Exoskeletal Assisted Rehabilitation After Spinal Cord Injury

Abstract This chapter reviews recent technologic advances to counteract the immobility and negative comorbidities that are associated with the lack of ambulation after spinal cord injury (SCI). A historical background of the progression of robotics in the medical field is reviewed to describe their evolution in rehabilitation medicine. Exoskeletal devices are a new robotic technology that has the potential to revolutionize therapeutic exercise after SCI. Different brands of exoskeletons have been introduced for rehabilitation and community ambulation with different designs and features. The use of exoskeletons may ameliorate several of the chronic health-related consequences that are likely to affect persons with SCI. Existing research is limited but suggests some health benefits of exoskeletons, including improvements in gait function, body composition, aerobic capacity, bone density, spasticity, bowel function, and quality of life. Clinical trials are underway to confirm these benefits and determine the underlying mechanisms that lead to such improvements. Maximizing the application of robotics in rehabilitation environments may be accomplished by providing hybrid protocols with other established techniques such as exercise, gait training, and functional electrical stimulation (FES). Future recommendations may include using FES and brain computer interfaces in conjunction with an exoskeleton to improve rehabilitation outcomes and quality of life after SCI. Further research is warranted to demonstrate the health and quality-of-life benefits of robotic exoskeletons in outpatient and home settings.