CLINICAL TRIAL APPLICATIONS OF THE LOCOMOTION EXOSKELETON «EXOATLET» IN SPINAL PATIENTS
Bushkov F.A., Kleshchunov S.S., Kosiaeva S.V., Bzhiliansky M.A., Ivanova G.E.
Rehabilitation center «Overcoming», Moscow

The article is devoted to an overview of modern medical robots used in everyday rehabilitation practice and hospital services. At thesame time, the emerging problems and new challenges associated with the COVID-19 pandemic are analyzed. Logically structured medical and technical solutions using innovative robotics are proposed. The concept model of the multifunctional autonomous robot “Helper” which is presented in the article has 7 functions that are critical in the face of a pandemic: movement along the specified routes; disinfection of premises and robot self disinfection; biometric identification; delivery of medicines; interpersonally communication;possibilities of telepresence and telemedicine; interactive musical-acoustic and virtual psychotherapy. It is an attempt to find effective practical response to the most serious challenges of our time associated with the pandemic aimed at reducing the risks of nosocomial spread of infection, unloading medical staff, providing psychological and service assistance to patients with COVID-19 who are undergoing rehabilitation treatment. The conclusive idea of the article is that medical robotics plays an increasingly significant role in the process of modern rehabilitation treatment and hospital services, which become especially important during a pandemic control and liquidation of its consequences. The relevant robotization of Healthcare Service has strategic importance with high medical,social and economic potential.

New Tasks for Medical Robotics in Rehabilitation and Hospital Services in a Pandemic Time – New Solutions: a Concept Model of an Autonomous Multifunctional Robot «Helper»

Shushardzhan

Pechenov²,

Allik³

et al. 2020

Potential benefits and limitations of robotic exoskeleton usage in patients with spinal cord injury: a review

Karjakin

Белова

Сушин

et al. 2020

Restoration of motor functions in patients with spinal cord injury (SCI) is a priority problem of this patient’s category medical rehabilitation. Despite the achievements of modern medicine, the level of movement restoration after SCI is often insignificant, many patients stayed confined to a wheelchair. Secondary complications (osteoporosis, obesity, cardiovascular, respiratory, urogenital, trophic and other disorders) used to develop in the injured people as a result of low physical activity, they aggravate the course of the main disease and complicate the process of medical rehabilitation. A hope for rehabilitation specialist and patients is associated with the appearance of robotic exoskeletons (RES), that might become an innovation means for improving the mobility of patients with SCI. The purpose of the review is to provide information on the possible benefits and disadvantages of the use of RES in the rehabilitation of patients with SCI. This article discusses the general characteristics of modern exoskeletons and the conditions of their use for patients with paralysis of the lower extremities. The article presents Information on the effectiveness and safety of the use of exoskeleton devices in neurorehabilitation, as well as data on limitations and problems associated with exoskeleton use in clinical practice. The results of meta-analyses and randomized studies on the potential benefits of the RES usage both in everyday life and in rehabilitation of patients with SCI are presented. The influence of walking training in the exoskeleton on the degree of motor functions improvement, overall physical activity level and body weight in patients with SCI is highlighted. The article draws attention to the unsolved problems and further perspectives of RES application in patients with SCI. It emphasizes the necessity for protocols standardization and large randomized comparative clinical trials organization with prolonged observational period of patients in order to determine exoskeletons usage potential.

Application of the Mechanotherapy Devices Simulating Step-Like Movements in Combination with Electrical Stimulation in Spinal Cord Injury Patients

Даминов

Ткаченко

Низаметдинова

2020

Summarizing the results of the world scientific data on this topic, the possibility to evoke step-like movements in the lower limbs of patients with spinal cord injury (SCI) below the level of damage was noted. That was verified during electrical stimulation in combination with mechanotherapy, the electrodes application to the definite areas of spinal cord. In addition, we stated that these measures led to reduction of muscle hypertonus in the lower limbs, improvement of neuromuscular junction and tolerance towards increasing stimulation that were instrumentally confirmed. We stated that it is impossible to achieve the same effect using only one of these methods isolated. The first studies were carried out by implantation of epidural electrodes in the spinal cord, and later by a combination of electrical stimulation and step-like movements with the same frequency setting manually. During further technology development, stimulation became percutaneous, and the movements were carried out using robotic mechanotherapy. The advantage of this method is obvious: the specialist needs to set the initial parameters which are selected individually for the patient,to monitor the progress of the procedure and to fix changes. These devices include robotic systems which perform movements in the lower extremities with full and partial axial load. Currently a study of the device for robotic therapy in horizontal unsupported state is ongoing in rehabilitation clinic of FSBI NMCC n. a. N.I. Pirogov. Its excellence is support absense, the training is held in conditions of complete body weight unloading. Multimodal electrical stimulation is performed simultaneously with robotic therapy: percutaneous electrical stimulation of the spinal cord and functional electrical stimulation (FES) of the legs, back and abdomen muscles. It was stated that parameters of neurological status were improved significantly. This article presents the results of unsupported robotic mechanotherapy`s clinical testing in the SCI patients rehabilitation.