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New review looks at the impact of robotic exoskeletons on walking recovery in individuals with acquired brain injury

A team of New Jersey researchers reviewed the evidence for the effects of robotic exoskeletons on ambulation recovery in individuals with acquired brain injury and established a systematic framework for evaluating such devices, which is required for rigorous research studies. The open-access article "Lower Extremity robotic exoskeleton devices for overground ambulation recovery in acquired brain injury - A review" (doi: 10.3389/fnbot.2023/1014616) was published May 25, 2023, in Frontiers in Neurorobotics published.

The authors are Kiran Karunakaran, PhD, Sai Pamula, Caitlyn Bach, Soha Saleh, PhD, and Karen Nolan, PhD, of the Center for Mobility and Rehabilitation Engineering Research at the Kessler Foundation, and Eliana Legelen, MA, of Montclair State University.

Acquired brain injury was defined as cerebral palsy, traumatic brain injury, or stroke. The review focused on 57 published studies of above-ground training in wearable robotic exoskeletons. The manuscript provides a comprehensive review of clinical and preclinical research on the therapeutic effects of various devices.

"Despite the rapid advances in the development and technology of robotic exoskeletons, it is the effectiveness of such devices are not yet fully understood. This review lays the groundwork for understanding the knowledge gaps that currently exist in robotic rehabilitation research," said lead author and corresponding author Dr. Karunakaran, referring to the many variables between devices and the clinical features of acquired brain injury. "For example, control mechanisms vary greatly between these devices, which has a big impact on how training is delivered," she added. "There is also great variability in other factors that affect the course of recovery, including the timing, duration, dosage and intensity of training in these devices."

Developing a framework for future research requires a comprehensive approach based on diagnosis, stage of recovery, and domain, said co-author Karen J. Nolan, PhD, associate director of the Center for Mobility and Rehabilitation Engineering Research and director of the Acquired Brain Injury Mobility Laboratory. "Through this approach, we will find the optimal ways to use robotic lower extremity exoskeletons to improve mobility for individuals with acquired brain injuries," Dr. Nolan said.

It is important to note that our review is unique in presenting both downstream (functional, biomechanical, physiological) and upstream (cortical) assessments after rehabilitation with different robotic devices for different types of acquired brain injury. Each device must be evaluated by domain, in each population, and at all stages of recovery. This is the necessary scope to determine response to treatment."

Kiran Karunakaran, PhD, first author

Source: New review looks at the effects of robotic exoskeletons on walking recovery in people with acquired brain injuries (

Tom Illauer

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