Journal of Spine

The Ability to Walk After a Spinal Cord Injury with Emphasis on Exoskeletons: A Review

Abstract

Van Silfhout L, Michael Edwards, Allard Hosman, Henk Van de Meent and Ronald Bartels

Background: In recent years, an increasing number of patients with a spinal cord injury (SCI) have been reintegrating into community life and have been getting back to a more active and independent lifestyle. Consequently, rehabilitation therapies have altered, to address activity limitations that patients may experience, to increase participation in the community and to improve patients’ overall quality of life. An innovative, supportive approach to locomotor training is through use of an exoskeleton, which could be used in those patients who are unable to ambulate by themselves. Study design: Review. Objective: To provide an overview of the current literature regarding ambulation in spinal cord injured patients with emphasis on outcome and the usage of exoskeletons, a new innovative way of rehabilitation therapy after a SCI.

Methods: This is a narrative review of the SCI literature on ambulation outcomes in patients with SCI. A systematic search was performed of all publications mentioning SCI, exoskeletons and ambulation. Relevant studies were included after screening of both title and abstract of the search results. Animal studies and non-English articles were excluded.

Results: Current literature shows that the final degree of motor-function recovery depends on neuronal plasticity, and that the largest amount of recovery can be achieved during the first-year post-injury. Training muscle strength and walking speed are important goals in rehabilitation therapy after a SCI. Furthermore, exoskeletons have been shown to be well tolerated by spinal cord injured patients and could be used by patients without any remaining ambulatory function.

Conclusion: This review showed that it is important to start early with the rehabilitation process after a SCI, to be able to fully benefit from neuroplasticity during the first-year post-injury. In patients without any remaining ambulatory function, such as patients with a complete SCI, exoskeletons have shown to reduce spasticity and improve ambulatory capacity.