Potential benefits and limitations of robotic exoskeleton usage in patients with spinal cord injury: a review

Abstract

Restoration of motor functions in patients with spinal cord injury (SCI) is a priority problem of this patient’s category medical rehabilitation. Despite the achievements of modern medicine, the level of movement restoration after SCI is often insignificant, many patients stayed confined to a wheelchair. Secondary complications (osteoporosis, obesity, cardiovascular, respiratory, urogenital, trophic and other disorders) used to develop in the injured people as a result of low physical activity, they aggravate the course of the main disease and complicate the process of medical rehabilitation. A hope for rehabilitation specialist and patients is associated with the appearance of robotic exoskeletons (RES), that might become an innovation means for improving the mobility of patients with SCI. The purpose of the review is to provide information on the possible benefits and disadvantages of the use of RES in the rehabilitation of patients with SCI. This article discusses the general characteristics of modern exoskeletons and the conditions of their use for patients with paralysis of the lower extremities. The article presents Information on the effectiveness and safety of the use of exoskeleton devices in neurorehabilitation, as well as data on limitations and problems associated with exoskeleton use in clinical practice. The results of meta-analyses and randomized studies on the potential benefits of the RES usage both in everyday life and in rehabilitation of patients with SCI are presented. The influence of walking training in the exoskeleton on the degree of motor functions improvement, overall physical activity level and body weight in patients with SCI is highlighted. The article draws attention to the unsolved problems and further perspectives of RES application in patients with SCI. It emphasizes the necessity for protocols standardization and large randomized comparative clinical trials organization with prolonged observational period of patients in order to determine exoskeletons usage potential.