Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: Systematic review with meta-analysis

Medical Devices: Evidence and Research

Volumn 9, Issue , 2016, Pages 455-466

  Miller, Larry E ^a   Zimmermann, Angela K ^a   Herbert, William G ^a,b  

^a Miller Scientific Consulting   (United States)

^b VIRGINIA POLYTECHNIC INSTITUTE AND STATE UNIVERSITY   (United States)

Author keywords

Ambulation; Ekso; Indego; Orthosis; ReWalk; SCI

Indexed keywords

HEALTH; PATIENT REHABILITATION; PERSONNEL TRAINING; RANDOM PROCESSES; SCALES (WEIGHING INSTRUMENTS); WALKING AIDS;

AMBULATION; EKSO; INDEGO; ORTHOSIS; REWALK;

EXOSKELETON (ROBOTICS);

ADULT; CLINICAL EFFECTIVENESS; DAILY LIFE ACTIVITY; EXOSKELETON; FALLING; FRACTURE; HEALTH INSURANCE; HUMAN; INCIDENCE; MALE; META ANALYSIS; MOBILIZATION; PHYSICAL ACTIVITY; PROSPECTIVE STUDY; RATING SCALE; RETROSPECTIVE STUDY; REVIEW; SAFETY; SELF REPORT; SPASTICITY; SPINAL CORD INJURY; SYSTEMATIC REVIEW; TRAINING; WALKING;

EID: 84961704498     PISSN: None     EISSN: 11791470     Source Type: Journal    
DOI: 10.2147/MDER.S103102     Document Type: Review

References (42)

1. Lee BB, Cripps RA, Fitzharris M, Wing PC. The global map for traumatic spinal cord injury epidemiology: update 2011, global incidence rate. Spinal Cord. 2014;52(2):110-116.
2. Sandrow-Feinberg HR, Houle JD. Exercise after spinal cord injury as an agent for neuroprotection, regeneration and rehabilitation. Brain Res. 2015;1619:12-21.
3. Jensen MP, Truitt AR, Schomer KG, Yorks ton KM, Baylor C, Molton IR. Frequency and age effects of secondary health conditions in individuals with spinal cord injury: a scoping review. Spinal Cord. 2013;51(12):882-892.
4. Sezer N, Akkus S, Ugurlu FG. Chronic complications of spinal cord injury. World J Orthop. 2015;6(1):24-33.
5. Ditunno PL, Patrick M, Stineman M, Ditunno JF. Who wants to walk? Preferences for recovery after SCI: a longitudinal and cross-sectional study. Spinal Cord. 2008;46(7):500-506.
6. Arem H, Moore SC, Patel A, et al. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Intern Med. 2015;175(6):959-967.
7. Bernardi M, Canale I, Castellano V, Di Filippo L, Felici F, Marchetti M. The efficiency of walking of paraplegic patients using a reciprocating gait orthosis. Paraplegia. 1995;33(7):409-415.
8. Scivoletto G, Petrelli A, Lucente LD, et al. One year follow up of spinal cord injury patients using a reciprocating gait orthosis: preliminary report. Spinal Cord. 2000;38(9):555-558.
9. Franceschini M, Baratta S, Zampolini M, Loria D, Lotta S. Reciprocating gait orthoses: a multicenter study of their use by spinal cord injured patients. Arch Phys Med Rehabil. 1997;78(6):582-586.
10. Sykes L, Edwards J, Powell ES, Ross ER. The reciprocating gait orthosis: long-term usage patterns. Arch Phys Med Rehabil. 1995; 76(8):779-783.
11. Foulds HJ, Bredin SS, Charlesworth SA, Ivey AC, Warburton DE. Exercise volume and intensity: a dose-response relationship with health benefits. Eur J Appl Physiol. 2014;114(8):1563-1571.
12. Electronic Code of Federal Regulations. Part 890-Physical Medicine Devices. §890.3480 Powered lower extremity exoskeleton. HYPERLINK “http://www.ecfr.gov/cgi-bin/text-idx?SID=9b627fd1822b8fcd87ad660db602de1c&mc=true&node=pt21.8.890&rgn=div5”\l“se21.8.890_13480” http://www.ecfr.gov/cgi-bin/text-idx?SID=9b627fd1822b8fcd87ad660db602de1c&mc=true&node=pt21.8.890&rgn=div5#se21.8.890_13480. Accessed December 18, 2015.
13. Federici S, Meloni F, Bracalenti M, De Filippis ML. The effectiveness of powered, active lower limb exoskeletons in neurorehabilitation: a systematic review. NeuroRehabilitation. 2015;37(3):321-340.
14. Lajeunesse V, Vincent C, Routhier F, Careau E, Michaud F. Exoskeletons’ design and usefulness evidence according to a systematic review of lower limb exoskeletons used for functional mobility by people with spinal cord injury. Disabil Rehabil Assist Technol. Epub 2015 Sep 4.
15. Louie DR, Eng JJ, Lam T; Spinal Cord Injury Research Evidence Research Team. Gait speed using powered robotic exoskeletons after spinal cord injury: a systematic review and correlational study. J Neuroeng Rehabil. 2015;12:82.
16. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151(4):W65-W94.
17. Butland RJ, Pang J, Gross ER, Woodcock AA, Geddes DM. Two-, six-, and 12-minute walking tests in respiratory disease. Br Med J (Clin Res Ed). 1982;284(6329):1607-1608.
18. Collins EG, Gater D, Kiratli J, Butler J, Hanson K, Langbein WE. Energy cost of physical activities in persons with spinal cord injury. Med Sci Sports Exerc. 2010;42(4):691-700.
19. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-381.
20. Kawashima N, Taguchi D, Nakazawa K, Akai M. Effect of lesion level on the orthotic gait performance in individuals with complete paraplegia. Spinal Cord. 2006;44(8):487-494.
21. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-560.
22. Arazpour M, Bani MA, Hutchins SW, Jones RK. The physiological cost index of walking with mechanical and powered gait orthosis in patients with spinal cord injury. Spinal Cord. 2013;51(5):356-359.
23. Asselin P, Knezevic S, Kornfeld S, et al. Heart rate and oxygen demand of powered exoskeleton-assisted walking in persons with paraplegia. J Rehabil Res Dev. 2015;52(2):147-158.
24. Benson I, Hart K, Tussler D, van Middendorp JJ. Lower-limb exoskeletons for individuals with chronic spinal cord injury: findings from a feasibility study. Clin Rehabil. 2016;30(1):73-84.
25. Esquenazi A, Talaty M, Packel A, Saulino M. The ReWalk powered exoskeleton to restore ambulatory function to individuals with thoracic-level motor-complete spinal cord injury. Am J Phys Med Rehabil. 2012;91(11):911-921.
26. 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. Top Spinal Cord Inj Rehabil. 2015;21(2):122-132.
27. Fineberg DB, Asselin P, Harel NY, et al. Vertical ground reaction force-based analysis of powered exoskeleton-assisted walking in persons with motor-complete paraplegia. J Spinal Cord Med. 2013;36(4): 313-321.
28. Hartigan C, Kandilakis C, Dalley S, et al. Mobility outcomes following five training sessions with a powered exoskeleton. Top Spinal Cord Inj Rehabil. 2015;21(2):93-99.
29. Kolakowsky-Hayner SA, Crew J, Moran S, Shah A. Safety and feasibility of using the Ekso bionic exosksleton to aid ambulation after spinal cord injury. J Spine. 2013;S4:003.
30. 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. Top Spinal Cord Inj Rehabil. 2015;21(2):110-121.
31. 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):18784-18874.
32. Spungen AM, Asselin PK, Fineberg DB, Kornfeld SD, Harel NY. Exoskeletal-assisted walking for persons with motor-complete paraplegia. Paper presented at: NATO Science and Technology Organization; Milan, Italy; April 15-17, 2013.
33. Talaty M, Esquenazi A, Briceno JE. Differentiating ability in users of the ReWalk(TM) powered exoskeleton: an analysis of walking kinematics. IEEE Int Conf Rehabil Robot. 2013;2013:6650469.
34. Yang A, Asselin P, Knezevic S, Kornfeld S, Spungen AM. Assessment of in-hospital walking velocity and level of assistance in a powered exoskeleton in persons with spinal cord injury. Top Spinal Cord Inj Rehabil. 2015;21(2):100-109.
35. Zeilig G, Weingarden H, Zwecker M, Dudkiewicz I, Bloch A, Esquenazi A. Safety and tolerance of the ReWalk exoskeleton suit for ambulation by people with complete spinal cord injury: a pilot study. J Spinal Cord Med. 2012;35(2):96-101.
36. ReWalk Robotics. Available from: http://rewalk.com/. Accessed January 31, 2016.
37. Ekso Bionics. Available from: http://www.eksobionics.com/. Accessed January 31, 2016.
38. Corp PH. Available from: http://www.indego.com/indego/en/home. Accessed January 31, 2016.
39. Hicks AL, Martin Ginis KA, Pelletier CA, Ditor DS, Foulon B, Wolfe DL. The effects of exercise training on physical capacity, strength, body composition and functional performance among adults with spinal cord injury: a systematic review. Spinal Cord. 2011;49(11):1103-1127.
40. Astorino TA, Harness ET, Witzke KA. Effect of chronic activity-based therapy on bone mineral density and bone turnover in persons with spinal cord injury. Eur J Appl Physiol. 2013;113(12):3027-3037.
41. Milia R, Roberto S, Marongiu E, et al. Improvement in hemodynamic responses to metaboreflex activation after one year of training in spinal cord injured humans. Biomed Res Int. 2014;2014:893468.
42. Stamatakis E, Rogers K, Ding D, et al. All-cause mortality effects of replacing sedentary time with physical activity and sleeping using an isotemporal substitution model: a prospective study of 201,129 mid-aged and older adults. Int J Behav Nutr Phys Act. 2015;12:121.