Rehabilitation of Lower-limb Paralysis
There are a few studies on the use of the device in the rehabilitation of lower-limb paralysis.2-5
In all of these studies, the rehabilitation clients were able to walk with the help of the device and additional support (crutches, walking support). The level of disability affected how much walking assistance was needed from the rehabilitator, but some subjects were almost completely independent. According to the studies, the walking speed remained slow (0.19 m/s to 0.55 m/s, the results depend on the level of disability), but it accelerated during rehabilitation.2,3,5 The device allows walking speeds of up to 0.78 m/s, which is considered sufficient speed for limited community ambulation.6
There have been some studies on similar devices for the rehabilitation of lower-limb paralysis, and review articles based on them have been published. In summary, these devices enable walking and upright positioning, walking speed increases as the amount of exercise increases but remains reasonably slow, the level of disability and elapsed time since the injury affect walking speed, the evidence of cardiovascular benefits is conflicting and users have found the devices safe and have a positive attitude toward them.7-11 The devices have the potential to intensify rehabilitation, but the evidence is still scarce.7
The reviews revealed that there were significant differences in the training times among the studies,7-9,11,12 the indicators used7-12 and the disability levels.7-9,12 Additionally, the sample sizes were small,7,8,11 and the quality of the studies was assessed as poor.7,9 There were also shortcomings regarding conflicts of interests.7
In the studies, the most common level of injury was T10, and most of the injuries were between the levels of T4 and T12.12 When purchasing the device, health professionals should consider whether the disabilities of the patients in a rehabilitation unit’s group are of a similar level.
Rehabilitation After a Stroke
One study looked at the use of the device for rehabilitation after a stroke. The research focused on describing the technical implementation of the device, and the preliminary results of one subject showed improvement in walking ability.13 According to the manufacturer, four studies have been conducted on the use of the device in post-stroke rehabilitation (42 participants in total). These participants’ gait tests showed improvement in their walking ability, but more detailed information was not available.14
One review of studies on similar types of devices for post-stroke rehabilitation was also found. According to the review, robot-assisted gait therapy is as effective as traditional rehabilitation. In a sub-acute situation, robot-assisted gait therapy can be an added benefit. The results of these studies were partially conflicting, and the authors noted that the research groups were small, most had no control group and the disability ratings were poorly reported.15
Rehabilitation for Other Reasons
The Canadian Agency for Drugs and Technologies in Health (CADHT) did not find any studies that could draw conclusions on the effectiveness of the devices in patients with lower-limb weakness. Lower-limb paralysis was excluded from the agency’s review.16
In the UK, the National Institute for Health and Care Excellence (NICE) has conducted an assessment for a single device of the same kind. The studies show that the use of the device improved independent walking, walking speed and walking distance. At the same time, NICE highlights evidence-related uncertainty, in particular the small sample sizes of the studies and the lack of control groups.17
The vertical position enabled by the device provides secondary benefits, including pain relief, improved bowel and bladder functions, the relief of spasticity and improved mental well-being.5,7,18
