Wearable powered exoskeletons for gait training in tetraplegia: a systematic review on feasibility, safety and potential health benefits.

Abstract

Recent developments in wearable powered exoskeletons (WPE) allow gait training (GT) for patients after spinal cord injury (SCI). Two recent meta-analyses on GT using WPE showed promising results for paraplegic patients (PP). To this date, there is no review focusing on tetraplegic patients (TP). The main objective of this review was to assess feasibility and safety of GT using WPE in patients after tetraplegia. This systematic review was performed according to PRISMA-S guidelines. Two independent reviewers searched several databases for studies on GT using WPE for TP. Primary outcomes concerned the number, type and severity of reported adverse events (AE). Secondary outcomes examined potential additional health benefits (AHB). Forty-one studies (6 randomized trials, 24 cohorts and 11 cases series) were selected, including 166 TP, 26 with complete lesions (AIS A) and 71 with level of injury above C6. Minor AE were reported in 17 TP, concerning cutaneous, cardiovascular or musculoskeletal systems. Occurrence of AE is significantly higher in a PP population compared to TP (p value = 0.001). Only one major AE concerned a TP. Studies of low level of evidence suggest that GT using WPE could lead to improvements in walking parameters, cardiovascular efficiency and to a reduction of spasticity. GT using WPE is a feasible and safe intervention for TP. To minimize occurrence of AE, a good patient selection and preparation is proposed. Future clinical trials should be performed to confirm current trends in terms of efficacy and potential AHB.