Gait robot-assisted rehabilitation in persons with spinal cord injury: A scoping review

Author:

Stampacchia Giulia1,Gazzotti Valeria2,Olivieri Matteo3,Andrenelli Elisa4,Bonaiuti Donatella5,Calabro Rocco Salvatore6,Carmignano Simona Maria78,Cassio Anna9,Fundaro Cira10,Companini Isabella11,Mazzoli David12,Cerulli Simona13,Chisari Carmelo14,Colombo Valentina15,Dalise Stefania14,Mazzoleni Daniele16,Melegari Corrado17,Merlo Andrea12,Boldrini Paolo18,Mazzoleni Stefano19,Posteraro Federico20,Mazzucchelli Miriam16,Benanti Paolo21,Castelli Enrico22,Draicchio Francesco23,Falabella Vincenzo24,Galeri Silvia25,Gimigliano Francesca26,Grigioni Mauro27,Mazzon Stefano28,Molteni Franco29,Morone Giovanni30,Petrarca Maurizio31,Picelli Alessandro32,Senatore Michele33,Turchetti Giuseppe34,Bizzarrini Emiliana35

Affiliation:

1. Azienda Ospedaliero Universitaria Pisana, Pisa, Italy

2. Centro Protesi Vigorso di Budrio, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Bologna, Italy

3. Scuola IMT Alti Studi di Lucca, Lucca, Italy

4. Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy

5. Piero Redaelli Geriatric Institute, Milan, Italy

6. IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy

7. Rehabilitation Therapeutic Center (CTR), Potenza, Italy

8. University of Salerno, Salerno, Italy

9. Spinal Cord Unit and Intensive Rehabilitation Medicine, Ospedale di Fiorenzuola d’Arda, AUSL Piacenza, Piacenza, Italy

10. Neurophysiopathology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Montescano, Pavia, Italy

11. Department of Neuromotor and Rehabilitation, LAM-Motion Analysis Laboratory, San Sebastiano Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy

12. Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy

13. Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy

14. Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy

15. Montecatone Rehabilitation Institute, Imola, Italy

16. School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy

17. Elias Neuroriabilitazione, Parma, Italy

18. Italian Society of Physical Medicine and Rehabilitation (SIMFER), Rome, Italy

19. Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy

20. Department of Rehabilitation, Versilia Hospital - AUSL12, Viareggio, Italy

21. Pontifical Gregorian University, Rome, Italy

22. Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy

23. Department of Occupational and Environmental Medicine Epidemiology and Hygiene, INAIL, Rome, Italy

24. Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy

25. IRCCS Fondazione Don Carlo Gnocchi, Pavia, Italy

26. Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy

27. National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy

28. Rehabilitation Unit, ULSS (Local Health Authority) Euganea, Camposampiero Hospital, Padua, Italy

29. Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy

30. IRCCS Santa Lucia Foundation, Rome, Italy

31. Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children’s Hospital, Rome, Italy

32. Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy

33. Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy

34. Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy

35. Department of Rehabilitation Medicine, Spinal Cord Unit, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy

Abstract

BACKGROUND: Many robots are available for gait rehabilitation (BWSTRT and ORET) and their application in persons with SCI allowed an improvement of walking function. OBJECTIVE: The aim of the study is to compare the effects of different robotic exoskeletons gait training in persons with different SCI level and severity. METHODS: Sixty-two studies were included in this systematic review; the study quality was assessed according to GRADE and PEDro’s scale. RESULTS: Quality assessment of included studies (n = 62) demonstrated a prevalence of evidence level 2; the quality of the studies was higher for BWSTRT (excellent and good) than for ORET (fair and good). Almost all persons recruited for BWSTRT had an incomplete SCI; both complete and incomplete SCI were recruited for ORET. The SCI lesion level in the persons recruited for BWSTRT are from cervical to sacral; mainly from thoracic to sacral for ORET; a high representation of AIS D lesion resulted both for BWSTRT (30%) and for ORET (45%). The walking performance, tested with 10MWT, 6MWT, TUG and WISCI, improved after exoskeleton training in persons with incomplete SCI lesions, when at least 20 sessions were applied. Persons with complete SCI lesions improved the dexterity in walking with exoskeleton, but did not recover independent walking function; symptoms such as spasticity, pain and cardiovascular endurance improved. CONCLUSION: Different exoskeletons are available for walking rehabilitation in persons with SCI. The choice about the kind of robotic gait training should be addressed on the basis of the lesion severity and the possible comorbidities.

Publisher

IOS Press

Subject

Neurology (clinical),Rehabilitation,Physical Therapy, Sports Therapy and Rehabilitation

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