FIGURE 4.

Examples of changes in the foot pressure characteristics during EWT with SCES in subjects with motor incomplete (A) and complete (B) paraplegia. For each example: MRI image, diagram of EWT (same format as in Figure 3B), plantar pressure recordings and vertical foot loading forces (right) during the initial test and after EWT with SCES are shown. Vertical dashed lines on the right panels correspond to the time when plantar pressure distribution patterns are illustrated on the middle panels (corresponding to the maximum foot loading at the end of the stance phase). (A) Subject P4 (AIS C, 2.5 years post-trauma). MRI: structural changes of the spinal cord with post-traumatic gliosis. After 6 sessions of training, there was a twofold increase of the plantar pressure and the amplitude of GRF. Also, P4 subject increased an ability to walk over-ground using a walker for balance (without exoskeleton) from 3 to 40 strides. The subject noted the emergence of paresthesia in leg muscles and new “feeling of support” with an increase of sensation (by + 3 AIS score for both light touch and pin-prick). (B) Subject P12 (AIS B, motor – 3, sensory 103/103, 11 years post-trauma), advanced EXO-walker. MRI: non-structured spinal cord at the level for lumbar enlargement (Th12-L1) with separated neural elements. Complicated L1 vertebral fracture with SC compression. Surgery: SC decompression and instrumental fixation. P12 is actively engaged in sports, as an actual member of the National Russian Paralympic Team in curling. In the first training session with SCES, the subject improved his achievement of non-stop walking in the exoskeleton from 120 min (previous achievement) to 185 min and set the new record. After 6 sessions of training, the pressure under the feet increased and spread to the front part of the foot, and the amplitude of GRF increased from ∼75% BW up to ∼100–105% BW. Wide arrows – sessions in which SCES started, and thin arrows – sessions in which F-Scan recordings were performed.