Domestic Use of the Exoskeleton for Gait Training in Patients with Spinal Cord Injuries: Ethical Dilemmas in Clinical Practice

• Published in: Frontiers in neuroscience Vol. 12; p. 78
• Main Authors: Bissolotti, Luciano, Nicoli, Federico, Picozzi, Mario
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Research Foundation 15-02-2018; Frontiers Media S.A
• Subjects: Balance; Ethics; Exoskeleton; exoskeleton spinal cord injury; financial; Gait; Hilario, Maybyner (Nene); Injuries; Life span; Medical; Metabolism; Neuroscience; Paralysis; Patients; principlism; Quality of life; Rehabilitation; Spinal cord injuries; Systematic review; Therapeutic applications; Walking; Withdrawal; Italy; exoskeleton spinal cord injury; principlism; Medical; ethics; gait; financial
• ISSN: 1662-4548; 1662-453X; 1662-453X
• DOI: 10.3389/fnins.2018.00078

To counteract these negative effects, Gait Retraining Programs have been operating for many years in order to exploit body-weight-supported gait on a treadmill (Sale et al., 2012), dynamic orthoses based upon passive mechanical hip-knee-ankle-foot orthoses (H-KAFO) which enable patients with SCI to ambulate over ground (Massucci et al., 1998) and/or similar synergic actions of Functional Electrical Stimulation (FES) with synchronized activation according to the different phases of the gait cycle (Nene and Patrick, 1990). Even though this type of technology has not proved to be effective in enhancing autonomous gait recovery in SCI patients, it can be considered both as an assistive device to realize independent assisted walking and a rehabilitation tool for its ability to provide effective benefits to specific functions (i.e., bowel movements) and structures (i.e., trunk control) of the human body. Fitting (the exoskeleton is adjusted according to the patient's measures); Donning (the specific strategy used to get into the ReWalk is explained); Standing (patients receive instructions about the way to control the activation of the exoskeleton while using crutches to stand up); Standing balance (while standing, shifting the body weight and moving the trunk to induce the walking phase); Walking with crutches and progressive goals in mobility (turning by 90 and 180°, arresting gait, walking through doors, using an elevator and walking close to other people); Sitting and Doffing. Concerns of an ethical nature may arise since the domestic use of the device depends mainly on personal resources. [...]in hospital settings the use of the exoskeleton for therapeutic purposes seems to be ethically justified because one single device can be available to many different patients for a limited period of time, and specifically to individualized therapeutic targets (Platz et al., 2016; Raab et al., 2016).