Robot-assisted gait training in individuals with spinal cord injury: A systematic review for the clinical effectiveness of Lokomat

Alashram, Anas R.; Annino, Giuseppe; Padua, Elvira

doi:10.1016/j.jocn.2021.07.019

Cited by 53 publications

(35 citation statements)

References 46 publications

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“…EXOs used in the military and industry fields were not targeted in this review, nor were Tamburella et al Journal of NeuroEngineering and Rehabilitation (2022) 19:27 the studies that aimed at addressing the effects of other robotic-assisted gait training for individuals with SCI. To date, the review [29], meta-analysis [30] and clinical practice guideline [31] studies on the effects of roboticassisted gait training, different from overground EXOs (e.g. body weight supported EXO on treadmill, end effector devices, etc.…) in the framework of SCI rehabilitation, are available.…”

Section: Introductionmentioning

confidence: 99%

Overground robotic training effects on walking and secondary health conditions in individuals with spinal cord injury: systematic review

Tamburella

Lorusso

Tramontano

et al. 2022

J NeuroEngineering Rehabil

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Overground powered lower limb exoskeletons (EXOs) have proven to be valid devices in gait rehabilitation in individuals with spinal cord injury (SCI). Although several articles have reported the effects of EXOs in these individuals, the few reviews available focused on specific domains, mainly walking. The aim of this systematic review is to provide a general overview of the effects of commercial EXOs (i.e. not EXOs used in military and industry applications) for medical purposes in individuals with SCI. This systematic review was conducted following the PRISMA guidelines and it referred to MED-LINE, EMBASE, SCOPUS, Web of Science and Cochrane library databases. The studies included were Randomized Clinical Trials (RCTs) and non-RCT based on EXOs intervention on individuals with SCI. Out of 1296 studies screened, 41 met inclusion criteria. Among all the EXO studies, the Ekso device was the most discussed, followed by ReWalk, Indego, HAL and Rex devices. Since 14 different domains were considered, the outcome measures were heterogeneous. The most investigated domain was walking, followed by cardiorespiratory/metabolic responses, spasticity, balance, quality of life, human–robot interaction, robot data, bowel functionality, strength, daily living activity, neurophysiology, sensory function, bladder functionality and body composition/bone density domains. There were no reports of negative effects due to EXOs trainings and most of the significant positive effects were noted in the walking domain for Ekso, ReWalk, HAL and Indego devices. Ekso studies reported significant effects due to training in almost all domains, while this was not the case with the Rex device. Not a single study carried out on sensory functions or bladder functionality reached significance for any EXO. It is not possible to draw general conclusions about the effects of EXOs usage due to the lack of high-quality studies as addressed by the Downs and Black tool, the heterogeneity of the outcome measures, of the protocols and of the SCI epidemiological/neurological features. However, the strengths and weaknesses of EXOs are starting to be defined, even considering the different types of adverse events that EXO training brought about. EXO training showed to bring significant improvements over time, but whether its effectiveness is greater or less than conventional therapy or other treatments is still mostly unknown. High-quality RCTs are necessary to better define the pros and cons of the EXOs available today. Studies of this kind could help clinicians to better choose the appropriate training for individuals with SCI.

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Section: Introductionmentioning

confidence: 99%

Overground robotic training effects on walking and secondary health conditions in individuals with spinal cord injury: systematic review

Tamburella

Lorusso

Tramontano

et al. 2022

J NeuroEngineering Rehabil

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“…In recent years, rehabilitation involving gait training with robots has become available for clinical use and is reportedly effective. 2 , 3 ) However, one problem with gait training with robots is that movements are determined by the output of the robot. To treat paralysis, training with muscle contraction that is independent of the motor torque of the robot may be useful, but it is difficult to achieve in rehabilitation using a robot alone.…”

Section: Introductionmentioning

confidence: 99%

Development of a Gait Rehabilitation Robot Using an Exoskeleton and Functional Electrical Stimulation: Validation in a Pseudo-paraplegic Model

Inoue

Kimura

Shimada

et al. 2022

PRM

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Objective: We have developed a robot for gait rehabilitation of paraplegics for use in combination with functional electrical stimulation (FES). The purpose of this study was to verify whether the robot-derived torque can be reduced by using FES in a healthy-person pseudo-paraplegic model. Methods: Nine healthy participants (22–36 years old) participated in this study. The robot exoskeleton was designed based on the hip–knee–ankle–foot orthosis for paraplegia. Participants walked on a treadmill using a rehabilitation lift to support their weight. The bilateral quadriceps femoris and hamstrings were stimulated using FES. The participants walked both with and without FES, and two walking speeds, 0.8 and 1.2 km/h, were used. Participants walked for 1 min in each of the four conditions: (a) 0.8 km/h without FES, (b) 0.8 km/h with FES, (c) 1.2 km/h without FES, and (d) 1.2 km/h with FES. The required robot torques in these conditions were compared for each hip and knee joint. The maximum torque was compared using one-way analysis of variance to determine whether there was a difference in the amount of assist torque for each gait cycle. Results: Walking with the exoskeleton robot in combination with FES significantly reduced the torque in hip and knee joints, except for the right hip during extension. Conclusions: In the healthy-participant pseudo-paraplegic model, walking with FES showed a reduction in the robot-derived torque at both the hip and knee joints. Our rehabilitation robot combined with FES has the potential to assist paraplegics with various degrees of muscle weakness and thereby provide effective rehabilitation.

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“…The advent of exoskeletal robotic technology can benefit the spinal cord injury population in three ways: (1) extensive repetitions of walking can help them improve and regain their walking ability, (2) the need for medical manual labor can be reduced, making extensive walking training feasible and even shortening the course of treatment, and (3) complications can be reduced, such as reduced pain, spasticity, osteoporosis and improved cardiorespiratory, lower urinary tract and bowel function (Esquenazi et al, 2012 ; Kolakowsky-Hayner, 2013 ; Benson et al, 2015 ; Stampacchia et al, 2016 ; Chun et al, 2019 ; Jang et al, 2019 ; Alashram et al, 2021 ; Brinkemper et al, 2021 ; Shackleton et al, 2021 ; Williams et al, 2021 ; Garnier-Villarreal et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

“…Good fixation and support of the trunk during walking is required for subjects with poor upper limb and trunk function, insufficient endurance, or cognitive impairment. However, the existing stationary gait robots are often bulky and some are equipped with a treadmill (Peshkin et al, 2005 ; Bessler et al, 2020 ; Alashram et al, 2021 ; Calabrò et al, 2022 ). Patients mostly need to be transferred specifically to a dedicated treatment room to use the device, which cannot be used within the patient's ward, resulting in reduced accessibility.…”

Section: Introductionmentioning

confidence: 99%

Safety and Feasibility of a Novel Exoskeleton for Locomotor Rehabilitation of Subjects With Spinal Cord Injury: A Prospective, Multi-Center, and Cross-Over Clinical Trial

Chen

Wang

et al. 2022

Front. Neurorobot.

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ObjectiveTo evaluate the safety, walking efficiency, physiological cost, don and doff time cost, and user satisfaction of Ai-robot.DesignProspective, multi-center, and cross-over trial.SubjectsParaplegic subjects (n = 40) with T6–L2 level spinal cord injury.MethodsSubjects who could walk independently using Aiwalker, Ailegs, and hip knee ankle foot orthosis (HKAFO) for 6 min within 30 days of training underwent 10 sets of tests. In each set, they completed three 6-min walk test (6MWT) sessions using the three aids in random order.ResultsSkin lesions, pressure sores, and fractures, were the main adverse events, likely due to a lack of experience in using exoskeleton systems. The average 6MWT distances of the Aiwalker, Ailegs, and HKAFO groups were 134.20 ± 18.74, 79.71 ± 18.06, and 48.31 ± 19.87 m, respectively. The average heart rate increases in the Aiwalker (4.21 ± 8.20%) and Ailegs (41.81 ± 23.47%) groups were both significantly lower than that in the HKAFO group (62.33 ± 28.32%) (both p < 0.001). The average donning/doffing time costs for Ailegs and Aiwalker were significantly shorter than that of HKAFO (both p < 0.001). Satisfaction was higher in the Ailegs and Aiwalker groups (both p < 0.001).ConclusionSubjects with paraplegia below T6 level were able to ambulate safely and efficiently with Ai-robot. The use of Ai-robot should be learned under the guidance of experienced medical personnel.

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Robot-assisted gait training in individuals with spinal cord injury: A systematic review for the clinical effectiveness of Lokomat

Cited by 53 publications

References 46 publications

Overground robotic training effects on walking and secondary health conditions in individuals with spinal cord injury: systematic review

Overground robotic training effects on walking and secondary health conditions in individuals with spinal cord injury: systematic review

Development of a Gait Rehabilitation Robot Using an Exoskeleton and Functional Electrical Stimulation: Validation in a Pseudo-paraplegic Model

Safety and Feasibility of a Novel Exoskeleton for Locomotor Rehabilitation of Subjects With Spinal Cord Injury: A Prospective, Multi-Center, and Cross-Over Clinical Trial

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