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Review
. 2021 Mar 1:28:55-64.
doi: 10.1016/j.jot.2021.01.001. eCollection 2021 May.

Wearable robotic exoskeleton for gait reconstruction in patients with spinal cord injury: A literature review

Koki Tan  1 , Soichiro Koyama  2 , Hiroaki Sakurai  2 , Toshio Teranishi  2 , Yoshikiyo Kanada  2 , Shigeo Tanabe  2
Affiliations
Review

Wearable robotic exoskeleton for gait reconstruction in patients with spinal cord injury: A literature review

Koki Tan et al. J Orthop Translat. .

Abstract

Objectives: Wearable robotic exoskeletons (WREs) have been globally developed to achieve gait reconstruction in patients with spinal cord injury (SCI). The present study aimed to enable evidence-based decision-making in selecting the optimal WRE according to residual motor function and to provide a new perspective on further development of appropriate WREs.

Methods: The current review was conducted by searching PubMed, Web of Science, and Google Scholar for relevant studies published from April 2015 to February 2020. Selected studies were analysed with a focus on the participants' neurological level of SCI, amount of training (number of training sessions and duration of the total training period), gait speed and endurance achieved, and subgroup exploration of the number of persons for assistance and the walking aid used among patients with cervical level injury.

Results: A total of 28 articles (nine using Ekso, three using Indego, ten using ReWalk, one using REX, five using Wearable Power-Assist Locomotor) involving 228 patients were included in the analysis. Across all WREs, T6 was the most frequently reported level of SCI. The amount of training showed a wide distribution (number of training sessions: 2-230 sessions [30-120 min per session]; duration of the total training period: 1-24 weeks [1-5 times per week]). The mean gait speed was 0.31 m/s (standard deviation [SD] 0.14), and the mean distance on the 6-min walking test as a measure of endurance was 108.9 m (SD 46.7). The subgroup exploration aimed at patients with cervical level injury indicated that 59.2% of patients were able to ambulate with no physical assistance and several patients used a walker as a walking aid.

Conclusion: The number of cervical level injury increased, as compared to the number previously indicated by a prior similar review. Training procedure was largely different among studies. Further improvement based on gait performance is required for use and dissemination in daily life.

The translational potential of this article: The present review reveals the current state of the clinical effectiveness of WREs for gait reconstruction in patients with SCI, contributing to evidence-based device application and further development.

Keywords: Gait reconstruction; Paraplegia; Tetraplegia; Wearable robotic exoskeleton.

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Conflict of interest statement

The authors have no conflicts of interest relevant to this article.

Figures

Figure 1
Figure 1
Number of patients according to the neurological level. The total number of patients according to neurological level is shown. WRE, Wearable robotic exoskeleton; WPAL, Wearable Power-Assist Locomotor.
Figure 2
Figure 2
Number of patients according to gait speed. The number of gait speed classes was determined based on Sturges’ histogram rule. WRE, Wearable robotic exoskeleton; WPAL, Wearable Power-Assist Locomotor.
Figure 3
Figure 3
Number of patients according to gait distance on the 6-min walking test (6MWT). The number of gait distance classes was determined based on Sturges’ histogram rule. WRE, Wearable robotic exoskeleton; WPAL, Wearable Power-Assist Locomotor.
Appendix Fig. 1
Appendix Fig. 1
Analysis procedure and study results during Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) phases: a flowchart of selection process based on the inclusion/exclusion criteria.
Appendix Fig. 2
Appendix Fig. 2
Proportion of patients according to the lesion level.
See this image and copyright information in PMC

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