Baylor Scott and White Institute for Rehabilitation, 909 N. Washington Ave., Dallas, TX, 75246, USA.
Baylor Scott and White Research Institute, 3434 Live Oak St., Dallas, TX, 75204, USA.
J Neuroeng Rehabil. 2023 Aug 4;20(1):102. doi: 10.1186/s12984-023-01220-w.
Overground exoskeleton gait training (OEGT) after neurological injury is safe, feasible, and may yield positive outcomes. However, no recommendations exist for initiation, progression, or termination of OEGT. This retrospective study highlights the clinical use and decision-making of OEGT within the physical therapy plan of care for patients after neurological injury during inpatient rehabilitation.
The records of patients admitted to inpatient rehabilitation after stroke, spinal cord injury, or traumatic brain injury who participated in at least one OEGT session were retrospectively reviewed. Session details were analyzed to illustrate progress and included: "up" time, "walk" time, step count, device assistance required for limb swing, and therapist-determined settings. Surveys were completed by therapists responsible for OEGT sessions to illuminate clinical decision-making.
On average, patients demonstrated progressive tolerance for OEGT over successive sessions as shown by increasing time upright and walking, step count, and decreased assistance required by the exoskeleton. Therapists place preference on using OEGT with patients with more functional dependency and assess feedback from the patient and device to determine when to change settings. OEGT is terminated when other gait methods yield higher step repetitions or intensities, or to prepare for discharge.
Our descriptive retrospective data suggests that patients after neurological injury may benefit from OEGT during inpatient rehabilitation. As no guidelines exist, therapists' clinical decisions are currently based on a combination of knowledge of motor recovery and experience. Future efforts should aim to develop evidence-based recommendations to facilitate functional recovery after neurological injury by leveraging OEGT.
神经损伤后进行地上外骨骼步态训练（OEGT）是安全、可行的，并且可能产生积极的结果。然而，目前还没有关于 OEGT 的启动、进展或终止的建议。本回顾性研究强调了在神经损伤后住院康复期间的物理治疗计划中，OEGT 的临床应用和决策。
回顾性审查了接受过卒中、脊髓损伤或创伤性脑损伤住院康复的患者的记录，这些患者至少参加了一次 OEGT 疗程。分析了疗程细节，以说明进展情况，包括：“站立”时间、“行走”时间、步数、摆动肢体所需的设备辅助以及治疗师确定的设置。负责 OEGT 疗程的治疗师完成了调查，以阐明临床决策。
平均而言，患者在连续疗程中表现出对 OEGT 的耐受性逐渐增加，表现为站立和行走时间、步数增加，外骨骼所需的辅助减少。治疗师更倾向于在功能依赖性更强的患者中使用 OEGT，并评估来自患者和设备的反馈，以确定何时更改设置。当其他步态方法产生更高的步重复或强度，或为准备出院时，OEGT 会终止。
我们的描述性回顾性数据表明，神经损伤后的患者可能受益于住院康复期间的 OEGT。由于目前没有指南，治疗师的临床决策目前基于对运动恢复的知识和经验的综合考虑。未来的努力应旨在制定基于证据的建议，通过利用 OEGT 促进神经损伤后的功能恢复。
