Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois (A.W.H. and A.J.); Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois (A.W.H.; J.S.); Max Näder Center for Rehabilitation Technologies and Outcomes Research (A.J.; C.K.M), Shirley Ryan AbilityLab, Chicago, Illinois (C.K.M. and J.S.); Marquette University, Milwaukee, Wisconsin (D.P.); Physical Therapy (C.T.), Craig Hospital, Englewood, Colorado (S.C.); Spinal Cord Injury and Disability Research (H.B.T.), TIRR Memorial Hermann, Houston, Texas (S.H.C. and A.S.); The University of Texas Health Science Center at Houston Department of PM&R (H.B.T, S.H.C., and A.S.); Crawford Research Institute, Shepherd Center, Atlanta, Georgia (C.L.F.; E.C.F-F.); Division of Physical Therapy, Emory University, Atlanta, Georgia (E.C.F.-F.); and School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia (E.C.F.-F.).
J Neurol Phys Ther. 2018 Oct;42(4):256-267. doi: 10.1097/NPT.0000000000000235.
Refinement of robotic exoskeletons for overground walking is progressing rapidly. We describe clinicians' experiences, evaluations, and training strategies using robotic exoskeletons in spinal cord injury rehabilitation and wellness settings and describe clinicians' perceptions of exoskeleton benefits and risks and developments that would enhance utility.
We convened focus groups at 4 spinal cord injury model system centers. A court reporter took verbatim notes and provided a transcript. Research staff used a thematic coding approach to summarize discussions.
Thirty clinicians participated in focus groups. They reported using exoskeletons primarily in outpatient and wellness settings; 1 center used exoskeletons during inpatient rehabilitation. A typical episode of outpatient exoskeleton therapy comprises 20 to 30 sessions and at least 2 staff members are involved in each session. Treatment focuses on standing, stepping, and gait training; therapists measure progress with standardized assessments. Beyond improved gait, participants attributed physiological, psychological, and social benefits to exoskeleton use. Potential risks included falls, skin irritation, and disappointed expectations. Participants identified enhancements that would be of value including greater durability and adjustability, lighter weight, 1-hand controls, ability to navigate stairs and uneven surfaces, and ability to balance without upper extremity support.
Each spinal cord injury model system center had shared and distinct practices in terms of how it integrates robotic exoskeletons into physical therapy services. There is currently little evidence to guide integration of exoskeletons into rehabilitation therapy services and a pressing need to generate evidence to guide practice and to inform patients' expectations as more devices enter the market.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A231).
用于地面行走的机器人外骨骼的改进正在迅速推进。我们描述了临床医生在脊髓损伤康复和健康环境中使用机器人外骨骼的经验、评估和培训策略，并描述了临床医生对外骨骼益处和风险的看法，以及那些可以提高实用性的发展。
我们在 4 个脊髓损伤模型系统中心召集了焦点小组。一名法庭记录员逐字记录并提供了一份抄本。研究人员使用主题编码方法总结讨论内容。
30 名临床医生参加了焦点小组。他们报告说主要在门诊和健康环境中使用外骨骼；1 个中心在住院康复期间使用外骨骼。门诊外骨骼治疗的一个典型疗程包括 20 到 30 次，每次至少有 2 名工作人员参与。治疗重点是站立、迈步和步态训练；治疗师使用标准化评估来衡量进展。除了改善步态外，参与者还将外骨骼使用归因于生理、心理和社会益处。潜在的风险包括跌倒、皮肤刺激和期望落空。参与者确定了一些有价值的改进，包括更高的耐用性和可调节性、更轻的重量、单手控制、上下楼梯和不平坦表面的导航能力，以及无需上肢支撑就能平衡的能力。
每个脊髓损伤模型系统中心在如何将机器人外骨骼融入物理治疗服务方面都有共同的和独特的做法。目前，几乎没有证据可以指导外骨骼融入康复治疗服务，并且迫切需要生成证据来指导实践，并告知患者更多设备进入市场后的期望。视频摘要可提供作者的更多见解（请参见视频，补充数字内容 1，可在 http://links.lww.com/JNPT/A231 获得）。
