Issue 3-85, 2018

Synchronized Application of the Exoskeleton with Functional Electrostimulation in the Spinal Cord Injury Patients

View article (Download PDF file)



Download XML file

1 Tkachenko P.V., 1 Daminov V.D., 1 Karpov O.E.

1 FSBE «National Medical Surgery Center named by N.I. Pirogov Ministry of Health RF», Moscow, Russia


ABSTRACT

Emergence of the exoskeletons became the real revolution in the expansion of a barrier-free environment for the SCIpatients. The aim was to evaluate the safety and effectiveness of the exoskeleton`s application in the complex rehabilitationof the SCI patients. 112 of SCI patients, thoracic level, the late period of trauma, with the syndrome of incomplete spinal cordinterruption. Objectively: lower paraparesis – from 0 to 3 points; muscle tone – up to 3 points (Ashworth scale); safe functionof the upper extremities. Patients of the main group had walking trainings in the exoskeleton in addition to traditionalrehabilitation program. Control group got only traditional rehabilitation program and robotic mechanotherapy on Lokomat.Rehabilitation course included 15 trainings. Blood pressure, heart rate were monitored. It was performed assessment ofthe neurological status, the ability to walk and using aids on the Hauser index, the degree of self-service and mobility wasassessed according to the VFM scale, revealed the features of electromyographic indices of the back and extensors of thehip joint muscles, evaluated the biomechanical parameters of patients walking and their psychological status on the 1st and15th day of rehabilitation.Results. Hemodynamics values were within acceptable values. Patients of the both groups had improvements in theneurological status – in paraparesis and muscle tone reducing. Main group patient`s walking became more stable in thelongitudinal and transverse di rections, and also less energy-consuming. Improvements in the management of the backmuscles and the hip extensor m u scles after the end of the rehabilitation course were noted. Training sessions on theexoskeleton contributed to a significant improvement in the psychological status – reducing depression, anxiety, improvingwell-being-activity. The achieved regression of clinical symptoms allowed the patients of the main group to expand selfserviceand mobility.


KEYWORDS: spinal cord injury, gait reconstruction, robotic mechanotherapy, exoskeleton, low paraparesis, muscle strength, muscle tone, depression


References:

  1. Leont'ev M.A., Ovchinnikov O.D. [The study of the indications for recovery of locomotor function in patients with SCI and factors impeding locomotion]; Vestnik Kuzbasskogo nauchnogo Centra SO RAMN; 2005; №1; 131-136.
  2. Dashko I.A. Avtoreferat kandidatskoj dissertacii [Differentiated integrated approach to the therapy and rehabilitation of patients depending on the extent and level of traumatic spinal cord injury]; Moskva; 2010 g.
  3. Zimina E.V. Avtoreferat kandidatskoy dissertacii [Medical rehabilitation of patients with the use of robotic reconstruction walk in the first months after spinal cord injury]; Moskva; 2010
  4. Daminov V.D., Gorokhova I.G., Tkachenko P.V [Antigravity Technology recovery walk in clinical rehabilitation]; VVM; 2015; №4; 33-36
  5. Mehrholz J, Elsner B, Werner C, Kugler J, Pohl M. Electromechanical-assisted training for walking after stroke; Cochrane Database Syst Rev; 2013 Jul 25;7:CD006185).
  6. Ruiz, Jennifer BS; Labas, Michele P. BS; Triche, Elizabeth W. PhD; Lo, Albert C. MD, PhD Combination of Robot-Assisted and Conventional Body-Weight Supported Treadmill Training Improves Gait in Persons With Multiple Sclerosis: A Pilot Study; Journal of Neurologic Physical Therapy; 2013; Volume 37; Issue 4; 187-193
  7. Daminov V.D. Avtoreferat doktorskoj dissertacii [Improving technology robotic system mechanotherapy in the rehabilitation of patients with central nervous system]; Moskva; 2013 g.
  8. Klochkov A.S. Avtoreferat kandidatskoj dissertacii [Robotic systems in restoring skill walk in stroke patients]; Moskva; 2012 g.
  9. Tkachenko P. V., Daminov V. D. [Necessity rehabilitation of patients with multiple sclerosis after stem cell transplantation]; VVM; 2015; №4; 9-12
  10. Christian Fisahn, Mirko Aach, Oliver Jansen, Marc Moisi, Angeli Mayadev, Krystle T. Pagarigan, Joseph R. Dettori, Thomas A. Schildhauer; The Effectiveness and Safety of Exoskeletons as Assistive and Rehabilitation Devices in the Treatment of Neurologic Gait Disorders in Patients with Spinal Cord Injury: A Systematic Review; Global Spine J.; 2016 Dec; 6(8):822-841.



Creative Commons License
The content is available under the Creative Commons Attribution 4.0 License.

©


This is an open article under the CC BY 4.0 license. Published by the National Medical Research Center for Rehabilitation and Balneology.