The reciprocating gait orthosis: Long-term usage patterns

Sykes, Laura Yoviene; Edwards, J.; Powell, E.; Ross, E.R.S.

doi:10.1016/s0003-9993(95)80534-6

Cited by 70 publications

(29 citation statements)

References 12 publications

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“…The main limitation of these devices is a high metabolic demand such that most patients eventually discontinue their use. 7 – 10 Since the health benefits of physical activity are largely dependent on exercise frequency and duration, 11 these traditional orthotic technologies likely have limited utility in ameliorating the chronic effects of inactivity due to SCI.…”

Section: Introductionmentioning

confidence: 99%

Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: systematic review with meta-analysis

Miller

Zimmermann

Herbert

2016

MDER

228

215

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Background: Powered exoskeletons are designed to safely facilitate ambulation in patients with spinal cord injury (SCI). We conducted the first meta-analysis of the available published research on the clinical effectiveness and safety of powered exoskeletons in SCI patients. Methods: MEDLINE and EMBASE databases were searched for studies of powered exoskeleton-assisted walking in patients with SCI. Main outcomes were analyzed using fixed and random effects meta-analysis models. Results: A total of 14 studies (eight ReWalk™, three Ekso™, two Indego ® , and one unspecified exoskeleton) representing 111 patients were included in the analysis. Training programs were typically conducted three times per week, 60-120 minutes per session, for 1-24 weeks. Ten studies utilized flat indoor surfaces for training and four studies incorporated complex training, including walking outdoors, navigating obstacles, climbing and descending stairs, and performing activities of daily living. Following the exoskeleton training program, 76% of patients were able to ambulate with no physical assistance. The weighted mean distance for the 6-minute walk test was 98 m. The physiologic demand of powered exoskeleton-assisted walking was 3.3 metabolic equivalents and rating of perceived exertion was 10 on the Borg 6-20 scale, comparable to self-reported exertion of an able-bodied person walking at 3 miles per hour. Improvements in spasticity and bowel movement regularity were reported in 38% and 61% of patients, respectively. No serious adverse events occurred. The incidence of fall at any time during training was 4.4%, all occurring while tethered using a first-generation exoskeleton and none resulting in injury. The incidence of bone fracture during training was 3.4%. These risks have since been mitigated with newer generation exoskeletons and refinements to patient eligibility criteria. Conclusion: Powered exoskeletons allow patients with SCI to safely ambulate in real-world settings at a physical activity intensity conducive to prolonged use and known to yield health benefits.

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Section: Introductionmentioning

confidence: 99%

Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: systematic review with meta-analysis

Miller

Zimmermann

Herbert

2016

MDER

228

215

View full text Add to dashboard Cite

show abstract

“…The main limitation of these devices is a high metabolic demand such that most patients eventually discontinue use. 38 – 41 Since the health benefits of physical activity are largely dependent on exercise frequency and duration, 42 these traditional orthotic technologies likely have limited utility in ameliorating the chronic effects of inactivity due to SCI. Functional electric stimulation-assisted exercise is a treatment modality in which electrical impulses are applied to intact peripheral nerves supplying paralyzed muscles in order to produce functional movement and stimulate contractions of those muscles to promote recovery of motor function.…”

Section: Discussionmentioning

confidence: 99%

Health and economic benefits of physical activity for patients with spinal cord injury

Miller¹,

Herbert²

2016

CEOR

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Spinal cord injury (SCI) is a traumatic, life-disrupting event with an annual incidence of 17,000 cases in the US. SCI is characterized by progressive physical deconditioning due to limited mobility and lack of modalities to allow safe physical activity that may partially offset these deleterious physical changes. Approximately, 50% of patients with SCI report no leisure-time physical activity and 15% report leisure-time physical activity below the threshold where meaningful health benefits could be realized. Collectively, about 363,000 patients with SCI, or 65% of the entire spinal cord injured population in the US, engages in insufficient physical activity and represents a target population that could derive considerable health benefits from even modest physical activity levels. Currently, the annual direct costs related to SCI exceed US$45 billion in the US. Rehabilitation protocols and technologies aimed to improve functional mobility have potential to significantly reduce the risk of medical complications and cost associated with SCI. Patients who commence routine physical activity in the first post-injury year and experience typical motor function improvements would realize US$290,000 to US$435,000 in lifetime cost savings, primarily due to fewer hospitalizations and less reliance on assistive care. New assistive technologies that allow patients with SCI to safely engage in routine physical activity are desperately needed.

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“…However, documents have demonstrated that PGOs and hybrid orthoses have less energy expenditure in comparison with mechanical orthoses [5,47,48]. SCI patients do not use their mechanical orthoses, with abandonment rates of 61-90% for children with myelomeningocele [49,50] and 46-54% in adults with spinal cord injury [10,[51][52][53] due to the high level of energy expenditure needed to ambulate.…”

Section: Energy Expenditure Of Spinal Cord Injury Patientsmentioning

confidence: 99%

Orthoses for Spinal Cord Injury Patients

Arazpour¹,

Bani²,

EbrahimMousavi³

et al. 2016

Recovery of Motor Function Following Spinal Cord Injury

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There are some limitations for patients with spinal cord injury SCI when walking with assistive devices. Heavy energy expenditure and walking high loads on the upper limb joints are two main reasons of high rejection rate of orthosis by these patients . Many devices have been designed to enable people with paraplegia to ambulate in an upright position as a solution of these limitations such as mechanical orthoses, hybrid orthoses and powered orthoses. "ll these devices are designed to solve the problem of standing and walking, but there are some other important notes, which should be considered. For example, the size and weight of external orthoses, donning and doffing, cumbersomeness and independency for using are very important.

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The reciprocating gait orthosis: Long-term usage patterns

Cited by 70 publications

References 12 publications

Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: systematic review with meta-analysis

Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: systematic review with meta-analysis

Health and economic benefits of physical activity for patients with spinal cord injury

Orthoses for Spinal Cord Injury Patients

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