Page 331 - Handbook of Electronic Assistive Technology

320 HANDBOOK OF ELECTRONIC ASSISTIVE TECHNOLOGY

Robot-assisted gait training has been explored for patients with traumatic brain injury,
SCIs, stroke, cerebral palsy, multiple sclerosis and Parkinson’s disease (Calabrò et al.,
2016).
Robotic exoskeletons are wearable electromechanical devices that have been devel-
oped as augmentative devices to enhance the physical performance of the wearer or as
orthotic devices for gait rehabilitation or locomotion assistance. These enable users with
appropriate physical abilities to stand, walk, climb stairs and perform ADL (Miller et al.,
2016). According to the Food and Drug Administration (FDA) a powered exoskeleton is ‘a
prescription device that is composed of an external, powered, motorized orthosis used
for medical purposes that is placed over a person’s paralyzed or weakened limbs for the
purpose of providing ambulation’ (Food and Drug Administration-HHS, 2015). Potential
benefits of robotic exoskeletons include:

• Increasing user independence.
• Secondary benefits such as improved bowel/bladder function, decreased chronic
pain, reduced spasticity and increased bone marrow density (Contreras-Vidal et al.,
2016).
• The reduction of energy required by the user to move joints, i.e., knee, hip and ankle,
as this load is taken by the exoskeleton itself.
• Providing repetitive, long and intense physiotherapy sessions, yet reducing both
therapist burden and healthcare costs (Bruni et al., 2018).
• Providing measurements of several kinematic and dynamic parameters of patient
limb movement and therefore performance-related indicators (e.g., range of motion,
velocity, smoothness) to objectively quantify patient progress (Masiero et al., 2014).

The robotic rehabilitation systems for the lower limbs can be classified into:

• Fixed site/stationary and
• Mobile/overground walking systems.

At present the range of disabilities that this type of appliance benefits is limited and
while used for rehabilitation, they are not yet at a stage where prosthetic limb exoskeletons
are used throughout the day for typical daily ambulation.

FIXED/STATIONARY SYSTEMS
Fixed or stationary exoskeletons systems incorporate a fixed structure combined with a
moving ground platform (such as a treadmill or footplates) and aim to automate tradi-
tional therapies (Calabrò et al., 2016). They may be treadmill-based or programmable foot
end-effector devices. Treadmill-based systems use a robotic orthotic/exoskeleton con-
nected to the patient’s lower limbs together with a body weight system to offload a part of
the weight of the patient during the stance phase of the gait, reducing the load needed to
be overcome by the patient, and ensuring safety and stability during walking (Bruni et al.,
2018). Foot end-effector systems use driven footplates for guiding the feet and simulating
the phases of the gait.