A systematic review of the determinants of implementation of a locomotor training program using a powered exoskeleton for individuals with a spinal cord injury

Clinical Rehabilitation, 2023 · DOI: 10.1177/02692155231164092 · Published: August 1, 2023

Spinal Cord Injury Assistive Technology Rehabilitation

Simple Explanation

Wearable powered exoskeletons are a promising tool for rehabilitation, especially for people with spinal cord injuries. However, there's a lack of clear guidance on how to best use these exoskeletons for locomotor training. This study reviews existing research to identify factors that influence the successful implementation of exoskeleton training programs in clinical settings for individuals with spinal cord injuries. The review highlights barriers such as device malfunctions and facilitators like adequate clinician training to improve the process.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Systematic Review

Key Findings

1
A major barrier is the high rate of adverse events like skin issues and falls, along with device malfunctions.
2
Clinician training, available time and resources, and discussing patient expectations are crucial facilitators.
3
Most identified factors relate to the exoskeleton's characteristics, followed by individual characteristics and the inner setting of the implementation.

Research Summary

This systematic review identifies determinants affecting the implementation of overground powered exoskeleton locomotor training programs for individuals with spinal cord injury. The intervention characteristics domain was the most documented, with the relative advantage of intensive repetitive locomotor training highlighted. However, device malfunctions and adverse events were reported as barriers. Limited information on context (inner and outer settings) and the implementation process may hinder the transition from knowledge to action, emphasizing the need for more research in these areas.

Practical Implications

Clinical Training Programs

Develop comprehensive training programs for clinicians to safely and effectively administer exoskeleton training, addressing device operation and troubleshooting.

Resource Allocation

Allocate sufficient time and resources within healthcare settings to support exoskeleton training, including space for storage and training sessions, and dedicated staff.

Patient Expectation Management

Establish clear and realistic objectives for exoskeleton training with patients, managing expectations and providing ongoing support through a multidisciplinary team.

Study Limitations

1
Data extraction was not completed by two independent reviewers.
2
Identified determinants were not analyzed separately for different users (e.g., patients, clinicians).
3
Methodological quality assessment of the included studies was not performed.

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