Prospects of exoskeletal orthosis of the upper extremities in patients of the older age group

Introduction. The causes of upper mono- and paraparesis leading to disability are often stroke, myopathy and trauma, the frequency of which increases with age. It is necessary to evaluate the results, features and prospects of using the innovative method of exoskeleton habilitation and rehabilitation in elderly patients. Objective: to demonstrate the possibilities of using the modification of the passive exoskeleton of the upper limbs "EXAR-34" in complex habilitation and rehabilitation of older patients with upper flaccid para- and monoparesis. Materials and methods. The experience of using the EXAR-34 exoskeleton using the anatomical parameterization method in 2 women and 2 men aged 63-86 years with upper flaccid para- and monoparesis of various etiologies is summarized. Goniometry and neurological status examination were used. Results. The design features of the modification of the upper limb exoskeleton of the EXAR series, to be used in elderly patients with upper mono- and paraparesis, are revealed and described. It is demonstrated how, as a result of exoskeleton habilitation and rehabilitation, all patients of the discussed category in a short time managed to steadily increase the volume of abduction and flexion in the shoulder-scapular joints compromised by pathology from the level of significant to insignificant limitation, which significantly improved their quality of life. The concept is outlined and an assessment is given of the positive and negative aspects of the use of passive exoskeletons in a complex of habilitation and rehabilitation measures for mono- and paraparesis in elderly and old people. The expansion of indications is substantiated and the conditions for using a passive exoskeleton in spastic paraplegia are determined. The pathogenetic effects and pathophysiological mechanisms of the influence of the EXAR series exoskeletons on neuromuscular transmission are revealed. Conclusions. The first experience of using the EXAR-34 passive upper limb exoskeleton in older patients with upper flaccid para- and monoparesis indicates good tolerance of the exoskeleton and pronounced habilitation and rehabilitation effects. The expansion of indications for the use of the EXAR-34 exoskeleton is possible due to a group of patients with post-stroke complications in the form of spastic paraplegia, after preliminary botulinum toxin therapy.