Exoscletes in medicine: world experience and clinical practice of the Pyrogov center

Analyzing the worldwide experience of the exoskeleton's application and own results in the Pirogov Center during the period from 2015 till 2017 years, it was noted that the priority areas for the exoskeleton's application are military industry and medicine. It should be noted that analyzed papers of the exoskeleton's application in medical rehabilitation of patients with spinal cord injury were differed in the length of the course, the number and type of training, characteristics and number of patients. Despite of this, most of the studies has been confirmed positive role in improving of motor control using of the exoskeletons - improving muscle activation pattern and movement coordination. Important positive results of the exoskeleton's application are: reduction of secondary complications of immobility, decreasing spasticity and pain, increasing of bone density, strengthening of the trunk and extremities muscles, increasing exercise tolerance, and in some cases, self independent walking. The advantage of the exoskeleton training was walking on the unmoving surface using the physiological pattern and significant decreased work of the physiotherapists with heavy patients. The experience of the exoskeleton's application has been analyzed in the Pirogov Center too, and it coincides with the data of the leading rehabilitation centers on the whole. The aim of our research was evaluation of the safety and effectiveness of the synchronized application of the exoskeleton ExoAtlet ® with FES in the complex rehabilitation of the SCI patients. Significant changes in the neurological status were not revealed after rehabilitation course. BP values were changed by not more than 15% from baseline, HR values were within acceptable values. ECG monitoring excluded significant cardiac pathology during walking. We had increasing tolerance to physical stress and reducing energy consumption in vertical direction during walking, increasing in the amplitude of the angular movements of the leg's joints. It was objectively noted improvements in back muscles control and muscle's maximum electrical activity, walking became more stable about the transverse and sagittal axis. This review leads to the conclusion on the possibility of the exoskeleton's application in rehabilitation of the patients with spinal cord injury.