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Exoskelette in der Rehabilitation Querschnittgelähmter

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Exoskeletons for rehabilitation of patients with spinal cord injuries

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Zusammenfassung

Hintergrund

Im Rahmen des Lokomotiontrainings bei der Behandlung querschnittgelähmter Patienten kommen zunehmend mobile Exoskelette in der Rehabilitation und Hilfsmittelversorgung zum Einsatz.

Fragestellung und Methodik

Die derzeit auf dem Markt verfügbaren exoskelettalen Systeme werden beschrieben, ihre Möglichkeiten in der klinischen Anwendung und die dafür zurzeit vorhandene Evidenz dargestellt. Daraus werden Empfehlungen zur klinischen Anwendung der verschiedenen Exoskelette in der Rehabilitation querschnittgelähmter Patienten abgeleitet.

Ergebnisse

Die Anwendbarkeit unterschiedlicher Exoskelette als Therapiegerät ist mit jeweils unterschiedlicher Zielsetzung möglich. Elektromechanisch kontrollierte Exoskelette zeigen ihre Einsetzbarkeit insbesondere in der Mobilisation bei neurogenen Gangstörungen durch direkte Gangunterstützung. Der Einsatz des neuronal gesteuerten HAL®-Exoskeletts verspricht zusätzlich funktionelle Verbesserungen auch in der chronischen Phase einer Querschnittlähmung bei Patienten mit motorischen Restfunktionen, wenn sie nach dem Training ohne Exoskelett gehen. Ergebnisse, die positive Einflüsse auf Knochendichte, Blasen-Mastdarm-Funktion und Durchblutung zeigen, sind denkbar, aber noch nicht hinreichend belegt. Effekte hinsichtlich Spastikreduktion und Linderung neuropathischer Schmerzen sind bisher lediglich in Fallserien oder im Rahmen kleiner Studien berichtet worden.

Schlussfolgerung

Exoskelette werden zunehmend bei querschnittgelähmten Patienten als „High-tech-Hilfsmittel“ zum Einsatz kommen, sind aber zurzeit im routinemäßigen Einsatz nicht etabliert. Neurologisch-kontrollierte Exoskelette versprechen einen positiven Einfluss auf die Behandlung akuter und chronischer Querschnittlähmungen und können damit eine zukünftige Alternative zum etablierten Lokomotiontraining darstellen.

Abstract

Background

Mobile exoskeletons are increasingly being applied in the course of rehabilitation and provision of medical aids to patients with spinal cord injuries.

Objectives and methods

This article gives a description of the currently available exoskeletal systems and the clinical application including scientific and medical evidence, to derive recommendations regarding clinical practice of the various exoskeletons in the rehabilitation of patients with spinal cord injuries.

Results

The different systems represent a useful adjunct to the therapeutic regimen depending on the medical objectives. Posture-controlled exoskeletons in particular enable mobilization of patients with neurological gait disorders via direct motion support. In addition the neurologically controlled exoskeleton HAL® leads to functional improvements in patients with residual muscular functions in the chronic phase of spinal cord injury in terms of improved walking abilities subsequent to training. However, beneficial effects on bone density, bladder function and perfusion are conceivable but not yet adequately supported by evidence. Positive effects on spasticity and neuropathic pain are currently based only on case series or small clinical trials.

Conclusion

Although exoskeletons are not yet an established tool in the treatment of spinal cord injuries, the systems will play a more important role in rehabilitation of patients with spinal cord injuries in the future. Neurologically controlled exoskeletons show beneficial effects in the treatment of acute and chronic spinal cord injuries and might therefore evolve to be a useful alternative to conventional locomotion training.

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Literatur

  1. Aach M, Cruciger O, Sczesny-Kaiser M et al (2014) Voluntary driven exoskeleton as a new tool for rehabilitation in chronic spinal cord injury: a pilot study. Spine J. pii:S1529-9430(14)00350-7. doi:10.1016/j.spinee.2014.03.042 (Epub ahead of print)

  2. Cruciger O, Schildhauer TA, Meindl RC et al (2014) Impact of locomotion training with a neurologic controlled hybrid assistive limb (HAL®) exoskeleton on neuropathic pain and health related quality of life (HRQoL) in chronic SCI: a case study. (submitted for publication)

  3. Cruciger O, Tegenthoff M, Schwenkreis P et al (2014) Locomotion training using voluntary driven exoskeleton (HAL) in acute incomplete SCI. Neurology 83(5):474. doi:10.1212/WNL.0000000000000645

    Article  PubMed  Google Scholar 

  4. Dalen N, Olsson KE (1974) Bone mineral content and physical activity. Acta Orthop Scand 45(2):170–174

    Article  CAS  PubMed  Google Scholar 

  5. Esquenazi A, Talaty M, Packel A, Saulino M (2012) The ReWalk powered exoskeleton to restore ambulatory function to individuals with thoracic-level motor-complete spinal cord injury. Am J Phys Med Rehabil 91(11):911–721. doi: 10.1097/PHM.0b013e318269d9a3

    Article  PubMed  Google Scholar 

  6. Farris RJ, Quintero HA, Murray SA et al (2014) A preliminary assessment of legged mobility provided by a lower limb exoskeleton for persons with paraplegia. IEEE Trans Neural Syst Rehabil Eng 22(3):482–490

    Article  PubMed  Google Scholar 

  7. Fineberg DB, Asselin P, Harel NY et al (2013) Vertical ground reaction force-based analysis of powered exoskeleton-assisted walking in persons with motor-complete paraplegia. J Spinal Cord Med 36(4):313–321

    Article  PubMed Central  PubMed  Google Scholar 

  8. Gould DW, Hsieh AC, Tinckler LF (1955) The effect of posture on bladder pressure. J Physiol 129(3):448–453

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Heilporn A, Schoutens A, Paternot J, Tricot A (1977) Longitudinal study of calcium and bone metabolism in paraplegic patients. Paraplegia 15(2):147–159

    Article  PubMed  Google Scholar 

  10. Heipertz W (1957) Grundsätze für die Behandlung und Eingliederung Querschnittsgelähmter. AOTS 48(6):679–690

    CAS  Google Scholar 

  11. Hussey RW, Stauffer ES (1973) Spinal cord injury: requirements for ambulation. Arch Phys Med Rehabil 54(12):544–547

    CAS  PubMed  Google Scholar 

  12. Knezevic S, Asselin P, Emmons R et al (2014) Energy expenditure during gait using the Rewalk™ exoskeletal walking system for persons with paraplegia. IJESAB 9(2):41

    Google Scholar 

  13. Kolakowsky-Hayner SA, Crew J, Moran S, Shah A (2013) Safety and feasibility of using the EksoTM bionic exoskeleton to aid ambulation after spinal cord injury. J Spine S4:003

    Google Scholar 

  14. Kubota S, Nakata Y, Eguchi K et al (2013) Feasibility of rehabilitation training with a newly developed wearable robot for patients with limited mobility. Arch Phys Med Rehabil 94:1080–1087

    Article  PubMed  Google Scholar 

  15. Lehmann U (1996) Paläontologisches Wörterbuch, 4. Aufl. In: Martin C (Hrsg) Lexikon der Geowissenschaften. Enke, Stuttgart, S 221

  16. Lünenburger L, Colombo G, Riener R, Dietz V (2004) Biofeedback in gait training with the robotic orthosis Lokomat. Conf Proc IEEE Eng Med Biol Soc 7:4888–4891

    PubMed  Google Scholar 

  17. Marsolais EB, Kobetic R, Chizeck HJ, Jacobs JL (1991) Orthoses and electrical stimulation for walking in complete paraplegia. Neurorehabil Neural Repair 5:13–22

    Article  Google Scholar 

  18. Mehrholz J, Kugler J, Pohl M (2012) Locomotor training for walking after spinal cord injury. Cochrane Database Syst Rev. doi:10.1002/14651858.CD006676.pub3

  19. Nilsson A, Vreede KS, Häglund V et al (2014) Gait training early after stroke with a new exoskeleton – the hybrid assistive limb: a study of safety and feasibility. J Neuroeng Rehabil 11:92

    Article  PubMed Central  PubMed  Google Scholar 

  20. Odéen I, Knuttson E (1981) Evaluation of the effects of muscle stretch and weight load in patient with spastic paraplegia. Scand J Rehabil Med 13(4):117–121

    PubMed  Google Scholar 

  21. Rosman N, Spira E (1974) Paraplegic use of walking braces: a survey. Arch Phys Med Rehabil 55(7):310–314

    CAS  PubMed  Google Scholar 

  22. Summers BN, McClelland MR, el Masri WS (1988) A clinical review of the adult hip guidance orthosis (Para Walker) in traumatic paraplegics. Paraplegia 26(1):19–26

    Article  CAS  PubMed  Google Scholar 

  23. Talaty M, Esquenazi A, Briceno JE (2013) Differentiating ability in users of the ReWalk(TM) powered exoskeleton: an analysis of walking kinematics. IEEE Int Conf Rehabil Robot. doi:10.1109/ICORR.2013.6650469

  24. Tomovic R, Vukobratovic M, Vodovnik L (1972) Hybrid actuators for orthotic systems: hybrid assistive systems. Proceedings of the 4th International Symposium on External Control of Human Extremities. Dubrovnik, Yugoslavia. 2:75–87

  25. Villiger M, Bohli D, Kiper D et al (2013) Virtual reality-augmented neurorehabilitation improves motor function and reduces neuropathic pain in patients with incomplete spinal cord injury. Neurorehabil Neural Repair 27(8):675–683. doi:10.1177/1545968313490999

    Article  PubMed  Google Scholar 

  26. Vodovnik L, Bajd T, Kralj A et al (1981) Functional electrical stimulation for control of locomotor systems. Crit Rev Bioeng 6(2):63–131

    CAS  PubMed  Google Scholar 

  27. Vodovnik L, Long C II, Reswick JB et al (1965) Myo-electric control of paralyzed muscles. IEEE Trans Biomed Eng 12(3):169–172

    Article  CAS  PubMed  Google Scholar 

  28. Vodovnik L, Rebersek S (1974) Information content of myo-control signals for orthotic and prosthetic systems. Arch Phys Med Rehabil 55(2):52–56

    CAS  PubMed  Google Scholar 

  29. Wing PC, Treadwell SJ (1983) The weight bearing shoulder. Paraplegia 21:107–145

    Article  CAS  PubMed  Google Scholar 

  30. Wylie EJ, Chakera TMH (1988) Degenerative joint abnormalties in patients with paraplegia duration greater than 20 years. Paraplegia 26:101–106

    Article  CAS  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Aach, R.C. Meindl, J. Geßmann, T.A. Schildhauer, M. Citak und O. Cruciger geben an, dass kein Interessenkonflikt besteht. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Abteilung für Rückenmarkverletzte, Chirurgische Universitätsklinik und Poliklinik, BG-Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland

    M. Aach, R.C. Meindl, J. Geßmann, M. Citak & O. Cruciger

  2. Chirurgische Universitätsklinik und Poliklinik, BG-Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bochum, Deutschland

    T.A. Schildhauer

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  1. M. Aach
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  2. R.C. Meindl
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  3. J. Geßmann
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  4. T.A. Schildhauer
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  5. M. Citak
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  6. O. Cruciger
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Correspondence to M. Aach.

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Aach, M., Meindl, R., Geßmann, J. et al. Exoskelette in der Rehabilitation Querschnittgelähmter. Unfallchirurg 118, 130–137 (2015). https://doi.org/10.1007/s00113-014-2616-1

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