Purpose:
To assess the effects of lower limb robotic exoskeletons on outcomes in
the rehabilitation of people with acquired brain injury.
Materials and methods:
A systematic review of seven electronic databases was conducted. The
primary outcome of interest was neuromuscular function. Secondary
outcomes included quality of life, mood, acceptability and safety.
Studies were assessed for methodological quality and recommendations
were made using the GRADE system.
Results: Of 2469 identified studies, 13 (
n = 322)
were included in the review. Five contained data suitable for
meta-analysis. When the data were pooled, there were no differences
between exoskeleton and control for 6-Minute Walk Test, Timed Up and Go
or 10-Meter Walk Test. Berg Balance Scale outcomes were significantly
better in controls (MD = 2.74, CI = 1.12–4.36,
p = 0.0009). There were no severe adverse events but drop-outs were 11.5% (
n = 37).
No studies reported the effect of robotic therapy on quality of life or
mood. Methodological quality was on average fair (15.6/27 on Downs and
Black Scale).
Conclusions:
Only small numbers of people with acquired brain injury had data
suitable for analysis. The available data
suggests no more benefit for
gait or balance with robotic therapy than conventional therapy. However,
some important outcomes have not been studied and further
well-conducted research is needed to determine whether such devices
offer benefit over conventional therapy, in particular subgroups of
those with acquired brain injury.
- Implications for Rehabilitation
There
is adequate evidence to recommend that powered over-ground lower limb
robotic exoskeletons should not be used clinically in those with ABI,
and that use should be restricted to research.
Further research (controlled trials) with dependent ambulators is recommended.
Research
of other outcomes such as acceptability, spasticity, sitting posture,
cardiorespiratory and psychological function, should be considered.
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