Utilization of overground exoskeleton gait training during inpatient rehabilitation: a descriptive analysis.
Jaime Gillespie, Dannae Arnold, Molly Trammell and 7 others
PMID 37542322WHAT IT FOUND
Patients with stroke, spinal cord injury, and traumatic brain injury tolerated progressively longer and more independent walking in overground exoskeletons during inpatient rehabilitation.
Therapists used specific clinical milestones to decide when to start, challenge, and stop the device, but no control group proves this approach improves outcomes.
Key findings
01Patients demonstrated progressive tolerance for exoskeleton gait training, with increased walking time and steps and decreased device assistance across sessions.
02Therapists initiated exoskeleton training primarily for patients who could not walk with other methods, citing the device's support and reduced burden on staff.
03Termination of exoskeleton training was driven by therapist observations of plateaued intensity or repetition, or the need to transition to real-world walking and caregiver training.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
There was no control group, so it is impossible to know if the observed improvements were due to the exoskeleton or simply the passage of time and concurrent rehabilitation. The study relied entirely on medical records, which lacked detailed documentation of specific device settings and mid-session changes. The sample size for patients with traumatic brain injury was small (25 patients), limiting generalizability for that group. All data came from a single hospital using devices from one manufacturer, so results may not apply to other settings or exoskeleton models. Changes in US healthcare policy in 2019 altered required outcome measures, making it difficult to correlate exoskeleton use with functional independence metrics.
Declared interests
The study was funded by the U.S. Department of Defense and the National Institute on Disability, Independent Living, and Rehabilitation Research. No conflicts of interest with exoskeleton manufacturers were declared.
The easy way to misread this
Do not interpret the increased walking time and reduced assistance as evidence that exoskeleton training causes better recovery than standard therapy. Without a control group, these trends may reflect natural recovery or the effects of concurrent rehabilitation.