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C. Shackleton et al.
(18) and one indicated no change (25). All the studies
using self-reported measures indicated improvements
in spasticity ratings across the intervention (2, 18) and
a significant reduction in RPE within a walking ses-
sion (26). The majority of the pain findings indicated
significant reductions in pain intensity both within a
session (4, 7, 26) and across the intervention (2, 18).
Three of the 8 studies reported no change in pain per-
ception within a session (19) or across the intervention
(15, 16) (Table IV).
User-satisfaction. Nine studies considered the partici-
pant satisfaction with using a robotic exoskeleton for
rehabilitation (Table V). Four studies used a VAS of
agreement from 1 to 5 regarding 10 statements (15,
16, 18, 19). Three of these studies showed that more
than 80% of those statements were rated as above
mean agreement (> 3 score). Two studies indicated a
disagreement (< 3 score) with the statements regar-
ding bowel function, ease of use of the device, and
safety in the device. Esquenazi et al. (18) stated that
all participants (n = 12) reported that using the device
caused no pain, and the majority (90%) found that it
caused no fatigue. Some participants (27%) reported
improved spasticity, and 45% reported improvements
in bowel function. Two studies considered the use of
a different VAS to rate the acceptability of the device
Table II. Cardiovascular outcomes in individuals with spinal cord injury (SCI) using robotic locomotor training (RLT)
Author
(reference)
Asselin et al.
(2015)(6)
Heart rate, bpm
Blood pressure, mmHg
RPE
Mean post-6MWT = 10±2*
Walking (118±21)
Sit (70±10)
Stand (81±12)
(p < 0.001)
Bash Baunsgaard HR increased by 15–21% from sit to walk
et al. (2018) (13) (p < 0.001)
Benson et al.
(2016) (7)
Evans et al.
(2015) (14)
Kozlowski et al.
(2015) (24)
Kressler et al.
(2014) (2)
T0–T1 = no significant change (p > 0.05)*
Post-session = higher HR (+9 bpm) compared
with pre-sessions*
T0 = 121±30
Within session = no significant change
(p > 0.05)*
T0–T1 = no significant change (p > 0.05)*
Post session = higher systolic BP (+4 mm/Hg)
than pre-session*
T0–T1 = significant decrease
(p = 0.001)*
T1 = 142±35
No significant change (p > 0.05)
Pre-session = 71–104 range
Post-session = 78–108 range*
T0 = 166.6±24.0
Pre – post session = increased systolic
pressures*
Pre - session = 6–13 range
Post session = 7.5–18.5 range*
T1 = 172.6±5.13
No significant change (p > 0.05)
Sale et al. (2016)
(15)
T0 = 3±3.464
T1 = 1.667±1.155
No significant change (p > 0.05)
T0–T1 = No significant change (p > 0.05)*
Sale et al. (2018)
(16)
Spungen et al.
(2013) (20)
from 1 to 7. One of these studies indicated a majority
positive response (93.7%) for the statements, with
only one negative response, related to transfer ability
into the device (11). Stampacchia et al. (26) found that
participants rated the positive sensations with high sco-
res (mean VAS score 6) and the negative experiences
with low scores (mean VAS score 2.5). Gagnon et al.
(27) used a VAS of 0–100%, in which the mean per-
centages for each question indicated that participants
were satisfied with the training (mean score 95.7%),
felt motivated to continue training (91.3%), and that
there was strong ability to use the device (79.6%).
A mean score of 67.9% was given for the perceived
health benefits and 16.7% for complications and risks
of using the device (27).
Using the Assistive Technology Device Predispo-
sition Assessment questionnaire, Benson et al. (7)
showed that QoL improved by 4 points and the mean
device form score decreased by 7 points across the
intervention. This study also showed that the mean
disability appraisal score decreased across the inter-
vention by 3 points (7). Platz et al. (25), which used
the SF-12v2 questionnaire, indicated that physical
functioning improved across the intervention by 0.38
z-score, and that emotional well-being was rated higher
than that of the normal population.
Indoor: 1.50±1.07–1.63±1.41
Outdoor: 2.38±1.60–1.75±1.28*
T0 = 15±2
T0 = 89±17 T0 = 136±16/70±6 T1 = 106±25 T1 = 124±18/70±10 T1 = 8±1
No significant change* No significant change* Significant change*
Mean HR = highest for 6MWT compared with the
other areas of walking session*
*Studies with missing original data or level of significance.
bpm: beats per min; mmHg: millimetres of mercury; RPE: rating of perceived exertion; 6MWT: 6-min walk test; significance: p < 0.05.
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