The Effectiveness and Safety of Exoskeletons as Assistive and Rehabilitation Devices in the Treatment of Neurologic Gait Disorders in Patients with Spinal Cord Injury: A Systematic Review

Global Spine J, 2016 · DOI: http://dx.doi.org/10.1055/s-0036-1593805 · Published: November 3, 2016

Spinal Cord Injury Assistive Technology Rehabilitation

Simple Explanation

This systematic review investigates the effectiveness and safety of wearable exoskeletons for improving walking in patients with spinal cord injuries (SCI). Exoskeletons are robotic devices that help individuals with SCI to stand and walk. The review compares the use of exoskeletons as assistive devices (to help people walk) versus rehabilitative devices (to improve long-term walking ability) against other methods like knee-ankle-foot orthoses (KAFOs) and conventional therapies. The study found no data comparing exoskeletons to KAFOs as assistive devices. As rehabilitation devices, exoskeletons showed no consistent benefit compared to conventional methods in patients with chronic SCI, suggesting a need for trials comparing newer exoskeleton models.

Study Duration

Not specified

Participants

Nine comparison studies (11 publications)

Evidence Level

Systematic Review

Key Findings

1
No studies were found comparing the use of exoskeletons as assistive devices to KAFOs in patients with SCI.
2
The 10-meter walk test velocity and Spinal Cord Independence Measure scores showed no significant difference in change from baseline among patients undergoing exoskeleton training compared with various comparator therapies.
3
The 6-minute walk test distance and Walking Index for Spinal Cord Injury scores showed mixed results, with some studies indicating no difference and others showing benefit of either exoskeleton or comparator therapies.

Research Summary

This systematic review aimed to determine the effectiveness and safety of powered exoskeletons as assistive and rehabilitation devices for improving locomotion in patients with spinal cord injury (SCI). The review found no studies comparing exoskeletons to conventional KAFOs as assistive devices. Nine studies evaluating exoskeletons as rehabilitative devices showed no consistent benefit compared to conventional methods in patients with chronic SCI. The authors conclude that there is a need for trials comparing later-generation exoskeletons to current rehabilitation strategies to determine their effectiveness in improving locomotion in SCI patients.

Practical Implications

Assistive Device Comparison Needed

Future research should focus on comparing exoskeletons directly to KAFOs to determine their relative benefits as assistive devices.

Targeted Rehabilitation

Consider patient-specific factors (e.g., walking capacity, motor neuron injury type) when prescribing exoskeleton therapy, as subgroups may respond differently.

Advanced Exoskeleton Evaluation

Clinical trials are needed to evaluate the effectiveness of newer exoskeleton technologies compared to conventional rehabilitation methods in SCI patients.

Study Limitations

1
Heterogeneity in comparison groups, co-interventions, outcomes, and study designs across included studies.
2
Inconsistent reporting of adverse events related to exoskeleton use.
3
Lack of long-term outcome data, such as osteoporosis, pathologic fractures, or skin breakdown.

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