Actively Controlled Exoskeletons Show Improved Function and Neuroplasticity Compared to Passive Control: A Systematic Review.

Study DesignSystematic Review.ObjectivesTo determine whether actively controlled exoskeletons or passively controlled exoskeletons are better at rehabilitating patients with SCIs.MethodsA literature search between January 2011 to June 2023 on Pubmed Central, Pubmed, Web of Science and Embase was carried out. Exoskeletons were classified as actively controlled if they detect bioelectrical signals (HAL). All other exoskeletons were classified as passively controlled (ReWalk, Ekso, H-MEX, Atlante, Indego, Rex Bionics, SuitX Phoenix, Lokomat and HANK). Functional outcomes used were 6 minute walk test (6MWT) distance and 10 metre walk test (10MWT) speed. Further subgroup analysis was carried out for acute and chronic SCI patients. All outcomes were examined without the aid of the exoskeleton device. Secondary outcomes including continence, pain and quality of life were also examined.Results555 articles were identified in the initial search and 27 were included in the review resulting in a total of 591 patients and 10 different exoskeleton models. HAL was the only exoskeleton to show improvements in both mobility and all secondary health outcomes. HANK and Ekso also showed improvements in mobility. Rewalk showed improvements in all secondary health outcomes with Ekso only showing improvements in QoL. No other exoskeletons showed significant improvements.ConclusionIn conclusion, the actively controlled exoskeleton HAL showed improvement in all outcomes of interest suggesting that neuroplasticity could be induced with HAL rehabilitation allowing the weakened bioelectrical signals to transcend the SCI to show genuine improvements.