Effectiveness of over-ground robotic locomotor training in improving walking performance, cardiovascular demands, secondary complications and user-satisfaction in individuals with spinal cord injuries: A systematic review

• Published in: Journal of rehabilitation medicine Vol. 51; no. 10; pp. 723 - 733
• Main Authors: Shackleton, Claire, Evans, Robert, Shamley, Delva, West, Sacha, Albertus, Yumna
• Format: Journal Article
• Language: English
• Published: Sweden Journal of Rehabilitation Medicine 01-11-2019; Medical Journals Sweden
• Subjects: claire shackleton, robert evans, delva shamley, sacha west, yumna albertus; Clinical trials; Evidence-based medicine; Humans; Injuries; Intervention; Neurology; Pain; Performance evaluation; Physical Therapy Modalities; Rehabilitation; Robotics; Robotics - methods; Spasticity; Spinal cord; Spinal cord injuries; Spinal Cord Injuries - rehabilitation; Systematic review; Walking; Walking - physiology; Claire Shackleton, Robert Evans, Delva Shamley, Sacha West, Yumna Albertus
• ISSN: 1650-1977; 1651-2081
• DOI: 10.2340/16501977-2601

To evaluate the effectiveness of over-ground robotic locomotor training in individuals with spinal cord injuries with regard to walking performance, cardiovascular demands, secondary health complications and user-satisfaction.
PubMed, Cochrane, Web of Science, Scopus, EBSCOhost and Engineering Village.
Trials in which robotic locomotor training was used for a minimum of 3 participants with spinal cord injury.
Independent extraction of data by 2 reviewers using a pre-established data abstraction table. Quality of evidence assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
Total of 27 non-controlled studies representing 308 participants. Most studies showed decreases in exertion ratings, pain and spasticity and reported positive well-being post-intervention. Seven studies were included in meta-analyses on walking performance, showing significant improvements post-intervention (p < 0.05), with pooled effects for the 6-min walking test and 10-metre walking test of-0.94 (95% confidence interval (95% CI) -1.53,-0.36) and -1.22 (95% CI -1.87,-0.57), respectively. The Timed Up and Go Test showed a positive pooled effect of 0.74 (95% CI 0.36, 1.11). Improvements in walking parameters were seen with an increase in session number; however, no significant cardiovascular changes were found over time.
Robotic locomotor training shows promise as a tool for improving neurological rehabilitation; however, there is limited evidence regarding its training benefits. Further high-powered, randomized controlled trials, with homogenous samples, are required to investigate these effects.