Wearable robotic exoskeleton for gait reconstruction in patients with spinal cord injury: A literature review

Tan, Koki; Koyama, Soichiro; Sakurai, Hiroaki; Teranishi, Toshio; Kanada, Yoshikiyo; Tanabe, Shigeo

doi:10.1016/j.jot.2021.01.001

Cited by 35 publications

(33 citation statements)

References 63 publications

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“…Due to the outstanding advantages of a simple mechanism, good motion flexibility and low cost, the end-traction ULRR is a research hotspot. According to the training posture of patients, the LLRTS for stroke patients can be divided into the standing type LLRTS [15,16], sitting-lying type LLRTS [17,18] and multi-posture type LLRTS [19,20]. Locomat, as a typical standing type LLRTS, with the help of the patient bodyweight support system, can accurately match the speed of the mechanical leg with the speed of a treadmill, which can assist patients with hip, knee and ankle joint movements to receive natural gait training [21,22].…”

Section: Stroke Patientmentioning

confidence: 99%

Design and Analysis of a Lower Limb Rehabilitation Training Component for Bedridden Stroke Patients

et al. 2021

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Carrying out the immediate rehabilitation interventional therapy will better improve the curative effect of rehabilitation therapy, after the condition of bedridden stroke patients becomes stable. A new lower limb rehabilitation training module, as a component of a synchronous rehabilitation robot for bedridden stroke patients’ upper and lower limbs, is proposed. It can electrically adjust the body shape of patients with a different weight and height. Firstly, the innovative mechanism design of the lower limb rehabilitation training module is studied. Then, the mechanism of the lower limb rehabilitation module is simplified and the geometric relationship of the human–machine linkage mechanism is deduced. Next, the trajectory planning and dynamic modeling of the human–machine linkage mechanism are carried out. Based on the analysis of the static moment safety protection of the human–machine linkage model, the motor driving force required in the rehabilitation process is calculated to achieve the purpose of rationalizing the rehabilitation movement of the patient’s lower limb. To reconstruct the patient’s motor functions, an active training control strategy based on the sandy soil model is proposed. Finally, the experimental platform of the proposed robot is constructed, and the preliminary physical experiment proves the feasibility of the lower limb rehabilitation component.

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Section: Stroke Patientmentioning

confidence: 99%

Design and Analysis of a Lower Limb Rehabilitation Training Component for Bedridden Stroke Patients

et al. 2021

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“…In contrast, wearable exoskeletons are designed to support patients with SCI to re-learn standing, weight shifting, and stepping patterns for walking, and can also utilize different environments for training, including flat indoor surfaces, walking outdoors, navigating obstacles, climbing and descending stairs, and performing activities of daily living ( 4 , 8 , 9 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Efficacy of Lokomat and Wearable Exoskeleton-Assisted Gait Training in People With Spinal Cord Injury: A Systematic Review and Network Meta-Analysis

et al. 2022

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ObjectiveLokomat and wearable exoskeleton-assisted walking (EAW) have not been directly compared previously. To conduct a network meta-analysis of randomized and non-randomized controlled trials to assess locomotor abilities achieved with two different types of robotic-assisted gait training (RAGT) program in persons with spinal cord injury (SCI).MethodsThree electronic databases, namely, PubMed, Embase, and the Cochrane Library, were systematically searched for randomized and non-randomized controlled trials published before August 2021, which assessed locomotor abilities after RAGT.ResultsOf 319 studies identified for this review, 12 studies were eligible and included in our analysis. Studies from 2013 to 2021 were covered and contained 353 valid data points (N-353) on patients with SCI receiving wearable EWA and Lokomat training. In the case of wearable EAW, the 10-m walk test (10-MWT) distance and speed scores significantly increased [distance: 0.85 (95% CI = 0.35, 1.34); speed: −1.76 (95% CI = −2.79, −0.73)]. The 6-min walk test (6-MWT) distance [−1.39 (95% CI = −2.01, −0.77)] and the timed up and go (TUG) test significantly increased [(1.19 (95% CI = 0.74, 1.64)], but no significant difference was observed in the walking index for spinal cord injury (WISCI-II) [−0.33 (95% CI = −0.79, 0.13)]. Among the patients using Lokomat, the 10-MWT-distance score significantly increased [−0.08 (95% CI = −0.14, −0.03)] and a significant increase in the WISCI-II was found [1.77 (95% CI = 0.23, 3.31)]. The result of network meta-analysis showed that the probability of wearable EAW to rank first and that of Lokomat to rank second was 89 and 47%, respectively, in the 10-MWT speed score, while that of Lokomat to rank first and wearable EAW to rank second was 73 and 63% in the WISCI-II scores.ConclusionLokomat and wearable EAW had effects on the performance of locomotion abilities, namely, distance, speed, and function. Wearable EAW might lead to better outcomes in walking speed compared with that in the case of Lokomat.

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“…In the past few decades, various wearable robotic exoskeletons (WREs) have been developed for stand and gait reconstruction in patients with motor-complete SCI. They offer the opportunity to walk in home and community environments by moving the paretic legs of patients with partial or complete SCI in a reciprocal stepping pattern (Fisahn et al, 2016;Miller et al, 2016;Palermo et al, 2017;Tan et al, 2021). Arazpour et al (2013) reported that the gait, speed, and endurance of patients with SCI using WREs are superior to those of patients using either reciprocating gait or hip-knee-ankle-foot orthoses (Arazpour et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Wearable Power-Assist Locomotor for Gait Reconstruction in Patients With Spinal Cord Injury: A Retrospective Study

et al. 2022

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Wearable robotic exoskeletons (WREs) have been developed from orthoses as assistive devices for gait reconstruction in patients with spinal cord injury. They can solve some problems encountered with orthoses, such as difficulty in independent walking and standing up and high energy consumption during walking. The Wearable Power-Assist Locomotor (WPAL), a WRE, was developed based on a knee–ankle–foot orthosis with a single medial hip joint. The WPAL has been updated seven times during the period from the beginning of its development, in 2005, to 2020. The latest version, launched as a commercialized model in 2016, is available for medical facilities. In this retrospective study, which included updated results from previous reports, all data were extracted from development research records from July 2007 to December 2020. The records were as follows: patient characteristics [the number of participants, injury level, and the American Spinal Injury Association Impairment Scale (AIS) score], the total number of WPAL trials when aggregating the cases with all the versions or only the latest version of the WPAL, and maximum walking performance (functional ambulation category [FAC], distance, and time of continuous walking). Thirty-one patients participated in the development research. The levels of spinal cord injury were cervical (C5–C8), upper thoracic (T3–T6), lower thoracic (T7–T12), and lumbar (L1) in 10, 5, 15, and 1 of the patients, respectively. The numbers of patients with AIS scores of A, B, C, and D were 20, 7, 4, and 0, respectively. The total number of WPAL trials was 1,785, of which 1,009 were used the latest version of the WPAL. Twenty of the patients achieved an FAC score of 4 after an average of 9 (median 8, range 2–22) WPAL trials. The continuous walking distance and time improved with the WPAL were compared to the orthosis. We confirmed that the WPAL improves walking independence in people with a wide range of spinal cord injuries, such as cervical spinal cord injuries. Further refinement of the WPAL will enable its long-term use at home.

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Wearable robotic exoskeleton for gait reconstruction in patients with spinal cord injury: A literature review

Cited by 35 publications

References 63 publications

Design and Analysis of a Lower Limb Rehabilitation Training Component for Bedridden Stroke Patients

Design and Analysis of a Lower Limb Rehabilitation Training Component for Bedridden Stroke Patients

Comparison of Efficacy of Lokomat and Wearable Exoskeleton-Assisted Gait Training in People With Spinal Cord Injury: A Systematic Review and Network Meta-Analysis

Wearable Power-Assist Locomotor for Gait Reconstruction in Patients With Spinal Cord Injury: A Retrospective Study

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