Posts Tagged Exoskeleton device

[Abstract] Systematic reviews of clinical benefits of exoskeleton use for gait and mobility in neurological disorders: a tertiary study

Abstract

Objective

To describe systematic reviews (SRs) of the use of exoskeletons for gait and mobility by persons with neurological disorders and to evaluate their quality as guidance for research and clinical practice.

Data sources

PubMed, EMBASE, Web of Science, CINAHL Complete, PsycINFO, Cochrane Database of Systematic Reviews, PEDro, and Google Scholar were searched from database inception to January 23, 2018.

Study selection

A total of 331 de-duplicated abstracts from bibliographic database and ancestor searching were independently screened by two reviewers, resulting in 109 articles for which full text was obtained. Independent screening of those 109 articles by two reviewers resulted in a final selection of 17 SRs.

Data extraction

Data were extracted by one reviewer using a pretested Excel form with 158 fields and checked by a second reviewer. Key data included the purpose of the SR, methods used, outcome measures presented, and conclusions. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 were used to evaluate reporting and methodological quality, respectively, of the SRs.

Data synthesis

The SRs generally were of poor methodological and reporting quality. They failed to report some information on patients (e.g. height, weight, baseline ambulatory status) and interventions (e.g. treatment hours/sessions planned and delivered) that clinicians and other stakeholders might want to have, and often failed to notice that the primary studies duplicated subjects.

Conclusions

Published SRs on exoskeletons have many weaknesses in design and execution; clinicians, researchers, and other stakeholders should be cautious in relying on them to make decisions on the use of this technology. Future studies need to address the multiple methodological limitations.

 

via Systematic reviews of clinical benefits of exoskeleton use for gait and mobility in neurological disorders: a tertiary study – Archives of Physical Medicine and Rehabilitation

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[Abstract] Effects of Electromechanical Exoskeleton-assisted Gait Training on Walking Ability of Stroke Patients: A Randomized Controlled Trial

Abstract

Objective

To assess the efficacy of electromechanical exoskeleton-assisted gait training on walking ability of stroke patients based on ambulatory function, muscle strength, balance, gait speed and capacity.

Design

Randomized controlled trial.

Setting

University rehabilitation hospital

Participants

Individuals with stroke who could stand alone.

Interventions

Forty patients were randomly assigned to control and experimental groups. The control group underwent physical therapist-assisted gait training by conventional method. The experimental group underwent electromechanical gait training assisted by an exoskeleton device. Both types of gait training were performed for 30 min each day. The therapeutic interventions were provided for 5 days a week for a period of 4 weeks in both groups.

Main Outcome Measures

Functional ambulatory category (FAC) before and after gait training. Changes in FAC were the primary outcomes to evaluate the efficacy of electromechanical exoskeleton-assisted assisted gait training. Changes in mobility, walking speed, walking capacity, leg muscle strength, daily activity and balance were secondary outcomes.

Results

FAC in the control group was 2.44±1.55 in the pre-training and 2.75±1.53 in the post-training. FAC in the experimental group was 3.22±1.31 in the pre-training and 3.78±1.44 in the post-training. Although FAC between pre- and post-training sessions improved in both groups, the changes in FAC were statistically significant in the experimental group alone. Most secondary outcomes in both groups also showed improvement after gait training. However, the differential outcomes were not varied between the two groups after adjusting the data for age and stroke duration. We did not exclude patients based on time since stroke onset. The average stroke duration was 530.11±389.21 days in the experimental group. The changes in FAC of the experimental group were negatively correlated with stroke duration. No adverse events were noticed during gait training in either group.

Conclusions

Electromechanical exoskeleton-assisted gait training is as effective as conventional gait training by physical therapist when as administered by a gait trainer. As an over-ground walking system without harness, electromechanical exoskeleton replaced a physical therapist in assisted gait training for patients who stand alone. Because the ambulatory function of stroke patients was affected negatively by stroke duration, the effect of electromechanical-assisted gait training might decline with increased stroke duration.

via Effects of Electromechanical Exoskeleton-assisted Gait Training on Walking Ability of Stroke Patients: A Randomized Controlled Trial – Archives of Physical Medicine and Rehabilitation

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[ARTICLE] Wearable robotic exoskeleton for overground gait training in sub-acute and chronic hemiparetic stroke patients: preliminary results – Full Text PDF

BACKGROUND: Recovery of therapeutic or functional ambulatory capacity in post-stroke patients is a primary goal of rehabilitation. Wearable powered exoskeletons allow patients with gait dysfunctions to perform over-ground gait training, even immediately after the acute event.
AIM: To investigate the feasibility and the clinical effects of an over-ground walking training with a wearable powered exoskeleton in sub-acute and chronic stroke patients.
DESIGN: Prospective, pilot pre-post, open label, non-randomized experimental study.
SETTING: A single neurological rehabilitation center for inpatients and outpatients.
POPULATION: Twenty-three post-stroke patients were enrolled: 12 sub-acute (mean age: 43.8±13.3 years, 5 male and 7 female, 7 right hemiparesis and 5 left hemiparesis) and 11 chronic (mean age: 55.5±15.9 years, 7 male and 4 female, 4 right hemiparesis and 7 left hemiparesis) patients.
METHODS: Patients underwent 12 sessions (60 min/session, 3 times/week) of walking rehabilitation training using Ekso™, a wearable bionic suit that enables individuals with lower extremity disabilities and minimal forearm strength to stand up, sit down and walk over a flat hard surface with a full weight-bearing reciprocal gait. Clinical evaluations were performed at the beginning of the training period (t0), after 6 sessions (t1) and after 12 sessions (t2) and were based on the Ashworth scale, Motricity Index, Trunk Control Test, Functional Ambulation Scale, 10-Meter Walking Test, 6-Minute Walking Test, and Walking Handicap Scale. Wilcoxon’s test (P<0.05) was used to detect significant changes.
RESULTS: Statistically significant improvements were observed at the three assessment periods for both groups in Motricity Index, Functional Ambulation Scale, 10-meter walking test, and 6-minute walking test. Sub-acute patients achieved statistically significant improvement in Trunk Control Test and Walking Handicap Scale at t0-t2. Sub-acute and chronic patient did not achieve significant improvement in Ashworth scale at t0-t2.
CONCLUSIONS: Twelve sessions of over-ground gait training using a powered wearable robotic exoskeleton improved ambulatory functions in sub-acute and chronic post-stroke patients. Large, randomized multicenter studies are needed to confirm these preliminary data.
CLINICAL REHABILITATION IMPACT: To plan a completely new individual tailored robotic rehabilitation strategy after stroke, including task-oriented over-ground gait training.

Full Text PDF

via Wearable robotic exoskeleton for overground gait training in sub-acute and chronic hemiparetic stroke patients: preliminary results – European Journal of Physical and Rehabilitation Medicine 2017 October;53(5):676-84 – Minerva Medica – Journals

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