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

Issue title: Thematic Issue: Integrating Robot-assisted Therapy Into Neurorehabilitation Clinical Practice: Where Are We Now? Where Are We Heading?

Guest editors: Giovanni Morone, Robert Riener and Stefano Mazzoleni

Article type: Review Article

Authors: Stampacchia, Giulia^{a; *} | Gazzotti, Valeria^b | Olivieri, Matteo^c | Andrenelli, Elisa^d | Bonaiuti, Donatella^e | Calabro, Rocco Salvatore^f | Carmignano, Simona Maria^{g; h} | Cassio, Annaⁱ | Fundaro, Cira^j | Companini, Isabella^k | Mazzoli, David^l | Cerulli, Simona^m | Chisari, Carmeloⁿ | Colombo, Valentina^o | Dalise, Stefaniaⁿ | Mazzoleni, Daniele^p | Melegari, Corrado^q | Merlo, Andrea^l | Boldrini, Paolo^r | Mazzoleni, Stefano^s | Posteraro, Federico^t | Mazzucchelli, Miriam^p | Benanti, Paolo^u | Castelli, Enrico^v | Draicchio, Francesco^w | Falabella, Vincenzo^x | Galeri, Silvia^y | Gimigliano, Francesca^z | Grigioni, Mauro^aa | Mazzon, Stefano^bb | Molteni, Franco^cc | Morone, Giovanni^dd | Petrarca, Maurizio^ee | Picelli, Alessandro^ff | Senatore, Michele^gg | Turchetti, Giuseppe^hh | Bizzarrini, Emilianaⁱⁱ

Affiliations: [a] Azienda Ospedaliero Universitaria Pisana, Pisa, Italy | [b] Centro Protesi Vigorso di Budrio, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Bologna, Italy | [c] Scuola IMT Alti Studi di Lucca, Lucca, Italy | [d] Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy | [e] Piero Redaelli Geriatric Institute, Milan, Italy | [f] IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy | [g] Rehabilitation Therapeutic Center (CTR), Potenza, Italy | [h] University of Salerno, Salerno, Italy | [i] Spinal Cord Unit and Intensive Rehabilitation Medicine, Ospedale di Fiorenzuola d’Arda, AUSL Piacenza, Piacenza, Italy | [j] Neurophysiopathology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Montescano, Pavia, Italy | [k] Department of Neuromotor and Rehabilitation, LAM-Motion Analysis Laboratory, San Sebastiano Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy | [l] Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy | [m] Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy | [n] Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy | [o] Montecatone Rehabilitation Institute, Imola, Italy | [p] School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy | [q] Elias Neuroriabilitazione, Parma, Italy | [r] Italian Society of Physical Medicine and Rehabilitation (SIMFER), Rome, Italy | [s] Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy | [t] Department of Rehabilitation, Versilia Hospital - AUSL12, Viareggio, Italy | [u] Pontifical Gregorian University, Rome, Italy | [v] Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy | [w] Department of Occupational and Environmental Medicine Epidemiology and Hygiene, INAIL, Rome, Italy | [x] Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy | [y] IRCCS Fondazione Don Carlo Gnocchi, Pavia, Italy | [z] Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy | [aa] National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy | [bb] Rehabilitation Unit, ULSS (Local Health Authority) Euganea, Camposampiero Hospital, Padua, Italy | [cc] Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy | [dd] IRCCS Santa Lucia Foundation, Rome, Italy | [ee] Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children’s Hospital, Rome, Italy | [ff] Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy | [gg] Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy | [hh] Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy | [ii] Department of Rehabilitation Medicine, Spinal Cord Unit, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy

Correspondence: [*] Address for correspondence: Giulia Stampacchia, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy. E-mail: g.stampacchia@ao-pisa.toscana.it.

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.

Keywords: Gait rehabilitation, exoskeleton robot, spinal cord injury

DOI: 10.3233/NRE-220061

Journal: NeuroRehabilitation, vol. 51, no. 4, pp. 609-647, 2022