Clinical Investigation to Validate the Safety and Performance of the ABLE Exoskeleton Device for Individuals With Multiple Sclerosis in a Clinical Setting

To assess safety, the number of Severe Adverse Events (SAE), Adverse Events (AE) and drop-outs due to the device will be assessed and reported.

Level of Assistance (LoA) to don/doff the device will be measured in every session. The level of assistance will be measured using a 6-item scale, from Total assistance to Independence, with Independence being the best outcome possible. Different assistance levels are defined taking into account the degree of participation of both the participant and the therapist on performing the activity.

The time taken to don/doff the device will be measured in every session. Time will be measured in minutes and seconds for each activity. Donning time will start from the moment the participant is ready to transfer into the device until all the straps and clips are correctly tightened. Doffing time will start from the moment the participant starts taking off the device until they have completely removed it.

Four therapy activity tasks will be attempted every session by the participant. The therapist will record the level of assistance required to complete each task during the session, using a 6-item scale, from Total assistance to Independence, with Independence being the best outcome possible. The tasks are the following: sit-to-stand, walk 10 meters, turn 180 degrees, and stand-to-sit.

In each training session, the time spent upright (in minutes) and the time spent walking (in minutes) with the device will be automatically measured and registered by the device.

In each session, the number of steps taken (step count) with the device will be automatically measured and registered by the device.

In each session, the distance walked (in meters) with the device will be automatically measured and registered by the device.

The Timed 25-Foot Walk (T25FW) test measures the time a person needs to walk 25 feet. This test will be performed in the pre-post evaluations without the device to assess the change in the walking function after the training.

The Ambulation Index (AI) is a rating scale that assesses mobility based on time and degree of assistance required when walking 25 feet as quickly as possible but safely. Scores range from 0 (asymptomatic and fully active) to 10 (bedridden). This test will be performed in the pre-post evaluations without the device to assess the change in the walking function after the training.

The 6-Minute Walk Test (6MWT) measures the distance a person can walk in 6 minutes. This test will be performed in the pre-post evaluations without the device to assess the change in the walking function after the training.

The Timed Up-and-Go Test (TUG) measures the time it takes a person to get up from a chair, walk 3 meters, turn around, and sit down again. This test will be performed in the pre-post evaluations without the device to assess the change in the walking function after the training.

The Trunk Impairment Scale (TIS) measures the motor impairment of the trunk through the evaluation of static and dynamic sitting balance as well as coordination of trunk movement. The total score ranges from 0 (minimal performance) to 23 (perfect performance). This test will be performed in the pre-post evaluations without the device to assess the change in the trunk impairment after training.

The Daniels Muscle Testing scale will be used to measure the strength of muscles in the lower extremities in the pre-post evaluations to assess motor function after the training. Scores range from 0 (absence of muscle activity) to 5 (normal muscle activity).

The Modified Ashworth Scale (MAS) measures spasticity in patients with lesions to the central nervous system. The scale assigns a grade of spasticity from 0 (no increase in muscle tone) to 4 (affected part rigid in flexion or extension). It will be evaluated in the pre-post evaluations without the device to assess the change in the spasticity after training.

The Borg Rating of Perceived Exertion (RPE) scale is used to measure a person's perception of their effort and exertion, breathlessness, and fatigue during physical activity. Scores range from 6 (no exertion at all) to 20 (maximal exertion). It will be evaluated in the pre-post evaluations without the device to assess the change in the perceived exertion after the training.

The Barthel Index (BI) will be used to assess the participants' ability to perform mobility and self-care activities of daily living (ADL). The total score ranges from 0 (total dependency) to 100 (independency). It will be evaluated in the pre-post evaluations without the device to assess the change in the independence to perform ADL after the training.

The Modified Fatigue Impact Scale (MFIS) provides an assessment of the effects of fatigue in terms of physical, cognitive, and psychosocial functioning in persons with multiple sclerosis. The total score ranges from 0 to 84, with higher scores meaning a higher impact of fatigue. It will be evaluated in the pre-post evaluations without the device to assess the change in the fatigue after the training.

The Multiple Sclerosis Quality of Life-54 (MSQoL-54) is a multidimensional health-related quality of life (QoL) measure that combines both generic and MS-specific items into a single instrument. There is no single overall score for the MSQoL-54. Two summary scores - physical health and mental health - can be derived from a weighted combination of scale scores. The higher the score, the best the outcome. It will be evaluated in the pre-post evaluations without the device to assess the change in the QoL after the training.

The Psychosocial Impact of Assistive Devices Scale (PIADS) is a 26-item, self-reported questionnaire that provides a measure of user perception and other psychological factors associated with assistive technology devices. Scores range from -78 (maximum negative impact) to +78 (maximum positive impact). It will be used to assess the effects of the ABLE Exoskeleton on functional independence, well-being, and quality of life of participants after the training program experience.

The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) is a 12-item outcome measure that assesses user satisfaction with two components (Device and Services) using a 5-point scale ranging from 1 (not satisfied) to 5 (very satisfied). Only the 8 items referred to the device will be evaluated to measure user satisfaction from participants and therapists with the ABLE Exoskeleton after the training program experience.