The Effects of Powered Exoskeleton Gait Training on Cardiovascular Function and Gait Performance: A Systematic Review

Abstract

Patients with neurological impairments often experience physical deconditioning, resulting in reduced fitness and health. Powered exoskeleton training may be a successful method to combat physical deconditioning and its comorbidities, providing patients with a valuable and novel experience. This systematic review aimed to conduct a search of relevant literature, to examine the effects of powered exoskeleton training on cardiovascular function and gait performance. Two electronic database searches were performed (2 April 2020 to 12 February 2021) and manual reference list searches of relevant manuscripts were completed. Studies meeting the inclusion criteria were systematically reviewed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. n = 63 relevant titles were highlighed; two further titles were identified through manual reference list searches. Following analysis n = 23 studies were included. Data extraction details included; sample size, age, gender, injury, the exoskeleton used, intervention duration, weekly sessions, total sessions, session duration and outcome measures. Results indicated that exoskeleton gait training elevated energy expenditure greater than wheelchair propulsion and improved gait function. Patients exercised at a moderate-intensity. Powered exoskeletons may increase energy expenditure to a similar level as non-exoskeleton walking, which may improve cardiovascular function more effectively than wheelchair propulsion alone.

Cardiorespiratory Responses to 10 Weeks of Exoskeleton-Assisted Overground Walking Training in Chronic Nonambulatory Patients with Spinal Cord Injury

“…The cardiorespiratory responses assessed using VO 2 in this study were consistent with those reported in previous studies, which indicated that the metabolic demand of walking with an exoskeleton is equivalent to a moderate level of physical activity [ 14 , 15 , 17 , 19 ]. The number of training sessions varied among the studies; however, exercise intensity was similar.…”

“…Additionally, it has been reported that walking with an exoskeleton can elicit activation of trunk muscles below the level of injury, implying that more muscles may be recruited during exoskeleton-assisted walking than activities performed in sitting position [ 13 ]. Previous studies have demonstrated that, according to cardiorespiratory responses, the exercise intensity of walking with a robotic exoskeleton is moderate in patients with SCI despite different training sessions performed before measurements [ 14 , 15 , 16 , 17 , 18 , 19 ]. Although long-term physical activity with a moderate intensity level is known to induce positive cardiorespiratory responses, most studies have not reported changes in cardiorespiratory responses after exoskeleton-assisted walking training with improved proficiency in exoskeleton use.…”

Knowledge Gaps in Biophysical Changes After Powered Robotic Exoskeleton Walking by Individuals With Spinal Cord Injury—A Scoping Review

“…Most of the currently available studies have reported on the impact of exoskeletons on the QOL and prevention of secondary health complications, on individuals with SCI, are of small scale and are heterogeneous in nature. Moreover, few meta-analyses and reviews have attempted to consolidate the dispersed data to reach more definitive conclusions of the effects of exoskeleton use (14)(15)(16)(17)(18)(19). Many of these reviews included other forms of gait training, such as BWSTT (19), or robotics, such as exoskeletons for upper limbs (16), while others have included the evaluation of exoskeletons beyond individuals with SCI, such as those with a history of stroke (18).…”

“…Moreover, few meta-analyses and reviews have attempted to consolidate the dispersed data to reach more definitive conclusions of the effects of exoskeleton use (14)(15)(16)(17)(18)(19). Many of these reviews included other forms of gait training, such as BWSTT (19), or robotics, such as exoskeletons for upper limbs (16), while others have included the evaluation of exoskeletons beyond individuals with SCI, such as those with a history of stroke (18). Furthermore, many studies have used the term exoskeleton loosely, often applying the term to different devices, such as reciprocating gait orthosis (RGO), driven gait orthoses, bodyweight-supported treadmill trainers, and some leg braces.…”

State-of-the-Art Sensors Research in Ireland

“…Duddy et al [28] examined the effects of powered exoskeleton gait training on cardiovascular function and gait performance via a systematic review. The included studies indicated that powered exoskeleton-assisted training may increase oxygen consumption to a level similar to non-exoskeleton walking, and elevate HR to a greater level than nonexoskeleton waking.…”