Systematic review on wearable lower‑limb exoskeletons for gait training in neuromuscular impairments

J NeuroEngineering Rehabil, 2021 · DOI: https://doi.org/10.1186/s12984-021-00815-5 · Published: January 12, 2021

Assistive Technology Rehabilitation Biomedical

Simple Explanation

Gait disorders reduce life quality for those with neuromuscular impairments. Wearable powered lower-limb exoskeletons are emerging for robotic gait rehabilitation. This systematic review offers a comprehensive overview of these exoskeletons for people with neuromuscular impairments. The review analyzes device technology (actuators, sensors, structure) and clinical aspects (training protocol, outcome measures, patient impairments) from 87 clinical studies. A database containing all compiled information is available. Wearable exoskeletons have potential in early rehabilitation, promoting exercise, and daily activities. However, their use is limited by bulky devices, the need for supervision, and limited evidence supporting benefits.

Study Duration

Not specified

Participants

87 clinical studies

Evidence Level

Systematic Review

Key Findings

1
Wearable exoskeletons are heavy and bulky devices that generally require supervision and walking aids, hindering mobility and independence.
2
Clinical validation studies of wearable exoskeletons are in early stages, with evidence limited to short intervention trials with few participants.
3
Randomized control trials are needed to demonstrate clinical efficacy of wearable exoskeletons when compared with conventional gait therapy.

Research Summary

This paper reviewed the design and clinical evaluation of wearable lower-limb exoskeletons intended to support walking in people with neuromuscular impairments. Wearable exoskeletons are still heavy and bulky devices that in general require supervision (usually from clinical staff) and the use of walking aids, which hinders mobility and independence. Clinical validation studies of wearable exoskeletons are currently in their early stages, thus evidence is still limited to short intervention trials with few participants

Practical Implications

Improved Design

Exoskeletons should be lighter, more modular, and easier to use independently.

Control System Advancement

Develop Assist-As-Needed control algorithms to adapt assistance based on user needs and promote neural plasticity.

Standardized Clinical Protocols

Establish standard clinical guidelines for validation studies and regulations for better understanding adverse events and risks.

Study Limitations

1
The review did not use delimiters related to study design.
2
The review did not assess study quality.
3
The lack of delimiters could produce some bias, especially for the conclusions related to clinical effectiveness.

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