Title : Do lower limb robotic exoskeletons have a role in neurological rehabilitation? A systematic review
Background: Technological advances have led to the emergence of robotic exoskeletons as a potential therapy option for patients with neurological conditions. To date, the body of evidence has focused on the spinal cord injury population but more recently there has been growing interest in people with acquired brain injury. Several different exoskeletons are currently available for purchase, and given the expense of these devices, careful evaluation of the proposed benefits is warranted before therapeutic recommendations can be made by therapists.
Method: A systematic review was conducted to synthesise all the available evidence relating to powered lower limb robotics in adults with acquired brain injury. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The quality of the evidence was evaluated and recommendations provided using the GRADE classification system. The primary outcome of interest was neuromuscular function and secondary outcomes included quality of life, mood, acceptability and safety.
Results: 16 studies with 325 participants were available, of which 6 studies included data suitable for meta-analysis. Overall, the included studies were of “fair” methodological quality and consistently reported positive findings but the size of the treatment effect varied widely. When data from the controlled studies were pooled, robotic therapy did not produce statistically significant improvements on endurance (MD = 8.80, CI = -14.75 – 32.35, P =0.46) or velocity (MD = 0.97, CI = -0.06 - 2.00, P = 0.06). The pooled data from three studies suggested a beneficial effect on balance as assessed by the Berg Balance Scale (MD = -2.84, CI = -4.46, -1.22, P = 0.0006). The robotic therapy was deemed acceptable with few drop outs and no severe adverse events. No studies commented on the effect of robotic therapy on quality of life or mood.
Conclusion: This review suggests there are limited short-term advantages associated with the use of robotic therapy in patients with acquired brain injury compared to conventional therapy. The strength of recommendations was graded as low-moderate, therefore we are unable to comment on many important rehabilitation outcomes due in part to the lack of evidence available, the heterogeneity of the participants and range of robotic devices.
What will the audience take away from this presentation?
- Robotic lower limb exoskeletons offer a safe and acceptable mode of therapy for patients with acquired brain injury.
- There is inadequate evidence to endorse robotic therapy in lieu of conventional therapy to improve gait in patients with acquired brain injury but it may be considered as a means for improving balance.
- Given the range of robotic devices and heterogeneous nature of acquired brain injury further research is required to determine the clinical merits of this emerging modality.