Utilization of overground exoskeleton gait training during inpatient rehabilitation: a descriptive analysis

Journal of NeuroEngineering and Rehabilitation, 2023 · DOI: https://doi.org/10.1186/s12984-023-01220-w · Published: July 16, 2023

Rehabilitation Biomedical

Simple Explanation

This study looks at how overground exoskeleton gait training (OEGT) is used in inpatient rehabilitation for patients with neurological injuries like stroke, spinal cord injury, or traumatic brain injury. The study reviewed patient records and therapist surveys to understand how OEGT is initiated, progressed, and terminated during rehabilitation. The results showed that patients generally tolerated OEGT well, with increasing time upright and walking, and decreasing assistance needed from the exoskeleton over time.

Study Duration

September 2016 and March 2022

Participants

228 patients (104 stroke, 99 SCI, and 25 TBI)

Evidence Level

Retrospective descriptive study

Key Findings

1
Patients demonstrated progressive tolerance for OEGT over successive sessions, as shown by increasing time upright and walking, step count, and decreased assistance required by the exoskeleton.
2
Therapists prefer using OEGT with patients with more functional dependency.
3
OEGT is terminated when other gait methods yield higher step repetitions or intensities, or to prepare for discharge.

Research Summary

This retrospective study aimed to understand the clinical use and decision-making behind overground exoskeleton gait training (OEGT) for patients with neurological injuries during inpatient rehabilitation. The study found that patients generally showed increased tolerance and decreased dependency on the exoskeleton over successive sessions. Therapists' insights provided context to the observed quantitative trends. The therapists' perspectives, based on six years of experience, highlighted factors influencing the initiation, progression, and termination of OEGT, emphasizing early adoption for severely impaired patients and deliberate transition to real-world walking approaches.

Practical Implications

Early OEGT Adoption

OEGT may allow for earlier initiation of walking retraining for severely impaired patients compared to other gait training methods.

Personalized Progression

Therapists should continuously monitor patient and device feedback to adjust OEGT settings and provide progressive challenges.

Strategic Termination

Termination of OEGT should be based on achieving functional milestones and preparing patients for real-world walking scenarios.

Study Limitations

1
Missing device and session data from the medical record limited the ability to draw concrete conclusions.
2
A lack of control subjects contributed to the inability to base clinical decisions on this data alone.
3
Limited sample size for patients with TBI further limits generalizability of this specific data.

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