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Safety and practicality study of using an exoskeleton in acute neurosurgery patients

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Abstract

Introduction

Early mobilization is key in neurologically impaired persons, limiting complications and improving long-term recovery. Self-balanced exoskeletons are used in rehabilitation departments to help patients stand and walk. We report the first case series of exoskeleton use in acute neurosurgery and intensive care patients, evaluating safety, clinical feasibility and patients’ satisfaction.

Methods

We report a retrospective observational study including individuals hospitalized in the neurosurgical intensive care and neurosurgery departments. We included patients with a medical prescription for an exoskeleton session, and who met no contraindication. Patients benefited from standing sessions using a self-balanced exoskeleton (Atalante, Wandercraft, France). Patients and sessions data were collected. Safety, feasibility and adherence were evaluated.

Results

Seventeen patients were scheduled for 70 standing sessions, of which 27 (39%) were completed. They were typically hospitalized for intracranial hemorrhage (74%) and presented with unilateral motor impairments, able to stand but with very insufficient weight shifting to the hemiplegic limb, requiring support (MRC 36.2 ± 3.70, SPB 2.0 ± 1.3, SPD 0.7 ± 0.5). The average duration of standing sessions was 16 ± 9 min. The only side effect was orthostatic hypotension (18.5%), which resolved with returning to seating position. The most frequent reason for not completing a session was understaffing (75%). All patients were satisfied and expressed a desire to repeat it.

Conclusions

Physiotherapy using the exoskeleton is safe and feasible in the acute neurosurgery setting, although it requires adaptation from the staff to organize the sessions. An efficacy study is ongoing to evaluate the benefits for the patients.

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Fig. 1

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Data availability

Data are available on demand for academic purpose.

Code availability

Not applicable.

Abbreviations

MRC:

Medical Research Council

SPB:

Seated postural balance

SPD:

Standing postural balance

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Acknowledgements

The authors thank Mrs Christine Bacnus and the neurosurgical department paramedical staff for their help. We thank « L'Union des Blessés de la Face et de la Tête » and « Fonds APRES » of the Assistance Publique – Hôpitaux de Paris APHP for financial support.

Funding

The exoskeleton was funded by « L'Union des Blessés de la Face et de la Tête» and « Fonds APRES» of the Assistance Publique – Hôpitaux de Paris APHP.

Author information

Author notes

  1. Audrey El Kaim and Manon Serra contributed equally to this work.

Authors and Affiliations

  1. Neurosurgery Department, Pitié Salpêtrière Hospital, Paris, France

    Audrey El Kaim, Henri De Noray, Audrey Lallemant, Corentin Gobatto, Alexandre Carpentier, Maximilien Riche & Caroline Apra

  2. Institute of Myology, Pitié Salpêtrière Hospital, Paris, France

    Audrey El Kaim

  3. Brain Machine Interface Clinical Research Group, Sorbonne University, Paris, France

    Manon Serra, Alexandre Carpentier & Maximilien Riche

  4. Physical and Rehabilitation Medicine Unit, Pitié Salpêtrière Hospital, Paris, France

    Manon Serra

  5. Department of Anesthesia, Critical Care and Perioperative Care, Pitié Salpêtrière Hospital, Paris, France

    Manon Serra, Henri De Noray, Audrey Lallemant, Corentin Gobatto & Vincent Degos

  6. Sorbonne Université, Paris, France

    Vincent Degos, Alexandre Carpentier & Maximilien Riche

  7. Université de Paris, NeuroDiderot, Inserm, 75019, Paris, France

    Vincent Degos

  8. PremUP, 75006, Paris, France

    Vincent Degos

  9. Neurosurgery Department, Henri Mondor Hospital, Créteil, France

    Caroline Apra

  10. Université Paris Est Créteil Val de Marne, Créteil, France

    Caroline Apra

  11. Mondor Institute of Biomedical Research, INSERM U955, Créteil, France

    Caroline Apra

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  1. Audrey El Kaim
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Contributions

CA developed the original idea. MS, VD, AC and CA coordinated the funding of the exoskeleton. VD, AC, MR and CA organized the access to the exoskeleton, selected and informed the patients. AEK, MS, AL, CG, HN and MR performed the exoskeleton sessions and collected the clinical data. AEK, MS, AL and CA performed the data analyses. AEK and MS drafted the manuscript. CA critically revised the manuscript. All authors approved the final version of the manuscript.

Corresponding author

Correspondence to Caroline Apra.

Ethics declarations

Ethics approval

The procedures used in this study adhere to the tenets of the Declaration of Helsinki and comply with the French law Jarde 2012–300. Approval was granted to the intensive care department for the use of innovative therapy to improve the standard of care.

Consent to participate

Informed consent was obtained from all individual participants included in the study or their legal guardian.

Consent for publication

The authors affirm that participants provided informed consent for publication of the images in Fig. 1 and for their data analysis and publication.

Conflicts of interest/Competing interests

The authors declare no conflict of interest.

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Previous communication

Preliminary results from this work have been presented at the congress for the “Société de Langue Française de Réanimation” in French in June 2023 by M. Serra.

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El Kaim, A., Serra, M., De Noray, H. et al. Safety and practicality study of using an exoskeleton in acute neurosurgery patients. Acta Neurochir 166, 221 (2024). https://doi.org/10.1007/s00701-024-06112-z

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  • DOI: https://doi.org/10.1007/s00701-024-06112-z

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