Knowledge Gaps in Biophysical Changes After Powered Robotic Exoskeleton Walking by Individuals With Spinal Cord Injury—A Scoping Review

Abstract

In addition to helping individuals with spinal cord injury (SCI) regain the ability to ambulate, the rapidly evolving capabilities of robotic exoskeletons provide an array of secondary biophysical benefits which can reduce the complications resulting from prolonged immobilization. The proposed benefits of increased life-long over-ground walking capacity include improved upper body muscular fitness, improved circulatory response, improved bowel movement regularity, and reduced pain and spasticity. Beyond the positive changes related to physical and biological function, exoskeletons have been suggested to improve SCI individuals' quality of life (QOL) by allowing increased participation in day-to-day activities. Most of the currently available studies that have reported on the impact of exoskeletons on the QOL and prevention of secondary health complications on individuals with SCI, are of small scale and are heterogeneous in nature. Moreover, few meta-analyses and reviews have attempted to consolidate the dispersed data to reach more definitive conclusions of the effects of exoskeleton use. This scoping review seeks to provide an overview on the known effects of overground exoskeleton use, on the prevention of secondary health complications, changes to the QOL, and their effect on the independence of SCI individuals in the community settings. Moreover, the intent of the review is to identify gaps in the literature currently available, and to make recommendations on focus study areas and methods for future investigations.

Functional recovery priorities and community rehabilitation service preferences of spinal cord injury individuals and caregivers of Chinese ethnicity and cultural background

“…Furthermore, with the popularization of exoskeleton technology—both for rehabilitation and for personal use, this trend may change in the foreseeable future when advanced technology becomes more ubiquitously available. Yip et al showed in a robust scoping review that there are numerous benefits to upright over-ground walking for chronic SCI individuals ( 28 ). These secondary biophysical benefits may also entice physicians and SCI individuals to adopt more walking exercises as a means to achieve life-long health maintenance.…”

“…In the past decade, we have seen significant scientific breakthrough in the arena of assistive technology and robotics in rehabilitation ( 26 – 28 ). Literature on innovative rehabilitation technology such as virtual reality has shown that it was useful in reducing neuropathic pain ( 29 ), enhancing rehabilitation of upper limb function ( 30 ), balance, motor recovery, as well as helping to improve user morale and participation among individuals with SCI ( 31 ).…”