title: The Effectiveness and Safety of Exoskeletons as Assistive and Rehabilitation Devices in the Treatment of Neurologic Gait Disorders in Patients with Spinal Cord Injury: A Systematic Review.
abstract: Study DesignSystematic review.Clinical Questions(1) When used as an assistive device, do wearable exoskeletons improve lower extremity function or gait compared with knee-ankle-foot orthoses (KAFOs) in patients with complete or incomplete spinal cord injury? (2) When used as a rehabilitation device, do wearable exoskeletons improve lower extremity function or gait compared with other rehabilitation strategies in patients with complete or incomplete spinal cord injury? (3) When used as an assistive or rehabilitation device, are wearable exoskeletons safe compared with KAFO for assistance or other rehabilitation strategies for rehabilitation in patients with complete or incomplete spinal cord injury?MethodsPubMed, Cochrane, and Embase databases and reference lists of key articles were searched from database inception to May 2, 2016, to identify studies evaluating the effectiveness of wearable exoskeletons used as assistive or rehabilitative devices in patients with incomplete or complete spinal cord injury.ResultsNo comparison studies were found evaluating exoskeletons as an assistive device. Nine comparison studies (11 publications) evaluated the use of exoskeletons as a rehabilitative device. The 10-meter walk test velocity and Spinal Cord Independence Measure scores showed no difference in change from baseline among patients undergoing exoskeleton training compared with various comparator therapies. The remaining primary outcome measures of 6-minute walk test distance and Walking Index for Spinal Cord Injury I and II and Functional Independence Measure-Locomotor scores showed mixed results, with some studies indicating no difference in change from baseline between exoskeleton training and comparator therapies, some indicating benefit of exoskeleton over comparator therapies, and some indicating benefit of comparator therapies over exoskeleton.ConclusionThere is no data to compare locomotion assistance with exoskeleton versus conventional KAFOs. There is no consistent benefit from rehabilitation using an exoskeleton versus a variety of conventional methods in patients with chronic spinal cord injury. Trials comparing later-generation exoskeletons are needed.
authors.affiliation: Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, United States; Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Fisahn
authors.affiliation: Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.
authors.forename: Mirko
authors.initials: M
authors.lastname: Aach
authors.affiliation: Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Jansen
authors.affiliation: Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington, United States.
authors.forename: Marc
authors.initials: M
authors.lastname: Moisi
authors.affiliation: Multiple Sclerosis Center, Swedish Medical Center, Seattle, Washington, United States.
authors.forename: Angeli
authors.initials: A
authors.lastname: Mayadev
authors.affiliation: Spectrum Research, Inc., Tacoma, Washington, United States.
authors.forename: Krystle T
authors.initials: KT
authors.lastname: Pagarigan
authors.affiliation: Spectrum Research, Inc., Tacoma, Washington, United States.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Dettori
authors.affiliation: Department of Trauma Surgery, BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Schildhauer
keywords: exoskeleton; rehabilitation; robotics; spinal cord injury