Citation

van Herpen FHM, van Dijsseldonk RB, Rijken H, Keijsers NLW, Louwerens JWK, van Nes IJW. Spinal Cord Ser. Cases 2019; 5: e99.

Affiliation

1Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands.

Copyright

(Copyright © 2019, Nature Publishing Group)

DOI

10.1038/s41394-019-0244-2

PMID

31839991

PMCID

PMC6906330

Abstract

INTRODUCTION: Powered robotic exoskeletons are a promising solution to enable standing and walking in patients with spinal cord injury (SCI). Although training and walking with an exoskeleton in motor complete SCI patients is considered safe, the risks of unexpected (technical) adverse events and the risk of fractures are not fully understood. This article reports the occurrence of two different cases of bone fracture during exoskeleton usage. Furthermore, advice is given for extra safety training and instructions. CASE PRESENTATION: The first case concerns a 47-year-old woman with T12 AIS A SCI. Her exoskeleton shut down unexpectedly probably causing a misalignment of the joints of her lower extremities relative to the joints of the exoskeleton, which resulted in a fracture of her left tibia. The second case involves a 39-year-old man with L1 AIS B SCI. An unexpected fracture of the right distal tibia occurred without a specific prior (traumatic) incident.

DISCUSSION: Exoskeleton training instructors, SCI patients and their buddies should be instructed how to handle emergency situations. Furthermore, they should be aware of the risk of stress fractures of the lower extremities. Proper alignment of the exoskeleton relative to the body is of utmost importance to reduce fracture risk. In the case of swelling and discoloring of the skin, radiographic examination should be performed in order to exclude any fracture.

© International Spinal Cord Society 2019.

Language: en

Keywords

Neurological disorders; Risk factors; Skeleton; Therapeutics