- Title
- Determining the benefits of wearable lower limb robotic exoskeletons in neurorehabilitation
- Creator
- Postol, Nicola
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2024
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Conventional neurorehabilitation is limited in its efficacy for those with the most severe mobility impairments. The reasons for this are multifactorial and include the required staffing levels and manual handling demands on therapists, the impetus for supported early discharge from hospital and the resultant difficulties with delivering the required dosage of therapy to optimise outcomes. For these reasons, there has been a focus on the way therapy is delivered with growing interest in technological supports, which range from exoskeletons paired with treadmills, to wearable overground exoskeletons which can be used in community environments. This program of research has been conducted to progress the available knowledge on the potential benefits of wearable overground exoskeletons as a neurorehabilitation tool for people with the most severe mobility impairments. A systematic review with meta-analysis was conducted to identify the gaps in the available literature, on the use of wearable overground exoskeletons for those with acquired brain injury. There was limited available evidence, and of the few studies that were evaluated, there was no evidence of benefit of exoskeletons over traditional therapy in terms of health-related outcomes. However, our ability to make conclusions was limited due to wide variation in exoskeleton design, small sample sizes, and the range of outcomes evaluated in the research was also limited, and often focused on gait parameters such as speed and endurance. The available research was also primarily conducted with ambulant participants. Most available wearable exoskeleton devices require the user to support themselves with a walking aid to take steps. This device requirement excludes those with the greatest need from accessing them. Therefore, we investigated the use of a free-standing wearable lower limb robotic exoskeleton over a period of 12 weeks of therapy, for people with the most common neurological causes of severe mobility impairment: stroke, spinal cord injury and multiple sclerosis. Based on the systematic review findings reported above, a battery of outcomes was assessed to comprehensively evaluate the merits of a free-standing wearable lower limb robotic exoskeleton. We found that this intervention can be safely delivered and is widely accepted by those who experience it. With statistically significant improvement in independence in people with stroke (p = 0.01) and quality of life in people with multiple sclerosis (p = 0.01), there is evidence to support further research in this field. Eligibility for the research, and therefore clinical feasibility, was limited in each population due to reasons such as cognitive impairment and joint contractures. One of the criticisms of wearable exoskeletons is the perceived notion that they deliver passive therapy. We evaluated oxygen consumption of both healthy and neurologically impaired people whilst completing exercises facilitated by a free-standing exoskeleton and showed that both groups increased oxygen consumption whilst using the device. The energy expenditure was dependent on the type of exercises performed and was highest during sit to stand and squat repetitions. As these tasks replicate everyday function, and both require extensor muscle use, this can further inform future therapy practices. To complete the evaluation of free-standing exoskeletons we sought the input from a key stakeholder group – rehabilitation therapists. This qualitative study evaluated the enablers and barriers to the use of this technology in neurorehabilitation and found that whilst therapists felt this type of intervention is highly acceptable to the patients and has some potential benefits in terms of variability of therapy and increased patient engagement, its application is currently limited by device characteristics and cost. Therapists believe devices need to include features such as accommodation of greater user weight and height, greater speed and better adaptability depending on the capabilities of the user, before these devices will be seen as commonplace in neurorehabilitation in Australia. Wearable lower limb robotic exoskeletons are an acceptable rehabilitation technology to therapists and people with severe mobility impairment secondary to neurological conditions. There is evidence to suggest that for those with severe mobility impairment, the user can be active within these devices, and can effect change in their levels of independence and health-related quality of life. This body of work supports the need for further investigation into the potential use of wearable lower limb robotic exoskeletons in neurorehabilitation, whilst acknowledging that clinical feasibility and therefore implementation is currently limited.
- Subject
- robotic exoskeletons; neurorehabilitation; mobility impairments; therapy; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1510094
- Identifier
- uon:56344
- Rights
- Copyright 2024 Nicola Postol
- Language
- eng
- Full Text
- Hits: 1645
- Visitors: 1554
- Downloads: 44
| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 2 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 326 KB | Adobe Acrobat PDF | View Details Download |