Applications, effectiveness and limitations of robotic physiotherapy in patients with spinal cord injury
Keywords:
Spinal cord injury, Robotic, RehabilitationwAbstract
Spinal cord injury (SCI) is a particularly serious pathological condition which puts a great strain on the health and functional status of the affected patient, while at the same time is accompanied by a very high morbidity and mortality rate. Among the various rehabilitation methods that have been used for the treatment of SCIs, since the 1990’s, robotic physiotherapy has been an innovative alternative option. Robotic physiotherapy involves the application of a series of robotic devices the use of which is intended to assist and enhance the level of a number of the patient’s functions that have been severely affected form the SCI, including their motor and sensory performance. This paper will attempt a brief narrative review of the literature in relation to the most recent research data regarding the applications, the effectiveness and the limitations of the use of robotic physiotherapy in patients suffering from spinal cord injury.
A total of 73 published papers since 2010 were isolated and studied, including 49 original research studies and 24 reviews / systematic reviews / meta-analyses. The main conclusion of the review is that with the use of these devices, patients with SCI have the possibility of a satisfactory level of safe walking, combined with the improvement of their activities of daily living and their quality of living. Ongoing research in this field will most probably enable the further improvement of the applications of the method in the coming years.
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References
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2. Holmes D. Spinal-cord injury: spurring regrowth. Nature. 2017;552(7684):S49.
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8. Balasubramanian S, Klein J, Burdet E. Robot-assisted rehabilitation of hand function. Curr Opin Neurol. 2010;23(6):661–70.
9. Rodríguez-Fernández A, Lobo-Prat J, Font-Llagunes JM. Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments. J Neuroeng Rehabil. 2021;18(1):22.
10. Carpino G, Pezzola A, Urbano M et al. Response to: Comment on “Assessing Effectiveness and Costs in Robot-Mediated Lower Limbs Rehabilitation: A Meta-Analysis and State of the Art.” J Healthc Eng. 2019;2019:9693801.
11. Zhang L, Lin F, Sun L et al. Comparison of Efficacy of Lokomat and Wearable Exoskeleton-Assisted Gait Training in People With Spinal Cord Injury: A Systematic Review and Network Meta-Analysis. Front Neurol. 2022;13:772660.
12. Schmidt K, Duarte JE, Grimmer M et al. The Myosuit: Bi-articular Anti-gravity Exosuit That Reduces Hip Extensor Activity in Sitting Transfers. Front Neurorobot. 2017;11:57.
13. Mehrholz J, Harvey LA, Thomas S et al. Is body-weight-supported treadmill training or robotic-assisted gait training superior to overground gait training and other forms of physiotherapy in people with spinal cord injury? A systematic review. Spinal Cord. 2017;55(8):722–9.
14. PRISMA [Internet]. [cited 2023 Jan 28]. Available from: https://www.prisma-statement.org/
15. Hidler J, Sainburg R. Role of Robotics in Neurorehabilitation. Top Spinal Cord Inj Rehabil. 2011;17(1):42–9.
16. Jayaraman A, Burt S, Rymer WZ. Use of Lower-Limb Robotics to Enhance Practice and Participation in Individuals With Neurological Conditions. Pediatr Phys Ther. 2017;29 Suppl 3:S48–56.
17. Hornby G, Campbell D, Zemon D, Kahn J. Clinical and quantitative evaluation of robotic-assisted treadmill walking to retrain ambulation after spinal cord injury. Topics in Spinal Cord Injury Rehabilitation. 2005;11(2):1–17.
18. Holanda LJ, Silva PMM, Amorim TC et al.. Robotic assisted gait as a tool for rehabilitation of individuals with spinal cord injury: a systematic review. J Neuroeng Rehabil. 2017;14(1):126.
19. Schwartz I, Sajina A, Neeb M et al. Locomotor training using a robotic device in patients with subacute spinal cord injury. Spinal Cord. 2011;49(10):1062–7.
20. Swinnen E, Duerinck S, Baeyens JP et al. Effectiveness of robot-assisted gait training in persons with spinal cord injury: a systematic review. J Rehabil Med. 2010;42(6):520–6.
21. Stucki G. International Classification of Functioning, Disability, and Health (ICF): a promising framework and classification for rehabilitation medicine. American journal of physical medicine & rehabilitation. 2005;84(10):733–40.
22. Mehrholz J, Kugler J, Pohl M. Locomotor training for walking after spinal cord injury. Cochrane Database Syst Rev. 2012;11:CD006676.
23. Morawietz C, Moffat F. Effects of locomotor training after incomplete spinal cord injury: a systematic review. Arch Phys Med Rehabil. 2013;94(11):2297–308.
24. Duerinck SM, Swinnen EM. The added value of an actuated ankle-foot orthosis to restore normal gait function in patients with spinal cord injury: a systematic review. J Rehabil Med. 2012;44:299–309.
25. Cheung EYY, Ng TKW, Yu KKK et al.. Robot-Assisted Training for People With Spinal Cord Injury: A Meta-Analysis. Arch Phys Med Rehabil. 2017;98(11):2320-31.e12.
26. Nam KY, Kim HJ, Kwon BS et al. Robot-assisted gait training (Lokomat) improves walking function and activity in people with spinal cord injury: a systematic review. J Neuroeng Rehabil. 2017;14(1):24.
27. Singh H, Unger J, Zariffa J et al. Robot-assisted upper extremity rehabilitation for cervical spinal cord injuries: a systematic scoping review. Disabil Rehabil Assist Technol. 2018;13(7):704–15.
28. Hayes SC, Wilcox JCR, White FHS, Vanicek N. The effects of robot assisted gait training on temporal-spatial characteristics of people with spinal cord injuries: A systematic review. J Spinal Cord Med. 2018;41(5):529–43.
29. Shackleton C, Evans R, Shamley D et al. Effectiveness of over-ground robotic locomotor training in improving walking performance, cardiovascular demands, secondary complications and user-satisfaction in individuals with spinal cord injuries: A systematic review. J Rehabil Med. 2019;51(10):723–33.
30. Alashram AR, Annino G, Padua E. Robot-assisted gait training in individuals with spinal cord injury: A systematic review for the clinical effectiveness of Lokomat. J Clin Neurosci. 2021;91:260–9.
31. Jamwal PK, Hussain S, Ghayesh MH. Robotic orthoses for gait rehabilitation: An overview of mechanical design and control strategies. Proc Inst Mech Eng H. 2020;234(5):444–57.
32. Dunkelberger N, Schearer EM, O’Malley MK. A review of methods for achieving upper limb movement following spinal cord injury through hybrid muscle stimulation and robotic assistance. Exp Neurol. 2020;328:113274.
33. Calabrò RS, Cacciola A, Bertè F et al. Robotic gait rehabilitation and substitution devices in neurological disorders: where are we now? Neurol Sci. 2016;37(4):503–14.
34. 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(4):497–514.
35. Kressler J, Thomas CK, Field-Fote EC 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(10):1878-87.e4.
36. Kerdraon J, Previnaire JG, Tucker M et al. Evaluation of safety and performance of the self balancing walking system Atalante in patients with complete motor spinal cord injury. Spinal Cord Ser Cases. 2021;7(1):71.
37. Xiang XN, Zong HY, Ou Y et al. Exoskeleton-assisted walking improves pulmonary function and walking parameters among individuals with spinal cord injury: a randomized controlled pilot study. J Neuroeng Rehabil. 2021;18(1):86.
2. Holmes D. Spinal-cord injury: spurring regrowth. Nature. 2017;552(7684):S49.
3. ASIA and ISCoS International Standards Committee. The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)-What’s new? Spinal Cord. 2019;57(10):815–7.
4. Osunronbi T, Sharma H. International Standards for Neurological Classification of Spinal Cord Injury: factors influencing the frequency, completion and accuracy of documentation of neurology for patients with traumatic spinal cord injuries. Eur J Orthop Surg Traumatol. 2019;29(8):1639–48.
5. Chay W, Kirshblum S. Predicting Outcomes After Spinal Cord Injury. Phys Med Rehabil Clin N Am. 2020;31(3):331–43.
6. Nas K, Yazmalar L, Şah V et al. Rehabilitation of spinal cord injuries. World J Orthop. 2015;6(1):8–16.
7. Munce SEP, Wodchis WP, Guilcher SJT et al. Direct costs of adult traumatic spinal cord injury in Ontario. Spinal Cord. 2013;51(1):64–9.
8. Balasubramanian S, Klein J, Burdet E. Robot-assisted rehabilitation of hand function. Curr Opin Neurol. 2010;23(6):661–70.
9. Rodríguez-Fernández A, Lobo-Prat J, Font-Llagunes JM. Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments. J Neuroeng Rehabil. 2021;18(1):22.
10. Carpino G, Pezzola A, Urbano M et al. Response to: Comment on “Assessing Effectiveness and Costs in Robot-Mediated Lower Limbs Rehabilitation: A Meta-Analysis and State of the Art.” J Healthc Eng. 2019;2019:9693801.
11. Zhang L, Lin F, Sun L et al. Comparison of Efficacy of Lokomat and Wearable Exoskeleton-Assisted Gait Training in People With Spinal Cord Injury: A Systematic Review and Network Meta-Analysis. Front Neurol. 2022;13:772660.
12. Schmidt K, Duarte JE, Grimmer M et al. The Myosuit: Bi-articular Anti-gravity Exosuit That Reduces Hip Extensor Activity in Sitting Transfers. Front Neurorobot. 2017;11:57.
13. Mehrholz J, Harvey LA, Thomas S et al. Is body-weight-supported treadmill training or robotic-assisted gait training superior to overground gait training and other forms of physiotherapy in people with spinal cord injury? A systematic review. Spinal Cord. 2017;55(8):722–9.
14. PRISMA [Internet]. [cited 2023 Jan 28]. Available from: https://www.prisma-statement.org/
15. Hidler J, Sainburg R. Role of Robotics in Neurorehabilitation. Top Spinal Cord Inj Rehabil. 2011;17(1):42–9.
16. Jayaraman A, Burt S, Rymer WZ. Use of Lower-Limb Robotics to Enhance Practice and Participation in Individuals With Neurological Conditions. Pediatr Phys Ther. 2017;29 Suppl 3:S48–56.
17. Hornby G, Campbell D, Zemon D, Kahn J. Clinical and quantitative evaluation of robotic-assisted treadmill walking to retrain ambulation after spinal cord injury. Topics in Spinal Cord Injury Rehabilitation. 2005;11(2):1–17.
18. Holanda LJ, Silva PMM, Amorim TC et al.. Robotic assisted gait as a tool for rehabilitation of individuals with spinal cord injury: a systematic review. J Neuroeng Rehabil. 2017;14(1):126.
19. Schwartz I, Sajina A, Neeb M et al. Locomotor training using a robotic device in patients with subacute spinal cord injury. Spinal Cord. 2011;49(10):1062–7.
20. Swinnen E, Duerinck S, Baeyens JP et al. Effectiveness of robot-assisted gait training in persons with spinal cord injury: a systematic review. J Rehabil Med. 2010;42(6):520–6.
21. Stucki G. International Classification of Functioning, Disability, and Health (ICF): a promising framework and classification for rehabilitation medicine. American journal of physical medicine & rehabilitation. 2005;84(10):733–40.
22. Mehrholz J, Kugler J, Pohl M. Locomotor training for walking after spinal cord injury. Cochrane Database Syst Rev. 2012;11:CD006676.
23. Morawietz C, Moffat F. Effects of locomotor training after incomplete spinal cord injury: a systematic review. Arch Phys Med Rehabil. 2013;94(11):2297–308.
24. Duerinck SM, Swinnen EM. The added value of an actuated ankle-foot orthosis to restore normal gait function in patients with spinal cord injury: a systematic review. J Rehabil Med. 2012;44:299–309.
25. Cheung EYY, Ng TKW, Yu KKK et al.. Robot-Assisted Training for People With Spinal Cord Injury: A Meta-Analysis. Arch Phys Med Rehabil. 2017;98(11):2320-31.e12.
26. Nam KY, Kim HJ, Kwon BS et al. Robot-assisted gait training (Lokomat) improves walking function and activity in people with spinal cord injury: a systematic review. J Neuroeng Rehabil. 2017;14(1):24.
27. Singh H, Unger J, Zariffa J et al. Robot-assisted upper extremity rehabilitation for cervical spinal cord injuries: a systematic scoping review. Disabil Rehabil Assist Technol. 2018;13(7):704–15.
28. Hayes SC, Wilcox JCR, White FHS, Vanicek N. The effects of robot assisted gait training on temporal-spatial characteristics of people with spinal cord injuries: A systematic review. J Spinal Cord Med. 2018;41(5):529–43.
29. Shackleton C, Evans R, Shamley D et al. Effectiveness of over-ground robotic locomotor training in improving walking performance, cardiovascular demands, secondary complications and user-satisfaction in individuals with spinal cord injuries: A systematic review. J Rehabil Med. 2019;51(10):723–33.
30. Alashram AR, Annino G, Padua E. Robot-assisted gait training in individuals with spinal cord injury: A systematic review for the clinical effectiveness of Lokomat. J Clin Neurosci. 2021;91:260–9.
31. Jamwal PK, Hussain S, Ghayesh MH. Robotic orthoses for gait rehabilitation: An overview of mechanical design and control strategies. Proc Inst Mech Eng H. 2020;234(5):444–57.
32. Dunkelberger N, Schearer EM, O’Malley MK. A review of methods for achieving upper limb movement following spinal cord injury through hybrid muscle stimulation and robotic assistance. Exp Neurol. 2020;328:113274.
33. Calabrò RS, Cacciola A, Bertè F et al. Robotic gait rehabilitation and substitution devices in neurological disorders: where are we now? Neurol Sci. 2016;37(4):503–14.
34. 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(4):497–514.
35. Kressler J, Thomas CK, Field-Fote EC 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(10):1878-87.e4.
36. Kerdraon J, Previnaire JG, Tucker M et al. Evaluation of safety and performance of the self balancing walking system Atalante in patients with complete motor spinal cord injury. Spinal Cord Ser Cases. 2021;7(1):71.
37. Xiang XN, Zong HY, Ou Y et al. Exoskeleton-assisted walking improves pulmonary function and walking parameters among individuals with spinal cord injury: a randomized controlled pilot study. J Neuroeng Rehabil. 2021;18(1):86.
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2023-12-28
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