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

Objectives: Wearable robotic exoskeletons (WREs) have been globally developed to achieve gait reconstruction in patients with spinal cord injury (SCI). The present study aimed to enable evidence-based decision-making in selecting the optimal WRE according to residual motor function and to provide a...

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Main Authors: Koki Tan, Soichiro Koyama, Hiroaki Sakurai, Toshio Teranishi, Yoshikiyo Kanada, Shigeo Tanabe
Format: Article
Language:English
Published: Elsevier 2021-05-01
Series:Journal of Orthopaedic Translation
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2214031X21000012
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author Koki Tan
Soichiro Koyama
Hiroaki Sakurai
Toshio Teranishi
Yoshikiyo Kanada
Shigeo Tanabe
author_facet Koki Tan
Soichiro Koyama
Hiroaki Sakurai
Toshio Teranishi
Yoshikiyo Kanada
Shigeo Tanabe
author_sort Koki Tan
collection DOAJ
description Objectives: Wearable robotic exoskeletons (WREs) have been globally developed to achieve gait reconstruction in patients with spinal cord injury (SCI). The present study aimed to enable evidence-based decision-making in selecting the optimal WRE according to residual motor function and to provide a new perspective on further development of appropriate WREs. Methods: The current review was conducted by searching PubMed, Web of Science, and Google Scholar for relevant studies published from April 2015 to February 2020. Selected studies were analysed with a focus on the participants’ neurological level of SCI, amount of training (number of training sessions and duration of the total training period), gait speed and endurance achieved, and subgroup exploration of the number of persons for assistance and the walking aid used among patients with cervical level injury. Results: A total of 28 articles (nine using Ekso, three using Indego, ten using ReWalk, one using REX, five using Wearable Power-Assist Locomotor) involving 228 patients were included in the analysis. Across all WREs, T6 was the most frequently reported level of SCI. The amount of training showed a wide distribution (number of training sessions: 2–230 sessions [30–120 min per session]; duration of the total training period: 1–24 weeks [1–5 times per week]). The mean gait speed was 0.31 m/s (standard deviation [SD] 0.14), and the mean distance on the 6-min walking test as a measure of endurance was 108.9 m (SD 46.7). The subgroup exploration aimed at patients with cervical level injury indicated that 59.2% of patients were able to ambulate with no physical assistance and several patients used a walker as a walking aid. Conclusion: The number of cervical level injury increased, as compared to the number previously indicated by a prior similar review. Training procedure was largely different among studies. Further improvement based on gait performance is required for use and dissemination in daily life. The translational potential of this article: The present review reveals the current state of the clinical effectiveness of WREs for gait reconstruction in patients with SCI, contributing to evidence-based device application and further development.
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spelling doaj.art-bfbb73d16ebf41f0a12c6dfb29d3ee9d2022-12-21T18:56:45ZengElsevierJournal of Orthopaedic Translation2214-031X2021-05-01285564Wearable robotic exoskeleton for gait reconstruction in patients with spinal cord injury: A literature reviewKoki Tan0Soichiro Koyama1Hiroaki Sakurai2Toshio Teranishi3Yoshikiyo Kanada4Shigeo Tanabe5Graduate School of Health Sciences, Fujita Health University, Toyoake, Aichi, JapanFaculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, JapanFaculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, JapanFaculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, JapanFaculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, JapanFaculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan; Corresponding author.Objectives: Wearable robotic exoskeletons (WREs) have been globally developed to achieve gait reconstruction in patients with spinal cord injury (SCI). The present study aimed to enable evidence-based decision-making in selecting the optimal WRE according to residual motor function and to provide a new perspective on further development of appropriate WREs. Methods: The current review was conducted by searching PubMed, Web of Science, and Google Scholar for relevant studies published from April 2015 to February 2020. Selected studies were analysed with a focus on the participants’ neurological level of SCI, amount of training (number of training sessions and duration of the total training period), gait speed and endurance achieved, and subgroup exploration of the number of persons for assistance and the walking aid used among patients with cervical level injury. Results: A total of 28 articles (nine using Ekso, three using Indego, ten using ReWalk, one using REX, five using Wearable Power-Assist Locomotor) involving 228 patients were included in the analysis. Across all WREs, T6 was the most frequently reported level of SCI. The amount of training showed a wide distribution (number of training sessions: 2–230 sessions [30–120 min per session]; duration of the total training period: 1–24 weeks [1–5 times per week]). The mean gait speed was 0.31 m/s (standard deviation [SD] 0.14), and the mean distance on the 6-min walking test as a measure of endurance was 108.9 m (SD 46.7). The subgroup exploration aimed at patients with cervical level injury indicated that 59.2% of patients were able to ambulate with no physical assistance and several patients used a walker as a walking aid. Conclusion: The number of cervical level injury increased, as compared to the number previously indicated by a prior similar review. Training procedure was largely different among studies. Further improvement based on gait performance is required for use and dissemination in daily life. The translational potential of this article: The present review reveals the current state of the clinical effectiveness of WREs for gait reconstruction in patients with SCI, contributing to evidence-based device application and further development.http://www.sciencedirect.com/science/article/pii/S2214031X21000012Gait reconstructionParaplegiaTetraplegiaWearable robotic exoskeleton
spellingShingle Koki Tan
Soichiro Koyama
Hiroaki Sakurai
Toshio Teranishi
Yoshikiyo Kanada
Shigeo Tanabe
Wearable robotic exoskeleton for gait reconstruction in patients with spinal cord injury: A literature review
Journal of Orthopaedic Translation
Gait reconstruction
Paraplegia
Tetraplegia
Wearable robotic exoskeleton
title Wearable robotic exoskeleton for gait reconstruction in patients with spinal cord injury: A literature review
title_full Wearable robotic exoskeleton for gait reconstruction in patients with spinal cord injury: A literature review
title_fullStr Wearable robotic exoskeleton for gait reconstruction in patients with spinal cord injury: A literature review
title_full_unstemmed Wearable robotic exoskeleton for gait reconstruction in patients with spinal cord injury: A literature review
title_short Wearable robotic exoskeleton for gait reconstruction in patients with spinal cord injury: A literature review
title_sort wearable robotic exoskeleton for gait reconstruction in patients with spinal cord injury a literature review
topic Gait reconstruction
Paraplegia
Tetraplegia
Wearable robotic exoskeleton
url http://www.sciencedirect.com/science/article/pii/S2214031X21000012
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