Different Types of Exoskeletons can Improve the Life of Spinal Cord Injury’s Patients – a Meta-Analysis

Abstract

The main aim of our study is to outline the role of different exoskeletons in the improvement of quality of life of patients with spinal cord injuries as an active part of their process of rehabilitation as well as part of their future autonomy. Thus, projecting in the future what kind of exoskeleton can be used in different steps of the process of social reinsert†ion of those with spinal cord injury. The robotic exoskeletons are emerging not as only as an option in the rehabilitation of patients with spinal cord injuries and the affection consequences of long terms but as future “suit” to be wear by those with lost autonomy. The main problem, despite the large number of the studies published is the heterogeneity of their design, different targets studied and as well different exoskeletons used. No recommendations are published aiming when, what kind and for how long can the patients use the robotic exoskeletons. In order to have a background to be used as a future prospective research, a meta-analysis of aiming for the use of different exoskeletons (ReWalk, Indego and Ekso) as tools for rehabilitation or personal used was performed. A number of 456 studies targeting patients with spinal cord injury using exoskeletons in their rehabilitation and regaining autonomy was found after an electronic search of the PubMed, PlosOne and clinicaltrials.gov research data bases. After applying the inclusion and exclusion criteria a number of 11 studies were selected. The statistical analysis was performed using MedCalc software. Success in using exoskeletons rehabilitation or social reinsertion was obtained at an RR/OR <1. Success was defined, in clinical terms, as an improvement of 6 time minutes walking test. Overall, the exoskeletons were an accepted and successful method in the rehabilitation of patients with spinal cord injuries (p: 0.0021, I2: 63.81). An unexpected surprise came as results showed the less adherence of the patients for the type Ekso exoskeleton (less autonomy) versus Rewalk and Indego that provided more autonomy (p: 0.0145, I2: 76,39%).