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

Abstract

<jats:title>Abstract</jats:title> <jats:p>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 are the benefits and risks for exoskeleton users?, and (3) what is the current evidence on clinical efficacy for wearable 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.</jats:p>

Robotic exoskeleton-assisted walking rehabilitation for stroke patients: a bibliometric and visual analysis

“…In the analysis of keyword co-occurrence, the high frequency of occurrence for "weight support" indicates that the weight ratio (the self-weight of the exoskeleton and its maximum load capacity) is a technical research focal point in the hardware configuration of exoskeletons. The average weight of exoskeletons used for stroke patients is 8.90 ± 7.48 kg, with a maximum carrying weight of 100 kg (Rodríguez-Fernández et al, 2021). The more joint drives an RE has, the heavier it becomes, and the overweight exoskeleton becomes a problem for patients to wear and carry (Tefertiller et al, 2018).…”

“…In recent years, due to advancements in chemical material sciences, control technologies, and the integration of artificial intelligence, there has been a rapid development of exoskeletal robotic devices (Yi and Yubing, 2024). These devices have emerged as groundbreaking in the adjunctive therapy of poststroke hemiparesis, facilitating the reclamation of ambulatory abilities and gait balance (Rodríguez-Fernández et al, 2021). Contrasting with end-effectors, robotic exoskeleton (RE) are wearable robotic units that are affixed to an individual's limbs, providing either a substitution or enhancement of limbs movement.…”

Use of Robotic Rehabilitation in Patients with Diseases of the Nervous System

“…(6,7) Lesión medular espinal: este síndrome compromete a aquellas enfermedades tanto traumáticas como atraumáticas que provocan un mal funcionamiento de la médula espinal como mensajero de estímulo y respuestas desde el campo receptivo hasta el SN y viceversa, lo cual provoca una alteración en toda la cadena del SS y su actuación; esto afecta en enorme medida la independencia o calidad de vida de quienes lo padecen. (8,9) Parálisis Cerebral: su primera descripción fue en el año 1862 por William John Litle, quien observó una serie de niños con alteraciones del tono muscular y fue capaz de identificar que esta rigidez espásticaprimer nombre que recibió la enfermedad-era una secuela del período de gestación y el nacimiento. (10) Esta enfermedad es la alteración psicosomática más frecuente de las edades tempranas de la vida, ocurre por una injuria directa en el SNC durante el desarrollo lo cual deja la posibilidad abierta de que sea prenatal, perinatal o neonatal temprana.…”