Robotic exoskeletons: The current pros and cons

Ashraf S Gorgey, Ashraf S Gorgey

Abstract

Robotic exoskeletons have emerged as rehabilitation tool that may ameliorate several of the existing health-related consequences after spinal cord injury (SCI). However, evidence to support its clinical application is still lacking considering their prohibitive cost. The current mini-review is written to highlight the main limitations and potential benefits of using exoskeletons in the rehabilitation of persons with SCI. We have recognized two main areas relevant to the design of exoskeletons and to their applications on major health consequences after SCI. The design prospective refers to safety concerns, fitting time and speed of exoskeletons. The health prospective refers to factors similar to body weight, physical activity, pressure injuries and bone health. Clinical trials are currently underway to address some of these limitations and to maximize the benefits in rehabilitation settings. Future directions highlight the need to use exoskeletons in conjunction with other existing and emerging technologies similar to functional electrical stimulation and brain-computer interface to address major limitations. Exoskeletons have the potential to revolutionize rehabilitation following SCI; however, it is still premature to make solid recommendations about their clinical use after SCI.

Keywords: Exoskeleton; Locomotion; Rehabilitation; Robotics; Spinal cord injury.

Conflict of interest statement

Conflict-of-interest statement: The author has nothing to declare related to the current work.

References

    1. Gorgey A, Sumrell R, Goetz L. Exoskeletal assisted rehabilitation after spinal cord injury. In: Atlas of Orthoses and Assistive Devices., editor. 5th ed. Canada: Elsevier; 2018. pp. 440–447.
    1. Miller LE, Zimmermann AK, Herbert WG. Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: systematic review with meta-analysis. Med Devices (Auckl) 2016;9:455–466.
    1. Federici S, Meloni F, Bracalenti M, De Filippis ML. The effectiveness of powered, active lower limb exoskeletons in neurorehabilitation: A systematic review. NeuroRehabilitation. 2015;37:321–340.
    1. Louie DR, Eng JJ, Lam T; Spinal Cord Injury Research Evidence (SCIRE) Research Team. Gait speed using powered robotic exoskeletons after spinal cord injury: a systematic review and correlational study. J Neuroeng Rehabil. 2015;12:82.
    1. Asselin P, Knezevic S, Kornfeld S, Cirnigliaro C, Agranova-Breyter I, Bauman WA, Spungen AM. Heart rate and oxygen demand of powered exoskeleton-assisted walking in persons with paraplegia. J Rehabil Res Dev. 2015;52:147–158.
    1. Bach Baunsgaard C, Vig Nissen U, Katrin Brust A, Frotzler A, Ribeill C, Kalke YB, León N, Gómez B, Samuelsson K, Antepohl W, et al. Gait training after spinal cord injury: safety, feasibility and gait function following 8 weeks of training with the exoskeletons from Ekso Bionics. Spinal Cord. 2018;56:106–116.
    1. Gorgey AS, Wade R, Sumrell R, Villadelgado L, Khalil RE, Lavis T. Exoskeleton Training May Improve Level of Physical Activity After Spinal Cord Injury: A Case Series. Top Spinal Cord Inj Rehabil. 2017;23:245–255.
    1. Evans N, Hartigan C, Kandilakis C, Pharo E, Clesson I. Acute Cardiorespiratory and Metabolic Responses During Exoskeleton-Assisted Walking Overground Among Persons with Chronic Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2015;21:122–132.
    1. Kressler J, Thomas CK, Field-Fote EC, Sanchez J, Widerström-Noga E, Cilien DC, Gant K, Ginnety K, Gonzalez H, Martinez A, et al. Understanding therapeutic benefits of overground bionic ambulation: exploratory case series in persons with chronic, complete spinal cord injury. Arch Phys Med Rehabil. 2014;95:1878–1887.e4.
    1. Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009;41:998–1005.
    1. Gorgey AS, Dolbow DR, Dolbow JD, Khalil RK, Castillo C, Gater DR. Effects of spinal cord injury on body composition and metabolic profile - part I. J Spinal Cord Med. 2014;37:693–702.
    1. Buchholz AC, Martin Ginis KA, Bray SR, Craven BC, Hicks AL, Hayes KC, Latimer AE, McColl MA, Potter PJ, Wolfe DL. Greater daily leisure time physical activity is associated with lower chronic disease risk in adults with spinal cord injury. Appl Physiol Nutr Metab. 2009;34:640–647.
    1. Dolbow DR, Gorgey AS, Daniels JA, Adler RA, Moore JR, Gater DR Jr. The effects of spinal cord injury and exercise on bone mass: a literature review. NeuroRehabilitation. 2011;29:261–269.
    1. Qin W, Bauman WA, Cardozo C. Bone and muscle loss after spinal cord injury: organ interactions. Ann N Y Acad Sci. 2010;1211:66–84.
    1. Gorgey AS, Gater DR Jr. Prevalence of Obesity After Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2007;12:1–7.
    1. National Spinal Cord Injury Statistical Center. Spinal cord injury facts and figures at a glance. Available from: .
    1. Tamez-Duque J, Cobian-Ugalde R, Kilicarslan A, Venkatakrishnan A, Soto R, Contreras-Vidal JL. Real-time strap pressure sensor system for powered exoskeletons. Sensors (Basel) 2015;15:4550–4563.
    1. Birch N, Graham J, Priestley T, Heywood C, Sakel M, Gall A, Nunn A, Signal N. Results of the first interim analysis of the RAPPER II trial in patients with spinal cord injury: ambulation and functional exercise programs in the REX powered walking aid. J Neuroeng Rehabil. 2017;14:60.
    1. Nightingale TE, Walhin JP, Thompson D, Bilzon JL. Biomarkers of cardiometabolic health are associated with body composition characteristics but not physical activity in persons with spinal cord injury. J Spinal Cord Med. 2017:1–10.
    1. Martin Ginis KA, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, Bernardi M, Ditor DS, Gaudet S, de Groot S, et al. Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord. 2018;56:308–321.
    1. Ginis KA, Arbour-Nicitopoulos KP, Latimer AE, Buchholz AC, Bray SR, Craven BC, Hayes KC, Hicks AL, McColl MA, Potter PJ, et al. Leisure time physical activity in a population-based sample of people with spinal cord injury part II: activity types, intensities, and durations. Arch Phys Med Rehabil. 2010;91:729–733.
    1. Evans N, Wingo B, Sasso E, Hicks A, Gorgey AS, Harness E. Exercise Recommendations and Considerations for Persons With Spinal Cord Injury. Arch Phys Med Rehabil. 2015;96:1749–1750.
    1. Leite SA, Monk AM, Upham PA, Bergenstal RM. Low cardiorespiratory fitness in people at risk for type 2 diabetes: early marker for insulin resistance. Diabetol Metab Syndr. 2009;1:8.
    1. del-Ama AJ, Gil-Agudo A, Pons JL, Moreno JC. Hybrid FES-robot cooperative control of ambulatory gait rehabilitation exoskeleton. J Neuroeng Rehabil. 2014;11:27.
    1. del-Ama AJ, Koutsou AD, Moreno JC, de-los-Reyes A, Gil-Agudo A, Pons JL. Review of hybrid exoskeletons to restore gait following spinal cord injury. J Rehabil Res Dev. 2012;49:497–514.
    1. Harvey LA, Herbert RD. Muscle stretching for treatment and prevention of contracture in people with spinal cord injury. Spinal Cord. 2002;40:1–9.
    1. Cirnigliaro CM, Myslinski MJ, La Fountaine MF, Kirshblum SC, Forrest GF, Bauman WA. Bone loss at the distal femur and proximal tibia in persons with spinal cord injury: imaging approaches, risk of fracture, and potential treatment options. Osteoporos Int. 2017;28:747–765.
    1. Garland DE, Adkins RH, Kushwaha V, Stewart C. Risk factors for osteoporosis at the knee in the spinal cord injury population. J Spinal Cord Med. 2004;27:202–206.
    1. Garland DE, Adkins RH, Stewart CA. Five-year longitudinal bone evaluations in individuals with chronic complete spinal cord injury. J Spinal Cord Med. 2008;31:543–550.
    1. Johnston TE, Marino RJ, Oleson CV, Schmidt-Read M, Leiby BE, Sendecki J, Singh H, Modlesky CM. Musculoskeletal Effects of 2 Functional Electrical Stimulation Cycling Paradigms Conducted at Different Cadences for People With Spinal Cord Injury: A Pilot Study. Arch Phys Med Rehabil. 2016;97:1413–1422.
    1. Saladin LK, Krause JS. Pressure ulcer prevalence and barriers to treatment after spinal cord injury: comparisons of four groups based on race-ethnicity. NeuroRehabilitation. 2009;24:57–66.
    1. Groah SL, Schladen M, Pineda CG, Hsieh CH. Prevention of Pressure Ulcers Among People With Spinal Cord Injury: A Systematic Review. PM R. 2015;7:613–636.
    1. Chaudhary U, Birbaumer N, Ramos-Murguialday A. Brain-computer interfaces for communication and rehabilitation. Nat Rev Neurol. 2016;12:513–525.
    1. Piazza S, Torricelli D, Brunetti F, del-Ama AJ, Gil-Agudo A, Pons JL. A novel FES control paradigm based on muscle synergies for postural rehabilitation therapy with hybrid exoskeletons. Conf Proc IEEE Eng Med Biol Soc. 2012;2012:1868–1871.
    1. Lerner ZF, Damiano DL, Bulea TC. A lower-extremity exoskeleton improves knee extension in children with crouch gait from cerebral palsy. Sci Transl Med. 2017;9:pii: eaam9145.
    1. Lerner ZF, Damiano DL, Bulea TC. The Effects of Exoskeleton Assisted Knee Extension on Lower-Extremity Gait Kinematics, Kinetics, and Muscle Activity in Children with Cerebral Palsy. Sci Rep. 2017;7:13512.

Source: PubMed

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