Wearable rehabilitation exoskeletons of the lower limb: analysis of versatility and adaptability

Abstract

Purpose

To analyse the versatility and adaptability of commercially available exoskeletons for mobility assistance and their adaptation to diverse pathologies through a review of clinical trials in robotic lower limb training.

Data Sources

A computer-aided search in bibliographic databases (PubMed and Web of Science) of clinical trials published up to September 2020 was done.

Methods

To be selected for detailed review, clinical trials had to meet the following criteria: (1) a protocol was designed and approved, (2) participants were people with pathologies, and (3) the trials were not a single case study. Clinical trial data were collected, extracted, and analysed, considering: objectives, trial participants, number of sessions, pathologies involved, and conclusions.

Results

The search resulted in 312 potentially relevant studies of seven commercial exoskeletons, of which 135 passed the preliminary screening; and 69 studies were finally selected. Of the 69 clinical trials included in the review about 50% involved Spinal Cord Injury participants, while roughly 25% focussed on stroke and two trials corresponded to patients with both disorders. The rest were composed of neurological diseases and trauma disorders.

Conclusions

The use of a single wearable robot for different medical conditions in various diseases is a challenge. Based on this comparative, the properties of the exoskeletons that improve the working ability with different pathologies and patient conditions have been evaluated. Suggestions were made for developing a new lower-limb exoskeleton based on various modules with a distributed control system to improve versatility in wearable technology for different gait pattern progression.

Implications for rehabilitation

• Wearable robotic exoskeletons for gait assistance have been analysed from the perspective of adaptation to different diseases.

• This paper emphasizes the importance of personalized therapies and adaptive assistive technology.

• Suggestions were made for a new modular exoskeleton capable of addressing the issue of low versatility characterizing currently wearable assistive technology.

Keywords:

• Robotic exoskeleton
• gait rehabilitation
• personalized therapy
• review
• modular exoskeleton

Disclosure statement

E Garcia is a founder and promoter of Marsi Bionics which produces one of the exoskeleton analysed; Atlas. A Plaza, G Puyuelo and E Garces work for Marsi Bionics and receive a salary for this work. The remaining authors have no conflicts of interest to declare.

Additional information

Funding

This work was partially supported by the Education and Research Counselling of Comunidad de Madrid [Project ref: IND2017/TIC-7698].