Tan Koki, Koyama Soichiro, Sakurai Hiroaki, Teranishi Toshio, Kanada Yoshikiyo, Tanabe Shigeo
Graduate School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan.
Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan.
J Orthop Translat. 2021 Mar 1;28:55-64. doi: 10.1016/j.jot.2021.01.001. eCollection 2021 May.
Wearable robotic exoskeletons (WREs) have been globally developed to achieve gait reconstruction in patients with spinal cord injury (SCI). The present study aimed to enable evidence-based decision-making in selecting the optimal WRE according to residual motor function and to provide a new perspective on further development of appropriate WREs.
The current review was conducted by searching PubMed, Web of Science, and Google Scholar for relevant studies published from April 2015 to February 2020. Selected studies were analysed with a focus on the participants' neurological level of SCI, amount of training (number of training sessions and duration of the total training period), gait speed and endurance achieved, and subgroup exploration of the number of persons for assistance and the walking aid used among patients with cervical level injury.
A total of 28 articles (nine using Ekso, three using Indego, ten using ReWalk, one using REX, five using Wearable Power-Assist Locomotor) involving 228 patients were included in the analysis. Across all WREs, T6 was the most frequently reported level of SCI. The amount of training showed a wide distribution (number of training sessions: 2-230 sessions [30-120 min per session]; duration of the total training period: 1-24 weeks [1-5 times per week]). The mean gait speed was 0.31 m/s (standard deviation [SD] 0.14), and the mean distance on the 6-min walking test as a measure of endurance was 108.9 m (SD 46.7). The subgroup exploration aimed at patients with cervical level injury indicated that 59.2% of patients were able to ambulate with no physical assistance and several patients used a walker as a walking aid.
The number of cervical level injury increased, as compared to the number previously indicated by a prior similar review. Training procedure was largely different among studies. Further improvement based on gait performance is required for use and dissemination in daily life.
The present review reveals the current state of the clinical effectiveness of WREs for gait reconstruction in patients with SCI, contributing to evidence-based device application and further development.
全球范围内都在研发可穿戴式机器人外骨骼（WREs），以实现脊髓损伤（SCI）患者的步态重建。本研究旨在根据残余运动功能，为选择最佳WRE提供循证决策依据，并为进一步开发合适的WREs提供新视角。
通过检索PubMed、科学网和谷歌学术，对2015年4月至2020年2月发表的相关研究进行了本次综述。对所选研究进行分析，重点关注参与者的SCI神经损伤水平、训练量（训练次数和总训练期时长）、达到的步态速度和耐力，以及对颈髓损伤患者中接受辅助的人数和使用的助行器进行亚组探索。
分析共纳入28篇文章（9篇使用Ekso，3篇使用Indego，10篇使用ReWalk，1篇使用REX，5篇使用可穿戴动力辅助运动装置），涉及228例患者。在所有WREs研究中，T6是最常报告的SCI损伤水平。训练量分布广泛（训练次数：2至230次[每次30至120分钟]；总训练期时长：1至24周[每周1至5次]）。平均步态速度为0.31米/秒（标准差[SD]0.14），作为耐力指标的6分钟步行试验的平均距离为108.9米（SD 46.7）。针对颈髓损伤患者的亚组探索表明，59.2%的患者能够在无身体辅助的情况下行走，部分患者使用步行器作为助行器。
与之前类似综述指出的数量相比，颈髓损伤患者数量有所增加。各研究之间的训练程序差异很大。在日常生活中的使用和推广方面，需要基于步态表现进一步改进。
本综述揭示了WREs用于SCI患者步态重建的临床有效性的当前状况，有助于循证设备应用和进一步发展。
