Gait robot-assisted rehabilitation in persons with spinal cord injury: A scoping review

Abstract

BACKGROUND: Many robots are available for gait rehabilitation (BWSTRT and ORET) and their application in persons with SCI allowed an improvement of walking function. OBJECTIVE: The aim of the study is to compare the effects of different robotic exoskeletons gait training in persons with different SCI level and severity. METHODS: Sixty-two studies were included in this systematic review; the study quality was assessed according to GRADE and PEDro’s scale. RESULTS: Quality assessment of included studies (n = 62) demonstrated a prevalence of evidence level 2; the quality of the studies was higher for BWSTRT (excellent and good) than for ORET (fair and good). Almost all persons recruited for BWSTRT had an incomplete SCI; both complete and incomplete SCI were recruited for ORET. The SCI lesion level in the persons recruited for BWSTRT are from cervical to sacral; mainly from thoracic to sacral for ORET; a high representation of AIS D lesion resulted both for BWSTRT (30%) and for ORET (45%). The walking performance, tested with 10MWT, 6MWT, TUG and WISCI, improved after exoskeleton training in persons with incomplete SCI lesions, when at least 20 sessions were applied. Persons with complete SCI lesions improved the dexterity in walking with exoskeleton, but did not recover independent walking function; symptoms such as spasticity, pain and cardiovascular endurance improved. CONCLUSION: Different exoskeletons are available for walking rehabilitation in persons with SCI. The choice about the kind of robotic gait training should be addressed on the basis of the lesion severity and the possible comorbidities.

Do Individuals with Spinal Cord Injury Benefit from Semi-Immersive Virtual Reality Cognitive Training? Preliminary Results from an Exploratory Study on an Underestimated Problem

“…From a rehabilitation point of view, conventional physiotherapy (i.e., exercise for strengthening muscles, static and dynamic balance activities, and gait training) is strongly recommended for people with SCI in order to prevent complications of being bedridden, such as muscle atrophy, pressure ulcers, and deterioration of the autonomic nervous system [ 5 , 6 ]. However, recent technological advances in neurorehabilitation, such as robotic devices and virtual reality (VR) systems, have been adopted to allow more intensive, repetitive, and task-oriented training, in order to achieve better outcomes [ 7 ]. Specifically, VR systems create virtual environments simulating everyday life scenarios in which patients are able to interact with different degrees of virtual immersion (i.e., non-immersive, semi-immersive, and immersive) [ 8 ].…”

Bridging the Gap between Basic Research and Clinical Practice: The Growing Role of Translational Neurorehabilitation

“…In detail, robotic devices can reproduce accurately human kinematics, aiding patients to perform those movements that are reduced or lost due to brain or spinal cord damage. Indeed, robotic devices can also quantify and monitor patients’ improvements objectively in order to promote a personalized and tailored rehabilitation approach [ 34 , 35 ]. Commonly, robotic devices are distinguished into two main categories, based on biomechanical features: exoskeletons (patients’ limbs are allocated in a robotic orthosis that allows them to move on a treadmill or over ground) and end-effectors (consisting of stationary devices in which the distal part is the only one able to move) [ 36 ].…”

Analysis of Kinetic Signal Undergoing Gait Training with the Lokomat Exoskeleton after Complete Spinal Cord Injury

“…However, patients are often more concerned with improving and restoring their actual walking capabilities [11]. This desire can be partially ful lled by robotic-assisted gait training, which has been shown to improve walking functions [12], leading to the recovery of some patients with complete spinal cord injuries [13]. Gait training with exoskeleton robots also has an impact on neural networks.…”