Neurorehabilitation in paraplegic patients with an active powered exoskeleton (Ekso)

Abstract

Background and Objectives: Spinal cord injury (SCI) is a severe disease where the patients lost the body function below the level of lesion. Neurorehabilitative exercise leads to improvements in physical functions such as strength, range of motion, transfers, wheelchair mobility, and gait. The aim of this study is to evaluate the impact of overground gait training using an active powered exoskeleton. Materials and Methods: Patients affected of SCI admitted to our rehabilitation unit have been studied. We used an active powered exoskeleton (Ekso). Training occurred each day for 5 days a week for a total of 4 weeks. Patients were trained for at least twenty sessions, with a duration of 45-60 min each session. Patients were scored with the 6 min walking test (6MWT) before and after treatment to evaluate the movement and Ashwort scale was used to test spasticity. Psychological tests were also performed to focus on depression (Beck Depression Inventory) and on self-perception (Body Uneasiness Test-A). Results: Thirteen patients were studied (mean age 31 ± 10.4; ten males and three females), who were affected by SCI with motor complete/incomplete lesions (seven complete, six incomplete), according to the American Spinal Injury Association guidelines. All patients completed the overground gait training for all 4 weeks without collateral effects. The motor recovery evaluated with the 6MWT in incomplete motor patients described a statistical significant recovery in terms of meters and absence of rest, especially in thoracic and lumbar level lesions (48/114 m [improvement 137.5%]; 98/214 m [improvement 118.37%], P < 0.05). We did not find any difference in terms of spasticity using the Ashworth Scale. After the treatment, we found in all patients a great improvement in mood disorders and body perception. Conclusions: The overground training with the exoskeleton is a promising therapeutical approach for SCI patients, which can increase both motor and psychological aspects.

Challenges and solutions for application and wider adoption of wearable robots

“…This subcategory is ideal either when the wearer needs substantial support by the machine or when high levels of controllability are needed on the limb. High-torque use cases include lower limb assistance for severely impaired people, (Esquenazi et al, 2012;Wang et al, 2015;Milia et al, 2016;Vouga et al, 2017;van der Kooij et al, 2019;Jyräkoski et al, 2020;Figure 2c;www.indego.com) or power augmentation applications in which also upper limbs might be involved (Kazerooni, 2005;Marcheschi et al, 2011;www.sarcos.com;www. raytheon.com;Figure 2a,b).…”

Different Prevention and Treatment Strategies for Knee Osteoarthritis (KOA) with Various Lower Limb Exoskeletons – A Comprehensive Review

“…At the same time, the gait and speed of the exoskeleton robot are improved to coordinate the movement of the human body and help the wearer complete the rehabilitation training, which can last 160 min. 65,66 The wearable lower limb exoskeleton Ekso GTTM 67 was developed by Ekso Bionics company (as shown in Fig. 4(h)).…”

A Novel Human-Machine Collaboration Model of an Ankle Joint Rehabilitation Robot Driven by EEG Signals

“…At present, AJRR can be divided into traditional pedestal type [11,12], parallel type [13][14][15][16], and wearable type [17][18][19][20][21] according to different structures and installation methods. e overall structure of the traditional pedestal AJRR is complex, the use and maintenance cost is high, the equipment is large, and the training method is single.…”