Top

Journal of NeuroEngineering and Rehabilitation

Published in:

Open Access 01-12-2017 | Review

Robotic assisted gait as a tool for rehabilitation of individuals with spinal cord injury: a systematic review

Authors: Ledycnarf J. Holanda, Patrícia M. M. Silva, Thiago C. Amorim, Matheus O. Lacerda, Camila R. Simão, Edgard Morya

Published in: Journal of NeuroEngineering and Rehabilitation | Issue 1/2017

Abstract

Background

Spinal cord injury (SCI) is characterized by a total or partial deficit of sensory and motor pathways. Impairments of this injury compromise muscle recruitment and motor planning, thus reducing functional capacity. SCI patients commonly present psychological, intestinal, urinary, osteomioarticular, tegumentary, cardiorespiratory and neural alterations that aggravate in chronic phase. One of the neurorehabilitation goals is the restoration of these abilities by favoring improvement in the quality of life and functional independence. Current literature highlights several benefits of robotic gait therapies in SCI individuals.

Objectives

The purpose of this study was to compare the robotic gait devices, and systematize the scientific evidences of these devices as a tool for rehabilitation of SCI individuals.

Methods

A systematic review was carried out in which relevant articles were identified by searching the following databases: Cochrane Library, PubMed, PEDro and Capes Periodic. Two authors selected the articles which used a robotic device for rehabilitation of spinal cord injury.

Results

Databases search found 2941 articles, 39 articles were included due to meet the inclusion criteria. The robotic devices presented distinct features, with increasing application in the last years. Studies have shown promising results regarding the reduction of pain perception and spasticity level; alteration of the proprioceptive capacity, sensitivity to temperature, vibration, pressure, reflex behavior, electrical activity at muscular and cortical level, classification of the injury level; increase in walking speed, step length and distance traveled; improvements in sitting posture, intestinal, cardiorespiratory, metabolic, tegmental and psychological functions.

Conclusions

This systematic review shows a significant progress encompassing robotic devices as an innovative and effective therapy for the rehabilitation of individuals with SCI.

Available only for authorised users

WHO: WHO | Spinal cord injury (2016). http://www.who.int/mediacentre/factsheets/fs384/en/ Accessed 2016–09-12.

Nas K, Yazmalar L, Şah V, Aydın A, Öneş K. Rehabilitation of spinal cord injuries. World J Orthopedics. 2015;6(1):8–16. https://doi.org/10.5312/wjo.v6.i1.8.CrossRef

Frood RT. The use of treadmill training to recover locomotor ability in patients with spinal cord injury. Bioscience Horizons. 2011;4(1):108–17. https://doi.org/10.1093/biohorizons/hzr003.CrossRef

Van Hedel HJA, Dietz V. Rehabilitation of locomotion after spinal cord injury. Restor Neurol Neurosci. 2010;28(1):123–34. https://doi.org/10.3233/RNN-2010-0508.PubMed

Louie DR, Eng JJ, Lam T. Gait speed using powered robotic exoskeletons after spinal cord injury: a systematic review and correlational study. J Neuroengineering Rehabilitation. 2015;12(1):82. https://doi.org/10.1186/s12984-015-0074-9.CrossRef

Mirbagheri, M.M., Patel, C., Quiney, K.: Robotic-assisted locomotor training impact on neuromuscular properties and muscle strength in Spinal Cord Injury. Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS, 4132–4135 (2011). doi:https://doi.org/10.1109/IEMBS.2011.6091026.

Schwartz I, Sajina A, Neeb M, Fisher I, Katz-Luerer M, Meiner Z. Locomotor training using a robotic device in patients with subacute spinal cord injury. Spinal Cord. 2011;49(10):1062–7. https://doi.org/10.1038/sc.2011.59.CrossRefPubMed

Schwartz I, Meiner Z. Robotic-assisted gait training in neurological patients: who may benefit? Ann Biomed Eng. 2015;43(5):1260–9. https://doi.org/10.1007/s10439-015-1283-x9.CrossRefPubMed

Kawashima N, Taguchi D, Nakazawa K, Akai M. Effect of lesion level on the orthotic gait performance in individuals with complete paraplegia. Spinal Cord: the official journal of the International Medical Society of Paraplegia. 2006;44(8):487–94. https://doi.org/10.1038/sj.sc.3101941.CrossRef

10.

Bolliger M, Trepp A, Zörner B, Dietz V. Modulation of spinal reflex by assisted locomotion in humans with chronic complete spinal cord injury. Clin Neurophysiol. 2010;121(12):2152–8. https://doi.org/10.1016/j.clinph.2010.05.018.CrossRefPubMed

11.

Donati ARC, Shokur S, Morya E, Campos DSF, Moioli RC, Gitti CM, Augusto PB, Tripodi S, Pires CG, Pereira GA, Brasil FL, Gallo S, Lin AA, Takigami AK, Aratanha MA, Joshi S, Bleuler H, Cheng G, Rudolph A, Nicolelis MAL. Long-term training with a brain-machine Interface-based gait protocol induces partial neurological recovery in paraplegic patients. Sci Rep. 2016;6(April):30383. https://doi.org/10.1038/srep30383.CrossRefPubMedPubMedCentral

12.

Aach M, Cruciger O, Sczesny-Kaiser M, Höffken O, Meindl RC, Tegenthoff M, Schwenkreis P, Sankai Y, Schildhauer TA. Voluntary driven exoskeleton as a new tool for rehabilitation in chronic spinal cord injury: a pilot study. Spine J: Official Journal of the North American Spine Society. 2014;14(12):2847–53. https://doi.org/10.1016/j.spinee.2014.03.042.CrossRef

13.

Chisholm AE, Malik RN, Blouin J-S, Borisoff J, Forwell S, Lam T. Feasibility of sensory tongue stimulation combined with task-specific therapy in people with spinal cord injury: a case study. J Neuroengineering and rehabilitation. 2014;11(1):96. https://doi.org/10.1186/1743-0003-11-96.CrossRef

14.

NCBI: Meet Toyota Welwalk WW-1000: Robotic System That Can Assist Paralyzed People Walk. 2017;(20017). Available from: http://newsroom.toyota.co.jp/en/detail/mail/15989382.

15.

Esquenazi A, Talaty M, Jayaraman A. Powered exoskeletons for walking assistance in persons with central nervous system injuries: a narrative review. PM&R. 2017;9(1):46–62.CrossRef

16.

Fleerkotte, B.M., Koopman, B., Buurke, J.H., Asseldonk, E.H.F.V., Kooij, H.V.D., Rietman, J.S.: <the Effect of Impedance Controlled Robotic Gait Training.Pdf>, 1–15 (2014). doi:https://doi.org/10.1186/1743-0003-11-26.

17.

Ekkelenkamp, R., Veneman, J., van der Kooij, H.: Lopes: Selective control of gait functions during the gait rehabilitation of cva patients. In: Rehabilitation Robotics, 2005. ICORR 2005. 9th International Conference On, pp. 361–364 (2005). IEEE.

18.

Sylos-Labini F, La Scaleia V, D’Avella A, Pisotta I, Tamburella F, Scivoletto G, Molinari M, Wang S, Wang L, van Asseldonk E, van der Kooij H, Hoellinger T, Cheron G, Thorsteinsson F, Ilzkovitz M, Gancet J, Hauffe R, Zanov F, Lacquaniti F, Ivanenko YP. EMG patterns during assisted walking in the exoskeleton. Front Hum Neurosci. 2014;8(June):423. https://doi.org/10.3389/fnhum.2014.00423.PubMedPubMedCentral

19.

Aurich-Schuler T, Grob F, van Hedel HJ, Labruyère R. Can lokomat therapy with children and adolescents be improved? An adaptive clinical pilot trial comparing guidance force, path control, and freed. J NeuroEngineering Rehabilitation. 2017;14(1):76.CrossRef

20.

Arazpour M, Gharib M, Hutchins SW, Bani MA, Curran S, Mousavi ME, Saberi H. The influence of trunk extension in using advanced reciprocating gait orthosis on walking in spinal cord injury patients: a pilot study. Prosthetics Orthot Int. 2015;39(4):286–92. https://doi.org/10.1177/0309364614531010.CrossRef

21.

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(2):147–58. https://doi.org/10.1682/JRRD.2014.02.0060.CrossRefPubMed

22.

Kozlowski AJ, Bryce TN, Dijkers MP. Time and effort required by persons with spinal cord injury to learn to use a powered exoskeleton for assisted walking. Topics in Spinal Cord injury rehabilitation. 2015;21(2):110–21. https://doi.org/10.1310/sci2102-110.CrossRefPubMedPubMedCentral

23.

Contreras-Vidal JL, Bhagat NA, Brantley J, Cruz-Garza JG, He Y, Manley Q, Nakagome S, Nathan K, Tan SH, Zhu F, et al. Powered exoskeletons for bipedal locomotion after spinal cord injury. J Neural Eng. 2016;13(3):031001.CrossRefPubMed

24.

Tanabe S, Hirano S, Saitoh E. Wearable power-assist Locomotor (WPAL) for supporting upright walking in persons with paraplegia. NeuroRehabilitation. 2013;33(1):99–106. https://doi.org/10.3233/NRE-130932.PubMed

25.

Sczesny-Kaiser M, Höffken O, Aach M, Cruciger O, Grasmücke D, Meindl R. Schildhauer, T.A., Schwenkreis, P., Tegenthoff, M.: HAL§R exoskeleton training improves walking parameters and normalizes cortical excitability in primary somatosensory cortex in spinal cord injury patients. Journal of NeuroEngineering and Rehabilitation. 2015;12(1):68. https://doi.org/10.1186/s12984-015-0058-9.CrossRefPubMedPubMedCentral

26.

Wall A, Borg J, Palmcrantz S. Clinical application of the hybrid assistive limb (hal) for gait training—a systematic review. Front Syst Neurosci. 2015;9:1–10. doi:10.3389/fnsys.2015.00048.

27.

Sale P, Russo EF, Russo M, Masiero S, Piccione F, Calabrò RS, Filoni S. Effects on mobility training and de-adaptations in subjects with spinal cord injury due to a wearable robot: a preliminary report. BMC Neurol. 2016;12:2–9. https://doi.org/10.1186/s12883-016-0536-0.

28.

Hartigan C, Kandilakis C, Dalley S, Clausen M, Wilson E, Morrison S, Etheridge S, Farris R. Mobility outcomes following five training sessions with a powered exoskeleton. Topics Spinal Cord Injury Rehabilitation. 2015;21(2):93–9. https://doi.org/10.1310/sci2102-93.CrossRef

29.

Houldin A, Luttin K, Lam T. Locomotor adaptations and aftereffects to resistance during walking in individuals with spinal cord injury. J Neurophysiol. 2011;106(1):247–58. https://doi.org/10.1152/jn.00753.2010.CrossRefPubMed

30.

Lam T, Pauhl K, Ferguson A, Malik RN, Krassioukov A, Eng JJ. Training with robot-applied resistance in people with motor-incomplete spinal cord injury. Pilot Study. 2015;52(1):113–30.

31.

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. Topics in Spinal Cord Injury Rehabilitation. 2015;21(2):122–32. https://doi.org/10.1310/sci2102-122.CrossRefPubMedPubMedCentral

32.

Dietz V, Grillner S, Trepp A, Hubli M, Bolliger M. Changes in spinal reflex and locomotor activity after a complete spinal cord injury: a common mechanism. Brain. 2009;132(8):2196–205. https://doi.org/10.1093/brain/awp124.CrossRefPubMed

33.

Gordon KE, Wu M, Kahn JH, Schmit BD. Feedback and feedforward locomotor adaptations to ankle-foot load in people with incomplete spinal cord injury. J Neurophysiol. 2010;104(3):1325–38. https://doi.org/10.1152/jn.00604.2009.CrossRefPubMed

34.

Hubli M, Dietz V, Bolliger M. Influence of spinal reflexes on the locomotor pattern after spinal cord injury. Gait Posture. 2011;34(3):409–14. https://doi.org/10.1016/j.gaitpost.2011.06.012.CrossRefPubMed

35.

Mirbagheri, M.M., Niu, X., Kindig, M., Varoqui, D.: The effects of locomotor training with a robotic-gait orthosis (Lokomat) on neuromuscular properties in persons with chronic SCI. Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS, 3854–3857 (2012). doi:https://doi.org/10.1109/EMBC.2012.6346808.

36.

Knikou M. Functional reorganization of soleus H-reflex modulation during stepping after robotic-assisted step training in people with complete and incomplete spinal cord injury. Exp Brain Res. 2013;228(3):279–96. https://doi.org/10.1007/s00221-013-3560-y.CrossRefPubMed

37.

Smith AC, Mummidisetty CK, Rymer WZ, Knikou M. Locomotor training alters the behavior of flexor reflexes during walking in human spinal cord injury. J Neurophysiol. 2014;112(9):2164–75. https://doi.org/10.1152/jn.00308.2014.CrossRefPubMed

38.

Mirbagheri MM, Kindig MW, Niu X. Effects of robotic-locomotor training on stretch reflex function and muscular properties in individuals with spinal cord injury. Clin Neurophysiol. 2015;126(5):997–1006. https://doi.org/10.1016/j.clinph.2014.09.010.15334406.CrossRefPubMed

39.

Lünenburger L, Bolliger M, Czell D, Müller R, Dietz V. Modulation of locomotor activity in complete spinal cord injury. Exp Brain Res. 2006;174(4):638–46. https://doi.org/10.1007/s00221-006-0509-4.CrossRefPubMed

40.

Banz R, Bolliger M, Colombo G, Dietz V, Lünenburger L. Computerized visual feedback: an adjunct to robotic-assisted gait training. Phys Ther. 2008;88(10):1135–45. https://doi.org/10.2522/ptj.20070203.CrossRefPubMed

41.

Moreh E, Meiner Z, Neeb M, Hiller N, Schwartz I. Spinal decompression sickness presenting as partial brown-sequard syndrome and treated with robotic-assisted body-weight support treadmill training. J Rehabil Med. 2009;41(1):88–9. https://doi.org/10.2340/16501977-0279.CrossRefPubMed

42.

Manella KJ, Torres J, Field-Fote EC. Restoration of walking function in an individual with chronic complete (AIS a) spinal cord injury. J Rehabil Med. 2010;42(8):795–8. https://doi.org/10.2340/16501977-0593.CrossRefPubMed

43.

Labruyère, R., Hedel, H.J.A.V.: <Strength Training Vs Robot Assisted Gait Training After Incomplete.Pdf>, 1–12 (2014).

44.

Niu X, Varoqui D, Kindig M, Mirbagheri MM. Prediction of gait recovery in spinal cord injured individuals trained with robotic gait orthosis. J NeuroEngineering Rehabilitation. 2014;11(1):42. https://doi.org/10.1186/1743-0003-11-42.CrossRef

45.

Gordon KE, Wald MJ, Schnitzer TJ. Effect of parathyroid hormone combined with gait training on bone density and bone architecture in people with chronic spinal cord injury. Pm R. 2013;5(8):663–71. https://doi.org/10.1016/j.pmrj.2013.03.032.CrossRefPubMed

46.

Varoqui D, Niu X, Mirbagheri MM. Ankle voluntary movement enhancement following robotic-assisted locomotor training in spinal cord injury. J Neuroengineering Rehabilitation. 2014;11(1):46. https://doi.org/10.1186/1743-0003-11-46.CrossRef

47.

Hoekstra F, van Nunen MPM, Gerrits KHL, Stolwijk-Swüste JM, Crins MHP, Janssen TWJ. Effect of robotic gait training on cardiorespiratory system in incomplete spinal cord injury. J Rehabil Res Dev. 2014;50(10):1411–22. https://doi.org/10.1682/JRRD.2012.10.0186.CrossRef

48.

Galen SS, Clarke CJ, Allan DB, Conway BA. A portable gait assessment tool to record temporal gait parameters in SCI. Med Eng Phys. 2011;33(5):626–32. https://doi.org/10.1016/j.medengphy.2011.01.003.CrossRefPubMed

49.

Lam T, Pauhl K, Krassioukov A, Eng JJ. Using robot-applied resistance to augment body-weight-supported treadmill training in an individual with incomplete spinal cord injury. Phys Ther. 2011;91(1):143–51. https://doi.org/10.2522/ptj.20100026.CrossRefPubMed

50.

Fenuta AM, Hicks AL. Metabolic demand and muscle activation during different forms of bodyweight supported locomotion in men with incomplete SCI. Biomed Res Int. 2014;2014 https://doi.org/10.1155/2014/632765.

51.

Yang A, Asselin P, Knezevic S, Kornfeld S, Spungen A. Assessment of in-hospital walking velocity and level of assistance in a powered exoskeleton in persons with spinal cord injury. Topics in Spinal Cord Injury Rehabilitation. 2015;21(2):100–9. https://doi.org/10.1310/sci2102-100.CrossRefPubMedPubMedCentral

Title: Robotic assisted gait as a tool for rehabilitation of individuals with spinal cord injury: a systematic review
Authors: Ledycnarf J. Holanda
Patrícia M. M. Silva
Thiago C. Amorim
Matheus O. Lacerda
Camila R. Simão
Edgard Morya
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Journal of NeuroEngineering and Rehabilitation / Issue 1/2017
Electronic ISSN: 1743-0003
DOI: https://doi.org/10.1186/s12984-017-0338-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Robotic assisted gait as a tool for rehabilitation of individuals with spinal cord injury: a systematic review

Abstract

Background

Objectives

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Objectives

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2017

Auto detection and segmentation of daily living activities during a Timed Up and Go task in people with Parkinson’s disease using multiple inertial sensors

A muscle-driven approach to restore stepping with an exoskeleton for individuals with paraplegia

Quantification of postural stability in minimally disabled multiple sclerosis patients by means of dynamic posturography: an observational study

Comprehensive measurement of stroke gait characteristics with a single accelerometer in the laboratory and community: a feasibility, validity and reliability study

Physical human-robot interaction of an active pelvis orthosis: toward ergonomic assessment of wearable robots

Walking in fully immersive virtual environments: an evaluation of potential adverse effects in older adults and individuals with Parkinson’s disease