Recovering the ability to stand and walk independently can have numerous health benefits for people with spinal cord injury (SCI). Wearable exoskeletons are being considered as a promising alternative to conventional knee-ankle-foot orthoses (KAFOs) for gait training and assisting functional mobility. However, comparisons between these two types of devices in terms of gait biomechanics and energetics have been limited. Through a randomized, crossover clinical trial, this study compared the use of a knee-powered lower limb exoskeleton (the ABLE Exoskeleton) against passive orthoses, which are the current standard of care for verticalization and gait ambulation outside the clinical setting in people with SCI. Ten patients with SCI completed a 10-session gait training program with each device followed by user satisfaction questionnaires. Walking with the ABLE Exoskeleton improved gait kinematics compared to the KAFOs, providing a more physiological gait pattern with less compensatory movements (38% reduction of circumduction, 25% increase of step length, 29% improvement in weight shifting). However, participants did not exhibit significantly better results in walking performance for the standard clinical tests (Timed Up and Go, 10-m Walk Test, and 6-min Walk Test), nor significant reductions in energy consumption. These results suggest that providing powered assistance only on the knee joints is not enough to significantly reduce the energy consumption required by people with SCI to walk compared to passive orthoses. Active assistance on the hip or ankle joints seems necessary to achieve this outcome.

恢复独立站立和行走的能力可以为脊髓损伤 (SCI) 患者带来许多健康益处。可穿戴外骨骼被认为是传统膝踝足矫形器（KAFO）的有前景的替代品，用于步态训练和辅助功能活动。然而，这两类设备在步态生物力学和能量学方面的比较有限。通过一项随机、交叉临床试验，本研究将膝动力下肢外骨骼（ABLE 外骨骼）与被动矫形器的使用进行了比较，被动矫形器是 SCI 患者在临床环境之外的垂直和步态行走的当前护理标准。 10 名 SCI 患者使用每种设备完成了为期 10 次的步态训练计划，随后进行了用户满意度调查问卷。与 KAFO 相比，使用 ABLE 外骨骼行走改善了步态运动学，提供了更符合生理学的步态模式，同时减少了代偿性运动（环转减少 38%，步长增加 25%，重心转移改善 29%）。然而，参与者在标准临床测试（计时起身行走、10 米步行测试和 6 分钟步行测试）中的步行表现并没有表现出明显更好的结果，能量消耗也没有显着降低。这些结果表明，与被动矫形器相比，仅对膝关节提供动力辅助不足以显着降低 SCI 患者行走所需的能量消耗。要实现这一结果，似乎需要对髋关节或踝关节进行积极协助。