The future of SCI rehabilitation: Understanding the impact of exoskeletons on gait mechanics

The Journal of Spinal Cord Medicine, 2018 · DOI: 10.1080/10790268.2018.1474681 · Published: May 1, 2018

Spinal Cord Injury Assistive Technology Rehabilitation

Simple Explanation

Robotic exoskeletons are being used in the rehabilitation of persons with spinal cord injury (SCI). Exoskeletons offer independence in standing and walking with very low metabolic cost, while also facilitating improvement in the users’ quality of life. This editorial references two articles published in the Journal of Spinal Cord Medicine that highlight the effects of exoskeleton use on the temporal-spatial, kinematic, and neuromechanical components of walking. More research investigating the gait and neuromechanical changes observed with exoskeleton use among individuals with SCI is desperately needed, as are studies examining the effect of training dosage and community use.

Study Duration

Not specified

Participants

Systematic review: 12 studies; Exploratory case series: 4 AB controls and 4 persons with SCI

Evidence Level

Level 4: Systematic review and case series

Key Findings

1
RAGT can result in positive neuronal adaptations, improved temporal-spatial gait mechanics, and decreases in energetic costs associated with walking (compared to traditional rehabilitation methods).
2
Over-ground modalities, require additional balance and support from the rest of the body and provide for more gait fluctuations, more closely mirroring AB populations.
3
Training did appear to improve one SCI subject’s ability to ambulate, as his gait symmetry, velocity, and neuromuscular activation improved, attributed to the repetitive loading and reciprocal movement of the lower extremities within the exoskeleton.

Research Summary

Hayes et al. surmised that for individuals with SCI, RAGT can result in positive neuronal adaptations, improved temporal-spatial gait mechanics, and decreases in energetic costs associated with walking (compared to traditional rehabilitation methods). Ramanujam et al. observed that AB individuals adopted different muscle activation patterns in their lower extremities while wearing the exoskeleton, which was primarily evidenced through differences observed in the amplitude and duration of musculature activation of the hip and knee. Both reports highlight that robotic exoskeleton research is still in its infancy and significant strides are needed to overcome several of the highlighted limitations.

Practical Implications

Improved Rehabilitation Strategies

Understanding how exoskeleton use and training duration impacts walking mechanics is fundamental to the development of improved rehabilitation strategies for individuals with SCI.

Future Powered Exoskeletons

Knowledge gained from current research may influence the development of future powered robotic exoskeletons that enhance neuromuscular function in persons with SCI.

Integration into Comprehensive Rehabilitation

RAGT, utilizing either treadmill or over-ground modalities, is helpful for both incomplete and complete SCI rehabilitation, especially when integrated into a more comprehensive and balanced rehabilitation regimen that considers the individual’s needs and capabilities.

Study Limitations

1
Variations among and within the study populations paired with the limited number of subjects across the articles make definitive results difficult at best.
2
Sweeping conclusions about the SCI gaiting patterns, either mechanically or neuromechanically, were ultimately not possible due to the limited number of SCI subjects.
3
Inconsistencies within the amount of exoskeleton training received by each individual with SCI, as well as the heterogeneity of the SCI demographics (injury and otherwise).

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