Objective: This comprehensive review provides a thorough analysis of the effects of robotic-assisted gait training on Parkinson’s disease patients’ gait parameters and makes recommendations for its practical use.

Background: Gait alterations are multifactorial and associated with the motor hallmarks of Parkinson’s: 1. They frequently display a flexed posture that, coupled with excessive joint immobility, leads to poor walking mechanics with high energy expenditure. 2. The forward-shifted center of gravity raises the risk of falling. 3. Bradykinathia and rigidity lead to a typical hypokinetic gait with an increment of cadence, stance, and double limb support phases, which make up for the reduced stride length, step length, and velocity. 4. loss of automaticity of the movement and lack of variability in visuospatial flow.

 Studies have already shown the many benefits of robotic-assisted gait training in Parkinson’s rehabilitation in the form of increasing cognitive loading, motor consolidation, and improving the gait of Parkinson’s patients through a process of feedback.

Method: The data is accredited for review across PubMed, Pedro, Cochrane Library, Web of Science, and various guideline databases, adhering to PRISMA guidelines. English-language publications have been selected that describe using a robotic system in detail, along with details about the intervention, limitations, and results. The evidence’s quality and degree have been evaluated.

We selected 21 papers from 2021 to 2024 from a total of 5140 findings, including 12 randomized controlled trials, 3 uncontrolled studies, 3 descriptive reports, and 3 systematic reviews.

Results: Notably, using an exoskeleton during rehabilitation provides proprioceptive feedback. These may normalize impaired motor output, minimize fatigue in Parkinson’s patients, and contribute to the improvement of gait disorders by activating the central pattern generator of the spinal cord. They may also lessen the disruption of coordinated rhythmic locomotion, which is one of the disease’s symptoms.

Conclusion: Our data suggest that robotic-assisted exercise improves the effortful rhythm locomotion of Parkinson’s patients.

References: 1. McGibbon, C. A., Sexton, A., & Gryfe, P. (2024). Exercising with a robotic exoskeleton can improve memory and gait in people with Parkinson’s disease by facilitating progressive exercise intensity. Scientific reports, 14(1), 4417.

2. Otlet, V., Vandamme, C., Warlop, T., Crevecoeur, F., & Ronsse, R. (2023). Effects of overground gait training assisted by a wearable exoskeleton in patients with Parkinson’s disease. Journal of neuroengineering and rehabilitation, 20(1), 156. https://doi.org/10.1186/s12984-023-01280-y

3. Kotani, N., Morishita, T., & Inoue, T. (2021). Potential role of biofeedback therapy for Parkinson’s disease. Neural Regeneration Research, 16(10).

4. Romanato, M., Spolaor, F., Beretta, C., Fichera, F., Bertoldo, A., Volpe, D., & Sawacha, Z. (2022). Quantitative assessment of training effects using EksoGT® exoskeleton in Parkinson’s disease patients: A randomized single blind clinical trial. Contemporary clinical trials communications, 28, 100926. https://doi.org/10.1016/j.conctc.2022.100926

5. Kawashima, N., Hasegawa, K., Iijima, M., Nagami, K., Makimura, T., Kumon, A., & Ohtsuki, S. (2022). Efficacy of Wearable Device Gait Training on Parkinson’s Disease: A Randomized Controlled Open-label Pilot Study. Internal medicine (Tokyo, Japan), 61(17), 2573–2580. https://doi.org/10.2169/internalmedicine.8949-21

6. Panizzolo, F. A., Cimino, S., Pettenello, E., Belfiore, A., Petrone, N., & Marcolin, G. (2022). Effect of a passive hip exoskeleton on walking distance in neurological patients. Assistive technology : the official journal of RESNA, 34(5), 527–532. https://doi.org/10.1080/10400435.2021.1880494

7. Picelli, A., Capecci, M., Filippetti, M., Varalta, V., Fonte, C., DI Censo, R., Zadra, A., Chignola, I., Scarpa, S., Amico, A. P., Antenucci, R., Baricich, A., Benanti, P., Bissolotti, L., Boldrini, P., Bonaiuti, D., Castelli, E., Cavalli, L., DI Stefano, G., Draicchio, F., … Nardone, A. (2021). Effects of robot-assisted gait training on postural instability in Parkinson’s disease: a systematic review. European journal of physical and rehabilitation medicine, 57(3), 472–477. https://doi.org/10.23736/S1973-9087.21.06939-2

8. Carmignano, S. M., Fundarò, C., Bonaiuti, D., Calabrò, R. S., Cassio, A., Mazzoli, D., Bizzarini, E., Campanini, I., Cerulli, S., Chisari, C., Colombo, V., Dalise, S., Gazzotti, V., Mazzoleni, D., Mazzucchelli, M., Melegari, C., Merlo, A., Stampacchia, G., Boldrini, P., Mazzoleni, S., … Andrenelli, E. (2022). Robot-assisted gait training in patients with Parkinson’s disease: Implications for clinical practice. A systematic review. NeuroRehabilitation, 51(4), 649–663. https://doi.org/10.3233/NRE-220026

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-prospect-of-exoskeletons-for-individuals-with-parkinsons-disease-a-comprehensive-review/