Actively Controlled Exoskeletons Show Improved Function and Neuroplasticity Compared to Passive Control: A Systematic...

Area of Science:

• Biomedical Engineering
• Rehabilitation Medicine
• Neuroscience

Background:

• Spinal cord injuries (SCI) present significant challenges in patient rehabilitation.
• Exoskeleton technology offers potential for restoring mobility and improving health outcomes in SCI patients.
• Distinguishing between actively and passively controlled exoskeletons is crucial for understanding their efficacy.

Purpose of the Study:

• To compare the effectiveness of actively controlled versus passively controlled exoskeletons in SCI rehabilitation.
• To evaluate the impact of different exoskeleton models on functional mobility and secondary health outcomes.
• To identify which exoskeleton technologies yield the most significant improvements for SCI patients.

Main Methods:

• A systematic review of literature published between January 2011 and June 2023.
• Searches conducted across major databases: PubMed Central, PubMed, Web of Science, and Embase.
• Exoskeletons classified as active (e.g., HAL) or passive (e.g., ReWalk, Ekso) based on bioelectrical signal detection.

Main Results:

• Out of 555 initial articles, 27 were included, involving 591 patients and 10 exoskeleton models.
• The actively controlled exoskeleton HAL demonstrated improvements in both mobility and all secondary health outcomes.
• Other exoskeletons like HANK and Ekso showed mobility improvements, while ReWalk improved secondary outcomes; Ekso improved QoL.

Conclusions:

• The actively controlled exoskeleton HAL emerged as superior, improving all assessed outcomes.
• HAL rehabilitation may induce neuroplasticity, enabling weakened bioelectrical signals to overcome the SCI.
• This suggests a significant potential for HAL in achieving genuine functional improvements in SCI patients.