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P. Walls1, P. Diu1, Y. Salem1, H. Liu1
1University of North Texas Health Science Center, Physical Therapy, Fort Worth, United States
Background: Robot assisted gait training (RAGT) is an intervention used to improve gait in individuals with lower extremity motor dysfunction. Previous literature is inconclusive about the effectiveness of this intervention in patients with spinal cord injury.
Purpose: The purpose of this systematic review is to evaluate the evidence on the effectiveness of exoskeleton use as an intervention for gait speed in individuals with spinal cord injury.
Methods: Electronic databases used in the search included PubMed, CINAHL, PEDro, and Scopus. Two reviewers independently searched all results from the databases and categorically organized relevant articles based on inclusion and exclusion criteria. Studies were included if they involved exoskeleton as an intervention for gait speed and were conducted on adults diagnosed with spinal cord injury. Studies were excluded if they used algorithmic models, had non-comparable intervention strategies, or if they used another alternative form of therapy in conjunction with exoskeleton gait training.
Results: The 37 final articles included ten randomized controlled trials, twelve quasi-experimental studies, one cohort study, and seven case studies or case series. The sample sizes ranged from 1 to 170 participants. Participant ages ranged from 18 to 81 years old. Duration of treatment ranged from a single session to 16 weeks, with frequency of treatment ranging from 1-2 sessions to 5 per week. Length of sessions ranged from 20 to 90 minutes. The primary outcome measure for gait speed used in most studies was the 10-meter walk test. Other outcome measures used included the 6-minute walk test, the 2-minute walk test, the Timed Up-and-Go test, treadmill speed, and motion capture analysis.
Conclusion(s): The evidence suggests that the use of robotic assistance may effectively improve gait speed in individuals with spinal cord injury. However, evidence is inconclusive as to whether RAGT is more effective in improving gait speed when compared to other interventions. Studies report that robotic assisted interventions are safe & feasible interventions without adverse events or exacerbation of symptoms for patients of this population. Variability between interventions was found.
Implications: Currently, available literature on robotic assisted gait training suggests it may be beneficial for improving gait speed in individuals with a spinal cord injury. The lack of adverse outcomes and potential for improving gait speed in even patients with chronic spinal cord injury further supports its utility. Future research should explore consistency in RAGT protocol, duration, and frequency, compare effectiveness of RAGT in acute versus chronic spinal cord injury populations, and measure gait speed consistently with the exoskeleton donned or doffed.
Funding, acknowledgements: No funding.
Keywords: exoskeleton, spinal cord injury, gait speed
Topic: Neurology: spinal cord injury
Did this work require ethics approval? No
Institution: University of North Texas Health Science Center
Committee: N/A
Reason: This is a systematic review of literature. No IRB approval required.
All authors, affiliations and abstracts have been published as submitted.
