Case Report: Description of two fractures during the use of a powered exoskeleton

Herpen, F H M van; Dijsseldonk, Rosanne B. van; Rijken, Hennie; Keijsers, Noël L.W.; Louwerens, Jan Willem K.; Nes, Ilse J. W. van

doi:10.1038/s41394-019-0244-2

Cited by 23 publications

(25 citation statements)

References 9 publications

(23 reference statements)

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“…While this was the only occurrence of a bone fracture in RAGT found through this review, there are several reports of bone fractures in overground exoskeletons (He et al, 2017 ; van Herpen et al, 2019 ). Misalignment is frequently mentioned as the assumed cause for bone fractures in overground exoskeleton devices (He et al, 2017 ; van Herpen et al, 2019 ), but this has not been discussed as a possible cause in the case report of the tibia fracture sustained during Lokomat training (Filippo et al, 2015 ). The authors of this case report discussed low bone mineral density as a possible influencing factor but did not report any details of the relevant training session or discussed other possible reasons.…”

Section: Discussionmentioning

confidence: 66%

“…To the best of our knowledge, there are no reports of bone fractures in end-effector-type devices. While this was the only occurrence of a bone fracture in RAGT found through this review, there are several reports of bone fractures in overground exoskeletons (He et al, 2017;van Herpen et al, 2019). Misalignment is frequently mentioned as the assumed cause for bone fractures in overground exoskeleton devices (He et al, 2017;van Herpen et al, 2019), but this has not been discussed as a possible cause in the case report of the tibia fracture sustained during Lokomat training (Filippo et al, 2015).…”

Section: Musculoskeletal Adverse Eventsmentioning

confidence: 83%

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Occurrence and Type of Adverse Events During the Use of Stationary Gait Robots—A Systematic Literature Review

et al. 2020

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Robot-assisted gait training (RAGT) devices are used in rehabilitation to improve patients' walking function. While there are some reports on the adverse events (AEs) and associated risks in overground exoskeletons, the risks of stationary gait trainers cannot be accurately assessed. We therefore aimed to collect information on AEs occurring during the use of stationary gait robots and identify associated risks, as well as gaps and needs, for safe use of these devices. We searched both bibliographic and full-text literature databases for peer-reviewed articles describing the outcomes of stationary RAGT and specifically mentioning AEs. We then compiled information on the occurrence and types of AEs and on the quality of AE reporting. Based on this, we analyzed the risks of RAGT in stationary gait robots. We included 50 studies involving 985 subjects and found reports of AEs in 18 of those studies. Many of the AE reports were incomplete or did not include sufficient detail on different aspects, such as severity or patient characteristics, which hinders the precise counts of AE-related information. Over 169 device-related AEs experienced by between 79 and 124 patients were reported. Soft tissue-related AEs occurred most frequently and were mostly reported in end-effector-type devices. Musculoskeletal AEs had the second highest prevalence and occurred mainly in exoskeleton-type devices. We further identified physiological AEs including blood pressure changes that occurred in both exoskeleton-type and end-effector-type devices. Training in stationary gait robots can cause injuries or discomfort to the skin, underlying tissue, and musculoskeletal system, as well as unwanted blood pressure changes. The underlying risks for the most prevalent injury types include excessive pressure and shear at the interface between robot and human (cuffs/harness), as well as increased moments and forces applied to the musculoskeletal system likely caused by misalignments (between joint axes of robot and human). There is a need for more structured and complete recording and dissemination of AEs related to robotic gait training to increase knowledge on risks. With this information, appropriate mitigation strategies can and should be developed and implemented in RAGT devices to increase their safety.

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Section: Discussionmentioning

confidence: 66%

Section: Musculoskeletal Adverse Eventsmentioning

confidence: 83%

Occurrence and Type of Adverse Events During the Use of Stationary Gait Robots—A Systematic Literature Review

et al. 2020

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“… Participants were required to have a buddy who received instructions about guiding the participant during multiple skills, including donning and doffing, sit-to-stand, and walking. In addition, a device related error was simulated so that both the participant and the buddy practiced trouble shooting via a graceful collapse (see van Herpen et al for a more detailed description of the trouble shooting protocol 23 ). This protocol was added to the current study from participant 7 onward, after the occurrence of a bone fracture as described in two case reports 23 .…”

Section: Methodsmentioning

confidence: 99%

Exoskeleton home and community use in people with complete spinal cord injury

Dijsseldonk

Nes

Geurts

et al. 2020

Sci Rep

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A consequence of a complete spinal cord injury (SCI) is the loss of gait capacity. Wearable exoskeletons for the lower extremity enable household and community ambulation in people with SCI. This study assessed the amount, purpose, and location of exoskeleton use in the home and community environment, without any restrictions. The number of steps taken was read from the exoskeleton software. Participants kept a daily logbook, and completed two user experience questionnaires (Quebec User Evaluation of Satisfaction with assistive Technology (D-QUEST) and System Usability Scale (SUS)). Fourteen people with a complete SCI used the ReWalk exoskeleton a median of 9 (range [1–15]) out of 16 ([12–21]) days, in which participants took a median of 3,226 ([330–28,882]) steps. The exoskeleton was mostly used for exercise purposes (74%) and social interaction (20%). The main location of use was outdoors (48%). Overall, participants were satisfied with the exoskeleton (D-QUEST 3.7 ± 0.4) and its usability (SUS 72.5 [52.5–95.0]). Participants with complete SCI report satisfaction with the exoskeleton for exercise and social interaction in the home and community, but report limitations as an assistive device during daily life.

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“…Studies found that misalignment due to suboptimal fitting can increase the metabolic cost and discomfort of the wearer producing pain, injuries [56,57] and augment the risk of bone fractures [58,59]. Therefore, the structure of the exoskeleton has to be able to adapt to the anthropometry of the users [60].…”

Section: Design and Structurementioning

confidence: 99%

Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments

Rodríguez-Fernández

Lobo-Prat

Font-Llagunes

2021

J NeuroEngineering Rehabil

212

134

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Gait disorders can reduce the quality of life for people with neuromuscular impairments. Therefore, walking recovery is one of the main priorities for counteracting sedentary lifestyle, reducing secondary health conditions and restoring legged mobility. At present, wearable powered lower-limb exoskeletons are emerging as a revolutionary technology for robotic gait rehabilitation. This systematic review provides a comprehensive overview on wearable lower-limb exoskeletons for people with neuromuscular impairments, addressing the following three questions: (1) what is the current technological status of wearable lower-limb exoskeletons for gait rehabilitation?, (2) what is the methodology used in the clinical validations of wearable lower-limb exoskeletons?, and (3) what are the benefits and current evidence on clinical efficacy of wearable lower-limb exoskeletons? We analyzed 87 clinical studies focusing on both device technology (e.g., actuators, sensors, structure) and clinical aspects (e.g., training protocol, outcome measures, patient impairments), and make available the database with all the compiled information. The results of the literature survey reveal that wearable exoskeletons have potential for a number of applications including early rehabilitation, promoting physical exercise, and carrying out daily living activities both at home and the community. Likewise, wearable exoskeletons may improve mobility and independence in non-ambulatory people, and may reduce secondary health conditions related to sedentariness, with all the advantages that this entails. However, the use of this technology is still limited by heavy and bulky devices, which require supervision and the use of walking aids. In addition, evidence supporting their benefits is still limited to short-intervention trials with few participants and diversity among their clinical protocols. Wearable lower-limb exoskeletons for gait rehabilitation are still in their early stages of development and randomized control trials are needed to demonstrate their clinical efficacy.

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Case Report: Description of two fractures during the use of a powered exoskeleton

Cited by 23 publications

References 9 publications

Occurrence and Type of Adverse Events During the Use of Stationary Gait Robots—A Systematic Literature Review

Occurrence and Type of Adverse Events During the Use of Stationary Gait Robots—A Systematic Literature Review

Exoskeleton home and community use in people with complete spinal cord injury

Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments

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