Safety and practicality study of using an exoskeleton in acute neurosurgery patients.
Acute neuro care
Brain hemorrhage
Early mobilization
Gait-balanced exoskeleton
Neurosurgery
Patient-centered rehabilitation.
Pulmonary embolism
Robot-assisted rehabilitation
Stroke
Traumatic brain injury
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
20 May 2024
20 May 2024
Historique:
received:
23
01
2024
accepted:
01
05
2024
medline:
20
5
2024
pubmed:
20
5
2024
entrez:
19
5
2024
Statut:
epublish
Résumé
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. 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. 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. 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.
Identifiants
pubmed: 38763932
doi: 10.1007/s00701-024-06112-z
pii: 10.1007/s00701-024-06112-z
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
221Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.
Références
Apra C, Serra M, Robert H, Carpentier A (2022) Early rehabilitation using gait exoskeletons is possible in the neurosurgical setting, even in patients with cognitive impairment. Neurochirurgie 68(4):458–460
doi: 10.1016/j.neuchi.2021.12.010
pubmed: 35260273
Bowen DJ, Kreuter M, Spring B et al (2009) How we design feasibility studies. Am J Prev Med 36(5):452–457
doi: 10.1016/j.amepre.2009.02.002
pubmed: 19362699
pmcid: 2859314
Cuschieri S (2019) The STROBE guidelines. Saudi J Anaesth 13(Suppl 1):S31–S34
doi: 10.4103/sja.SJA_543_18
pubmed: 30930717
pmcid: 6398292
Langhorne P, Wu O, Rodgers H, Ashburn A, Bernhardt J (2017) A Very Early rehabilitation trial after stroke (AVERT): a phase III, multicentre, randomised controlled trial. Health Technol Assess 21(54):1–120
doi: 10.3310/hta21540
pubmed: 28967376
pmcid: 5641820
Lee SY, Amatya B, Judson R, Truesdale M, Reinhardt JD, Uddin T, Xiong X-H, Khan F (2019) Clinical practice guidelines for rehabilitation in traumatic brain injury: a critical appraisal. Brain Inj 33(10):1263–1271
doi: 10.1080/02699052.2019.1641747
pubmed: 31314607
Lo K, Stephenson M, Lockwood C (2017) Effectiveness of robotic assisted rehabilitation for mobility and functional ability in adult stroke patients: a systematic review. JBI Database System Rev Implement Rep 15(12):3049–3091
doi: 10.11124/JBISRIR-2017-003456
pubmed: 29219877
Louie DR, Mortenson WB, Durocher M, Teasell R, Yao J, Eng JJ (2020) Exoskeleton for post-stroke recovery of ambulation (ExStRA): study protocol for a mixed-methods study investigating the efficacy and acceptance of an exoskeleton-based physical therapy program during stroke inpatient rehabilitation. BMC Neurol 20(1):35
doi: 10.1186/s12883-020-1617-7
pubmed: 31992219
pmcid: 6988257
Morone G, Bragoni M, Iosa M, De Angelis D, Venturiero V, Coiro P, Pratesi L, Paolucci S (2011) Who may benefit from robotic-assisted gait training? A randomized clinical trial in patients with subacute stroke. Neurorehabil Neural Repair 25(7):636–644
doi: 10.1177/1545968311401034
pubmed: 21444654
Mortenson WB, Pysklywec A, Chau L, Prescott M, Townson A (2022) Therapists’ experience of training and implementing an exoskeleton in a rehabilitation centre. Disabil Rehabil 44(7):1060–1066
doi: 10.1080/09638288.2020.1789765
pubmed: 32649239
Nydahl P, Sricharoenchai T, Chandra S, Kundt FS, Huang M, Fischill M, Needham DM (2017) Safety of patient mobilization and rehabilitation in the intensive care unit. Systematic review with meta-analysis. Ann Am Thorac Soc 14(5):766–777
doi: 10.1513/AnnalsATS.201611-843SR
pubmed: 28231030
Park G-M, Cho S-H, Hong J-T, Kim D-H, Shin J-C (2023) Effects and safety of wearable exoskeleton for robot-assisted gait training: a retrospective preliminary study. J Pers Med 13(4):676
doi: 10.3390/jpm13040676
pubmed: 37109062
pmcid: 10144215
Ueba T, Hamada O, Ogata T, Inoue T, Shiota E, Sankai Y (2013) Feasibility and safety of acute phase rehabilitation after stroke using the hybrid assistive limb robot suit. Neurol Med Chir 53(5):287–290
doi: 10.2176/nmc.53.287
Winkelman C, Peereboom K (2010) Staff-perceived barriers and facilitators. Crit Care Nurse 30(2):S13–S16. https://doi.org/10.4037/ccn2010393
Winstein CJ, Stein J, Arena R et al (2016) Guidelines for adult stroke rehabilitation and recovery. Stroke 47(6):e98–e169
doi: 10.1161/STR.0000000000000098
pubmed: 27145936