Exoskeleton gait training after spinal cord injury: An exploratory study on secondary health conditions

Baunsgaard, Carsten Bach; Nissen, Ulla Vig; Brust, Anne Katrin; Frotzler, Angela; Ribeill, Cornelia; Kalke, Yorck-Bernhard; León, Natacha; Gómez, Belén; Samuelsson, Kersti; Antepohl, Wolfram; Holmström, Ulrika; Marklund, Niklas; Glott, Thomas; Opheim, Arve; Penalva, Jesús Benito; Murillo, Narda; Nachtegaal, Janneke; Faber, Willemijn; Biering‐Sørensen, Fin

doi:10.2340/16501977-2372

Cited by 65 publications

(107 citation statements)

References 34 publications

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“…Another advantage of exoskeleton use are the potential health benefits 11,12 . Because of the possibility to stand and walk in an upright position, exoskeletons may help to prevent secondary health complications, such as spasticity 11,12 , impaired bowel function 13 , and related loss of quality of life 11 . From this perspective, exoskeletons are used as an exercise device to promote physical health and well-being by reducing secondary health complications.…”

mentioning

confidence: 99%

Exoskeleton home and community use in people with complete spinal cord injury

Dijsseldonk

Nes

Geurts

et al. 2020

Sci Rep

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A consequence of a complete spinal cord injury (SCI) is the loss of gait capacity. Wearable exoskeletons for the lower extremity enable household and community ambulation in people with SCI. This study assessed the amount, purpose, and location of exoskeleton use in the home and community environment, without any restrictions. The number of steps taken was read from the exoskeleton software. Participants kept a daily logbook, and completed two user experience questionnaires (Quebec User Evaluation of Satisfaction with assistive Technology (D-QUEST) and System Usability Scale (SUS)). Fourteen people with a complete SCI used the ReWalk exoskeleton a median of 9 (range [1–15]) out of 16 ([12–21]) days, in which participants took a median of 3,226 ([330–28,882]) steps. The exoskeleton was mostly used for exercise purposes (74%) and social interaction (20%). The main location of use was outdoors (48%). Overall, participants were satisfied with the exoskeleton (D-QUEST 3.7 ± 0.4) and its usability (SUS 72.5 [52.5–95.0]). Participants with complete SCI report satisfaction with the exoskeleton for exercise and social interaction in the home and community, but report limitations as an assistive device during daily life.

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mentioning

confidence: 99%

Exoskeleton home and community use in people with complete spinal cord injury

Dijsseldonk

Nes

Geurts

et al. 2020

Sci Rep

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“…Several studies use SCIM III in the population with SCI to assess functional independence in ADL. Osterthun et al 27 used SCIM III to assess functional recovery in people with SCI and verified the existence of a strong correlation of the motor score of upper limbs with the domain of self-care [28][29][30] .…”

Section: Discussionmentioning

confidence: 99%

Comparação da incapacidade percebida e independência funcional em indivíduos com lesão medular atletas e não atletas

et al. 2019

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RESUMO Os comprometimentos da funcionalidade em indivíduos com lesão medular (LM) geram complicações secundárias, sendo o descondicionamento físico preponderante e um exacerbador das complicações da lesão. O objetivo foi avaliar em atletas e não atletas com LM a incapacidade percebida e a independência funcional. Os questionários WHODAS 2.0 e SCIM III foram aplicados em 37 voluntários com LM e seus dados sociodemográficos foram coletados. Os escores totais do WHODAS 2.0 e SCIM III de indivíduos com LM torácica e LM cervical foram comparados por meio do teste de Mann-Whitney. Quanto à incapacidade percebida observou-se diferença significativa no WHODAS 2.0 entre atletas e não atletas com LM torácica. Em relação à independência funcional não houve diferenças significativas entre os grupos no SCIM III. Apesar de a prática esportiva promover benefícios para a saúde, no grupo de indivíduos com LM cervical não foram encontradas diferenças significativas, o que pode ser explicado pelo maior grau de comprometimento motor desses indivíduos.

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“…Observational studies (n=35; 40.2%) represented the most frequent study design among the selected studies, followed by pilot studies (n=31; 35.6%), experimental validations (n=15; 17.2%) and experimental studies (n=6; 6.9%). It should also be pointed out that only 10 out of the 87 studies presented a follow-up evaluation after the intervention with the device [19,47,65,[89][90][91][92][93][94][95]. The average time elapsed between the study and the follow-up evaluation was 2 months, ranging from 1 week [65] to 1 year [19].…”

Section: Methodsmentioning

confidence: 99%

“…Only a few studies assessed the improvement related to secondary health conditions. For example, Baunsgaard et al [92] and Juszczak et al [108] were the only reviewed studies that have measured bowel/bladder function. They were, together with the study by Jayaraman et al…”

Section: Outcome Measuresmentioning

confidence: 99%

“…We found only one study [66] reporting falls, which occurred in three patients: two of them when they were starting to ambulate with forearm crutches, and the other patient fell down during a sit-to-stand transition (because of mechanical programming errors as mentioned in the original study). A total of studies reported mild to moderate adverse events such as orthostatic hypertension [122,123], skin abrasions [21, 48, 64-66, 89, 91, 96, 109, 124-128], fatigue of the upper extremities [123,127], low back pain [66,92], and other adverse events such as urinary tract infections [126], talus fracture [126], dizziness [91], calcaneus fracture [123] and severe knee hyperextension [123]. Studies also described that skin abrasions were reduced using padding and size adjustments, and that fatigue of the upper extremities improved with practice.…”

Section: Safety and Risksmentioning

confidence: 99%

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Systematic Review on Wearable Lower-Limb Exoskeletons for Gait Training in Neuromuscular Impairments

Rodríguez-Fernández

Lobo-Prat²,

Font-Llagunes

2020

Preprint

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Gait disorders can reduce the quality of life for people with neuromuscular impairments. Therefore, walking recovery is one of the main priorities for counteracting sedentary lifestyle, reducing secondary health conditions and restoring legged mobility. At present, wearable powered lower-limb exoskeletons are emerging as a revolutionary technology for robotic gait rehabilitation. This systematic review provides a comprehensive overview on wearable lower-limb exoskeletons for people with neuromuscular impairments, addressing the following three questions: (1) what is the current technological status of wearable lower-limb exoskeletons for gait rehabilitation?, (2) what is the methodology used in the clinical validations of wearable lower-limb exoskeletons?, and (3) what are the benefits and current evidence on clinical efficacy of wearable lower-limb exoskeletons? We analyzed 87 clinical studies focusing on both device technology (e.g., actuators, sensors, structure) and clinical aspects (e.g., training protocol, outcome measures, patient impairments), and make available the database with all the compiled information. The results of the literature survey reveal that wearable exoskeletons have potential for a number of applications including early rehabilitation, promoting physical exercise, and carrying out daily living activities both at home and the community. Likewise, wearable exoskeletons may improve mobility and independence in non-ambulatory people, and may reduce secondary health conditions related to sedentariness, with all the advantages that this entails. However, the use of this technology is still limited by heavy and bulky devices, which require supervision and the use of walking aids. In addition, evidence supporting their benefits is still limited to short-intervention trials with few participants and diversity among their clinical protocols. Wearable lower-limb exoskeletons for gait rehabilitation are still in their early stages of development and randomized control trials are needed to demonstrate their clinical efficacy.

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Exoskeleton gait training after spinal cord injury: An exploratory study on secondary health conditions

Abstract: Training seemed not to provoke new pain. Spasticity decreased after a single training session. SCIM III and quality of life increased longitudinally for subsets of participants.

Cited by 65 publications

References 34 publications

Exoskeleton home and community use in people with complete spinal cord injury

Exoskeleton home and community use in people with complete spinal cord injury

Comparação da incapacidade percebida e independência funcional em indivíduos com lesão medular atletas e não atletas

Systematic Review on Wearable Lower-Limb Exoskeletons for Gait Training in Neuromuscular Impairments

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