can be due to the intervention itself, rather than the initial adaptation associated with early familiarization. However, research on these initial familiarization sessions for lower-limb exoskeletons is lacking, highlighting the need for this study. A total of 70 participants from the community-based exoskeleton clinic at Dublin City University (DCU), using the Ekso NR exoskeleton, were included in this study. To analyze the impact of exoskeleton training during the initial sessions, steps per minute (SPM) and the ratio of walk time to operating time (ROW) were used as a gait effectiveness parameter across the initial eight sessions (S1 to S8). Post-hoc analyses revealed significant differences between S1 and S2 (p = 0.003, adjusted p = 0.014) and between S4 and S5 (p = 0.002, adjusted p = 0.014) for SPM scores. Significant differences were also observed between S1 and S2 (p < 0.001, adjusted p < 0.001) and between S2 and S3 (p = 0.001, adjusted p = 0.007) for ROW scores. Notably, the first plateaus (no statistically significant improvement) were observed in SPM scores between sessions 2 and 3 and ROW scores between sessions 3 and 4. These findings suggest that baseline measures should be taken during session 3.Clinical relevance- This study underscores the clinical importance of establishing accurate baseline measures for gait effectiveness in community-based rehabilitation using the Ekso NR exoskeleton. The findings indicate that session 3 may serve as the optimal baseline, ensuring that observed improvements reflect true rehabilitation progress rather than early familiarization effects.