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

Frontiers in Neurology, 2022 · DOI: 10.3389/fneur.2022.792295 · Published: March 10, 2022

Spinal Cord Injury Assistive Technology Rehabilitation

Simple Explanation

Robotic exoskeletons are being developed to help people with spinal cord injuries (SCI) walk again and provide secondary health benefits, such as improved fitness and reduced complications from being immobile. Exoskeletons may also improve the quality of life for SCI individuals by increasing their ability to participate in daily activities. Most current studies on exoskeletons and their impact on SCI individuals' quality of life are small and varied. More reviews are needed to consolidate the data.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Level 5: Scoping Review

Key Findings

1
The review identified a lack of research on the cardiovascular benefits of long-term exoskeleton use, the effects on bone mineral density and body composition, and the applicability of exoskeletons for independence and functional gain.
2
Many studies used a wide range of metrics in measuring cardiovascular health, resulting in heterogeneous studies that are difficult to compare.
3
Longer periods of training with exoskeletons may be required to elicit health benefits, such as reducing neuropathic pain.

Research Summary

The review summarizes current literature on health-related benefits of exoskeleton walking for SCI individuals and identifies gaps in the current knowledge base. SCI research is still limited in the area of cardiovascular benefits of longer-term exoskeleton use. Investigations on the effects of exoskeleton use on BMD and body composition have not received sufficient emphasis.

Practical Implications

Standardize research methodologies

Future studies should restrict study populations, control for factors beyond SCI, and increase training time.

Improve outcome measures

Parameters should consistently reflect changes and be widely available. Studies should utilize patient surveys and reporting.

Compare exoskeleton use with other ambulation methods

Case-control studies should compare exoskeleton use with other modes of ambulation, such as gait orthoses or BWSTT.

Study Limitations

1
The scope is limited to overground, lower limb, and powered robotic exoskeletons.
2
Criticisms on study methods do not apply to other forms of exoskeletons.
3
The recommendations made can be universally applied.

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