Exoskeleton for rehabilitation: how it works

Silvi Cadri
Dottoressa in Neuroscienze e Riabilitazione Neuropsicologica
5 minutes
Robotic neurorehabilitation and rehabilitation exoskeletons offer an innovative, versatile, and efficient perspective.
Table of contents

    The editorial staff of Emianopsia is pleased to host Dr. Cadri, a Doctor in Neuroscience and Neuropsychological Rehabilitation, who will give us an overview of the use of the exoskeleton for rehabilitation.

    The neurorehabilitation process

    Neurorehabilitation is an active, dynamic, and interdisciplinary process, which ranges from cognitive to motor rehabilitation and is oriented towards functional restoration and the highest level of autonomy compatible with the patient’s residual abilities.

    Mainly, the neurorehabilitation process is aimed at people with disabilities, permanent or temporary, secondary to a lesion of the central or peripheral nervous system, such as cerebrovascular trauma or spinal injuries.

    These are the conditions that, more than others, cause serious consequences from a physiological and motor point of view as well as in cognitive and psychological terms, impacting the quality of life of the patient and his or her family.

    All of us, for example, are usually accustomed to conceiving gestures such as standing up, fetching something, or looking someone in the eye as spontaneous and natural.

    Unfortunately, in some cases, these everyday routines become just a memory or a limitation for the person who is suddenly forced to change his or her life patterns.

    Thanks to 21st-century knowledge, technology, and robotics in neurorehabilitation are trying to address these limitations, with an increasingly important impact on clinical practice.

    Robotic neurorehabilitation

    Robotic neurorehabilitation has been booming in recent years, with the constant development of technologically advanced equipment to facilitate rehabilitation programs and to reduce the individual’s disability.

    Today, thanks to robotic medicine, there are numerous tools, aimed at a wide range of clinical pictures, that can maximize the potential for neurological recovery after brain or spinal injuries.

    An example of the use of robotic devices in this field is rehabilitation programs using a wearable exoskeleton.

    Exoskeleton for Rehabilitation

    The exoskeleton used in rehabilitation medicine is an electro-medical walking device for people suffering from weakness, motor deficits, or paralysis of the lower limbs, such as in the case of spinal cord injury clinical pictures.

    The word exo, in Greek, means ‘outside’, and unlike the normal human skeleton that supports the body from the inside, an exoskeleton supports the body from the outside allowing the user to strengthen and improve the coordination of voluntary movement of the lower limbs.

    Specifically, the structure of the exoskeleton includes a series of components, corresponding to the joints, made of lightweight but strong materials, such as steel and carbon, to ensure safety.

    Through medical, physiotherapeutic, and neuropsychological evaluations, the criteria for inclusion and exclusion to the use of the exoskeleton are examined, assessing the costs and benefits for each individual.

    This is because exoskeleton training is customized and specific to the patient’s characteristics.

    Its use tends to require adequate user training and involves an intensive rehabilitation program, organized hierarchically and with specific goals.

    In the first phases, the training aims at re-education in exercise and motor skills; subsequently, the work focuses on the acquisition of standing and walking.

    During training, thanks to the support of the exoskeleton, the patient shifts and swings his or her body weight, trying to maintain balance.

    The use of such technologies produces improvements in motor recovery, thanks also to the numerous feedbacks that the patient can benefit from.

    Thus, neurorehabilitation, especially that involving robotic devices, is not only a process performed for the disabled person but also one that is performed by the disabled person; in fact, the awareness of autonomously practicing the therapy offers an important motivational boost to the patient.

    In the motor neurorehabilitation scenario, there are numerous exoskeletons, differing in features and design, which are continuously being developed and improved at a technical and functional level.

    Among these, the first to take up the rehabilitation task are exoskeletons equipped with a support trunk, capable of covering a large number of neuromotor pathologies.

    While other more recent exoskeletons with refined structural features are designed for home use.

    Clinical research in gait pattern rehabilitation shows that subjects with neurologically relevant injuries or peripheral neuromotor deficits have great potential for recovery when subjected to rehabilitation programs with robotic devices such as exoskeletons.

    Robotic training with the use of an exoskeleton aims to bring about both functional changes and changes in the patient’s overall well-being, by modifying the way the patient perceives, controls, and relates to his or her body.

    Indeed, its contribution affects not only physiological aspects and motor skills, conferring greater stability, but also neuropsychological aspects such as mood and body image perception.

    Rehabilitative exoskeleton: a glimpse into the future

    At present, there are no other neurorehabilitation techniques that offer such extraordinary potential in terms of autonomy; however, the path to demonstrating the ecological potential of the exoskeleton remains long and with numerous obstacles.

    The exoskeleton for rehabilitation has some major limitations, such as overly restrictive inclusion criteria.

    In addition, the device is still very expensive and bulky, which is why researchers are working to ensure that, in the future, the exoskeleton will permanently replace the wheelchair, without first having improved structurally and in terms of affordability.

    Although it still has critical points, robotics in neurorehabilitation can fit exactly where the work of doctors and professionals seems to be no longer sufficient, offering an innovative, versatile, and efficient rehabilitation perspective when combined with traditional medical therapies and physical exercise.

    Thus, we can affirm the innovative scope of this therapeutic dimension that not only embraces numerous pathologies and medical conditions but also accelerates and enhances recovery times and allows us to look to the future of rehabilitation by focusing more on the autonomies of daily life.


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    Silvi Cadri
    Dottoressa in Neuroscienze e Riabilitazione Neuropsicologica
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