Month: July 2022

Postoperative therapy is a big part of the recovery process and is necessary to restore joint movement, strength, and flexibility. It might be required after surgical procedures like orthopedic, cardiac, thoracic, neurological, and abdominal surgery. Many patients may prefer skipping this step of their recovery, but this can result in improper or incomplete healing. 

Postsurgical therapy is helpful if you are experiencing stiffness, pain, muscle weakness, reduced mobility, reduced balance, and reduced coordination. It also helps with any physical and psychological effects you may have endured due to surgery. 

According to a National Institutes of Health (NIH) study, patients who stay in bed after surgery tend to lose muscle strength, heart capacity, and lung capacity due to a lack of physical activity. [1] But with the incorporation of physical therapy in recovery, you can prevent functional atrophy. This article will explore the phases of postoperative rehabilitation, types of physical therapy, and the benefits of postoperative rehabilitation. 

The 3 Phases of Postoperative Rehabilitation

There are three main phases in postsurgical rehabilitation, and they differ from patient to patient depending on the type of surgery. They are broken down into:

1. Stage 1: In this stage, you’ll be immobilized as you’ll be fresh from the surgery room. Typically, you’ll be in pain, and the surgical area will be swollen. At this point, rest is recommended for a few hours or days, depending on the type of surgery. 
2. Stage 2: In this stage, the pain and swelling will reduce. You’ll be able to move a little and will be ready to start physical therapy. The goal, at this point, is to strengthen the body, improve stability, and restore range of motion. 
3. Stage 3: In this stage, you’ll be continuing to heal and are ready to rehabilitate and learn to complete your activities of daily living. The ultimate goal of physical therapy will be achieved in this stage.

Surgery Operations That Require Postoperative Physical Therapy

These are five surgical procedures that necessitate physical therapy as part of the recovery process. They include: 

• Brain tumor surgery: A 2019 pilot study on the effectiveness of rehabilitation therapy after brain tumor surgery reported that intensive rehabilitation resulted in improved motor function, cognition function, and Activities of Daily Living (ADL). [2] In this case, physical therapists focus on range-of-motion exercises, balance, gait, and endurance training. 
• ACL and Meniscus Repair: ACL knee ligament and meniscus cartilage repair is a problem often associated with athletes. According to a 2019 study conducted by the International Journal of Sports Physical Therapy, physical therapy is vital in hastening the healing process and avoiding re-injury. Physical therapists usually focus on building quadriceps and hamstring strength in the recovery process. [3]
• Back and Spine Surgery: Physical therapy is vital, especially because of the delicate nature of spinal surgeries. Your physical therapist will show you exercises and movements for your back that don’t put pressure on your spine. Therapy strategies normally include stretches and exercises that get the blood flowing. In the case of more invasive surgeries, for example, spinal fusion, your therapist can monitor your back health and update your doctor on the healing progress.
• Heart Attack/Bypass Surgery: According to a 2018 study by the Journal of Physical Therapy Science, preoperative physical therapy can help prevent cardiopulmonary complications by offering patients a safe space to move. Low-impact exercises tend to improve health and reduce your stay in the hospital. Coupled with postoperative therapy, you can recover faster while avoiding all postsurgical complications. [4] 
• Achilles Tendon Release (Tenotomy): This is a type of surgery that is done to fix a damaged or contracted Achilles tendon. This procedure can be performed to relieve shortened and stiff muscles to allow for better range of movement. This is a common problem for patients with spinal cord injuries because, after a spinal cord injury, the normal flow of nerve signals is disrupted and feet tend to relax into a toe-pointed position. This could limit a person’s ability to stand if not corrected. 

Major Types of Physical Therapy For Postoperative Patients

Physical therapy strategies are not one-size-fits-all. The type of therapy recommended always depends on your physical condition and biomechanical needs. In this section, we will explore rehabilitation methods that are applicable to patients who have undergone any kind of surgery. 

1. Stretching

After surgery, the soft tissue normally contracts, and scar tissue forms. This can decrease flexibility and make it difficult for you to move. However, regular stretching can help prevent immobility caused by scar tissue. It also helps increase joint flexibility and a full range of motion in case of joint surgeries. Overall, stretching makes life much easier and allows you to do simple tasks like reaching over your head, walking, and even climbing stairs. 

Stretching has also been shown to help improve balance and reduce pain by relaxing tense or spasming muscles. Lower back, abdominal, hip, and leg muscle stretches are recommended if you’ve undergone back surgeries.

Common hamstring exercises targeting the outer hip and lower back include Knee to Chest Stretch, Figure 4 Stretch, Pigeon Stretch, and Doorway Hamstring Stretch. These stretches are particularly great for tight and restricted muscles. The Pigeon Stretch and Doorway Hamstring Stretch are more advanced and should only be performed in a pain-free range. Other types of stretches used in postoperative therapy include:

2. Range of Motion Therapy

Range of motion (ROM) is concerned with how far you can move an affected joint or limb in all directions and positions naturally without strain and pain. There isn’t one standard definition of ROM. According to Dr. Aldalbert Kapandji, who specializes in physical therapy, range of motion is “the extent of osteokinematic motion available for movement activities, functional or otherwise, with or without assistance.” [5] 

Range of motion exercises increase movement, reduce pain, and improve joint integrity and function. Range of motion exercise and stretching are generally performed in the first phase of rehabilitation to help regain joint functionality before moving to more advanced practices.

Range of motion therapy normally includes: 

• Passive routines where the therapist guides your movements. 
• Interactive routines where both you and the therapist do the work.
• Active routines where you do the exercises on your own. 

Range of motion exercises involving circling joints and knee extensions are beneficial in different situations, including:

• Soft tissue and joint recovery
• Joint and soft tissue mobility
• Neuromuscular reeducation
• Synovial movement enhancement 

3. Strengthening

Strengthening exercises are a crucial part of physical therapy and help improve muscle function around the surgical area. Strengthening exercises are customarily performed alongside or after the range of motion exercises because increased joint movement without an equal increase in strength might cause injury.

Strengthening exercises are also vital in improving your core strength. The core is a major focus area because it is the source of stability. Rebuilding core strength improves stability and mobility and helps prevent additional injuries. It allows you to increase the load you can handle without overexerting and injuring yourself. In addition, strengthening can also be used for the back and pelvis areas. Strengthening exercises typically include leg raises, hamstring and quadriceps contractions, and squats using a chair.

Strengthening exercises can also include bridge exercises and ball bridge exercises. These exercises are great for strengthening the hamstring, lumbar extensor, pelvic, back, and buttocks. These exercises should be done in a pain-free range; once you’ve mastered them, you can move on to more advanced strengthening exercises. 

4. Ultrasound and Electrical Therapy

Ultrasound and electrical therapy help improve blood flow and retrain nerves. Ultrasound therapy involves the use of high-frequency sound waves on deep tissue. The high-frequency sound waves used to stimulate deep tissue are so low that even the human ear cannot pick them up. This type of therapy utilizes a probe for administration and is known to reduce pain, accelerate healing, and reduce inflammation in the soft tissues. A 2014 study conducted by the Journal of Physical Therapy Science reported that therapeutic ultrasound increases range of motion and pain threshold for at least 20 minutes. [6]

Electrical therapy involves the use of low electrical current on the deep tissues. Electrical stimulation works by sending small electrical currents to the targeted area and the nerves surrounding it. It is extremely helpful in increasing blood flow, pain management, and improving muscle flexibility. A 2021 study conducted by Frontiers in Medicine reported, “As a supplementary treatment after total knee arthroplasty, postoperative neuromuscular electrical stimulation could improve the short-term to long-term quadriceps muscle strength, mid-term pain, and mid-term function.” [7]

5. Gait Training

Walking is a great physiotherapy technique that’s primarily used for neurosurgery patients. It normally involves rewiring and training the brain to control walking muscles. This is achieved because of the brain’s neuroplasticity – the ability of the brain to form and reorganize synaptic connections. When walking is practiced regularly after surgery, it allows the brain to strengthen and create neural pathways that support movements involved in walking. Some high repetition walking exercises include leg and balance exercises.

Benefits of Postoperative Therapy

General Surgery 

A postoperative therapy program after general surgery is a crucial part of recovery and offers a host of benefits like: 

1. Proper Healing and Faster Recovery Time

Many complications can arise after surgery, including infection and muscle atrophy, which might lead to poor healing. That’s why postoperative therapy is important. Postoperative therapy can help wounds heal properly by minimizing scar tissue, retraining muscles, and recovering joint function. It also allows you to enjoy a faster recovery time. According to a 2017 study conducted by Acta Medica, beginning physical therapy following a joint replacement surgery can reduce your hospital stay and help you recover faster. [8]

2. Patient Participation

Patients who actively participate in their own recovery process have been shown to have better results and recovery experiences than those who don’t in a 2013 review conducted by researchers from the Health Policy Research Group at the University of Oregon. [9]

3. Improves Mobility

Joint replacement surgeries normally result in reduced mobility, making activities that may seem ordinary, like walking, difficult. This happens because of the body’s natural response, which is to protect the area of surgery by swelling, reducing the range of motion, and tightening the muscles. This makes physical therapy extremely important, especially after knee and hip replacement surgeries, as it may help you recover your mobility through targeted postoperative therapy practices. 

4. Eases Pain and Swelling

Swelling and pain after surgery normally vary from one person to another. The pain usually arises when chemicals that stimulate nerve endings are released, and the excess inflammation compresses the nerves. Exercises are a great tool for reducing swelling, which results in improved mobility, faster healing, and reduced pain. Postoperative physical therapy administration can also help in preventing chronic pain.

According to a 2013 review conducted by London-based medical researchers, postoperative therapy is quite effective in improving short-term lower back pain and long-term lower back and leg pain if you’ve undergone lumbar spinal stenosis surgery. [10]

5. Reduces Scar Tissue Formation

During the healing process, scar tissue forms, and tissues contract. This normally leads to scarring and reduced mobility. However, mobilization techniques can help prevent this using ultrasound therapy, which effectively increases flexibility and softens the scar tissue. According to a 2016 study conducted by researchers for the Internal Medicine Review journal of Washington D.C., low-intensity therapeutic ultrasound can help treat soft tissue injuries and improve musculoskeletal and post-operative recovery outcomes. [11]

6. Reduces the Development of Secondary Issues

Physical therapy can help reduce surgical complications like blood clots, and infection, among others. Specific exercises and movements may help in reducing the risk of contractures and other complications.

7. Improves Flexibility

Staying in bed after surgery is detrimental for you, and it may lead to weak muscles, which will make you susceptible to injury. When your joints become stiff, activities like walking, climbing stairs, and reaching overhead can be compromised. However, stretching exercises can help you keep your joints flexible and muscles limber. 

Neurosurgery

Neurosurgery is involved with the treatment of conditions affecting the nervous system, including the spinal cord, brain, and peripheral nervous system. This makes postoperative rehabilitation very important as part of helping a patient regain their pre-surgery functionalities. Benefits attributed to physical therapy include:

• Increased Range of Movement – Patients are able to increase their limb and joint movement in any direction without any pain.
• Improved Gait – Physical therapy can help you improve your balance, coordination, and walking movement control.
• Increased Muscle Strength – Physical therapy is great for training leg and back muscles to support the weight of the body. 
• Reduced Spasticity and Contractures (Shortened Muscles) – Surgery may lead to muscle tightness, otherwise referred to as spasticity, which can limit movement and cause pain. But physical therapy can help you avoid these complications.

Conclusion

Postoperative therapy is vital when you are recovering from surgery, and its efficacy has been shown in different studies. It will help you heal faster, regain mobility, reduce pain, and prevent postoperative complications. In case you’ve undergone surgery, physical therapy will offer you the recovery support you need on your healing journey.

References:

1. Assessing the effectiveness of routine use of post-operative in-patient physical therapy services https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506300/
2. Intensive Rehabilitation Therapy Following Brain Tumor Surgery: A Pilot Study of Effectiveness and Long-Term Satisfaction https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6509576/
3. Restoring knee extensor strength after anterior cruciate ligament reconstruction: a clinical commentary https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350662/
4. Prevention of postoperative pulmonary complications through preoperative physiotherapy interventions in patients undergoing coronary artery bypass graft: literature review  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110234/
5. The clinical evaluation of the upper limb joints’ function: back to Hippocrates https://www.sciencedirect.com/science/article/abs/pii/S0749071203000295?via%3Dihub
6. Effects of Therapeutic Ultrasound on Range of Motion and Stretch Pain  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4047237/
7. Effect of Neuromuscular Electrical Stimulation After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8677678/
8. Early rehabilitation after elective total knee arthroplasty  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357664/
9. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs https://www.ncbi.nlm.nih.gov/pubmed/23381511
10. Rehabilitation following surgery for lumbar spinal stenosis – McGregor, AH – 2013 | Cochrane Library https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009644.pub2/abstract
11. Low-Intensity Ultrasound for Promoting Soft Tissue Healing: A Systematic Review of the Literature and Medical Technology  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128661/

According to the World Health Organization (WHO), between 250,000 and 500,000 people suffer from spinal cord injuries (SCIs) every year due to blunt force trauma, road crashes, falls, and other mechanisms of injury. [1] A few years ago, this would have meant the end of autonomy and mobility for many people, but thanks to advances in technology, there are more rehabilitation therapies available, including exoskeletons. The FDA designates medical exoskeletons as a class II (intermediate risk) medical device, and they are cleared for use with patients who have an SCI. [2]

Exoskeletons give people with spinal cord injuries a chance to ambulate, exercise, and engage in mobility and autonomous activities. In this article, you’ll learn what exoskeletons are, how they operate, and how they can be beneficial in physical therapy for patients with spinal cord injuries.

What is a Spinal Cord Injury (SCI)?

According to the National Institute of Neurological Disorders and Stroke (NINDS), a spinal cord injury is “damage to the tight bundle of cells and nerves that sends and receives signals from the brain to and from the rest of the body.” [3] SCIs could be a direct result of damage to the spinal cord itself, such as from a gun shot wound, but could also result from damage to surrounding tissues and bones that then compress the spinal cord. These injuries can permanently or temporarily affect mobility, sensation, and other body processes. Depending on the extent and location of the damage to the spinal cord, patients may experience some form of paralysis and/or sensory deficits that could be improved through rehabilitation, potentially leading to full recovery.

The most common causes of SCI are grouped into traumatic and non-traumatic causes. Traumatic SCI causes may include car accidents, falls, and sports-related accidents. Non-traumatic causes include tumors, neurodegenerative diseases, infections, and genetic causes. 

Rehabilitation Methods Available for Patients with Spinal Cord Injury

Rehabilitation therapies for patients with a spinal cord injury depend on the extent of damage and the type of injury. Patients usually start in the intensive care unit, followed by acute care, inpatient, and outpatient rehabilitation. Some hospitals even have a spinal cord injury department that specializes in this type of rehabilitation. This can last anywhere from three to twelve months or more, depending on the severity of the injury. Popular rehabilitative techniques include: 

1. Range of Movement, Strength, and Stretching Exercises

Spinal cord injuries limit the range of movement by causing joint immobility and flexibility issues. However, this can be remedied using stretching and strength exercises. According to a 2020 study, range of movement exercises help “prevent contractures, protect tenodesis effect, strengthen paralyzed muscles, promote nerve and cerebral remodeling, and improve spinal microenvironment and functional prognosis.” [3]

2. Functional Electrical Stimulation

Functional electrical stimulation works by artificially stimulating the sensory-motor systems using electrical pulses. It activates neural pathways, which stimulate the muscles and cause movement. This therapy is used alongside other rehabilitation methods in order to restore mobility. According to a study, this procedure also “provides cardiorespiratory fitness; improves posture and trunk stability; prevents contractures, pressure ulcers, and orthostatic hypotension; promotes nerve restoration; and prevents peripheral nerve deterioration.” [4]

3. Epidural Electrical Stimulation (EES) of the Spinal Cord

In this procedure, a device is implanted over the spinal cord’s dura mater through a laminectomy. It then produces a rhythmic electric pulse to the posterior nerve roots, which activate the central circuits which are responsible for regulating pain, movement, and the cardiorespiratory system. EES is beneficial for reducing fatigue, improving cardiovascular fitness, increasing body mass, and improving urination in patients. [4] However, this is not a simple procedure, as patients must undergo surgery for the device to be implanted and is not yet widely available. 

4. Transcutaneous Electrical Nerve Stimulation (TENS)

TENS utilizes a high and low electrical stimulation to the nerve to manage pain. It may also help with proprioception, balance, and spasticity. This method is very affordable, and patients can do it by themselves without much assistance.  

5. Occupational Therapy

Occupational therapy focuses on improving the physical, sensory, and cognitive functions of the patients. It helps patients suffering from SCI regain their autonomy and independence. It focuses on the execution of daily activities like grooming, bathing, cooking, and dressing, among others. Occupation is the gateway that helps patients attain inclusion and total adaptation to their environment.

6. Robotic Exoskeletons

Wearable robotics, also known as robotic exoskeletons or exosuits, are a recent development in the healthcare industry that present unlimited potential for patients with spinal cord injuries and are used in conjunction with physical therapists. Robotic exoskeletons are used in rehabilitation to help in mobility recovery through repeated movements that lead to increased neural plasticity. [5] Exosuits offer benefits like improved gait, better life quality, improved moods, and better bladder control, among others, as discussed below.

According to Dr. Chester Ho, Associate Professor at the University of Calgary’s Department of Clinical Neurosciences and member of the Hotchkiss Brain Institute, introducing robotic exosuits early in a patient’s rehabilitation process offers better chances of recovery. He says, “The first nine months after a spinal cord injury are pivotal to recovery, so we want to attempt to introduce rehabilitation and mobilization early on and see if it makes a difference.” [6]

What Is An Exoskeleton?

Exoskeletons, first developed in 1890, are wearable electromechanical devices that support joint movement while enhancing the wearer’s strength and ambulatory capabilities. An exoskeleton frame is made to surround the waist and other joints like the shoulders and knees. Exoskeletons can be classified into two types: active, powered by an external power source; or passive, powered by mechanical springs and counterbalance forces. 

Exoskeletons are used in physical rehabilitation clinics to promote a patient’s mobility and increase their muscle strength. They do this by allowing for repeated movements that increase neural plasticity and help develop mobility. [4] The use of exoskeletons in physical therapy is reported to increase “quality of life, body composition, bone density, neuropathic pain, spasticity, gait speed, number of steps, and distance before and after 90 days of training.” [4]

How Are Exoskeletons Controlled?

Exoskeleton control is vital in a physical therapy environment. Exoskeletons offer multiple control modes, and operators can choose the amount of resistance that is applied at the joints. Exoskeletons can be controlled by the patient or physical therapist depending on the degree of patient recovery. Control methods include: [7]

• Sensors: Sensor-controlled exosuits have numerous sensors fitted into the build that capture nerve signals and control torque, pressure, tilt, and rotation. 
• Buttons/control panels: Some exosuits contain pre-programmed modes, which are normally controlled by the user or by the physical therapist. Most control panels are located on the walking aids.
• Joystick: This is commonly found in active exosuits that provide all the energy required by the wearer.
• Mind-Controlled: These use an electrode skull cap as the main method of control.

No-control: Most passive exosuits do not have control buttons and respond to the mechanical movements of the wearer.

Exoskeleton control is vital in a physical therapy environment. Exoskeletons offer multiple control modes, and operators can choose the amount of resistance that is applied at the joints. Exoskeletons can be controlled by the patient or physical therapist depending on the degree of patient recovery. Control methods include: [7]

• Sensors: Sensor-controlled exosuits have numerous sensors fitted into the build that capture nerve signals and control torque, pressure, tilt, and rotation. 
• Buttons/control panels: Some exosuits contain pre-programmed modes, which are normally controlled by the user or by the physical therapist. Most control panels are located on the walking aids.
• Joystick: This is commonly found in active exosuits that provide all the energy required by the wearer.
• Mind-Controlled: These use an electrode skull cap as the main method of control.

No-control: Most passive exosuits do not have control buttons and respond to the mechanical movements of the wearer.

Types of Medical Exoskeletons

All exoskeletons are not built equally. They have different features and capabilities. In addition, the use of medical exoskeletons may differ between individuals based on the extent of injury and their recovery capacity. Exoskeletons are normally divided into:

• Upper Body Exoskeletons

Upper body exoskeletons are built to support the upper extremities, including the arms and torso. They are specifically designed to help patients with upper-body motor rehabilitation by positioning the shoulder, arm, and elbow through specific motions and orientations. They are extremely important to therapists because they can be used for intense motor exercises and task-specific movements.

• Lower Body Exoskeletons

Rehabilitative lower body exoskeletons are made for patients with lower limb motor dysfunctions to enable the recovery of lower extremity mobility. They normally use impedance control to generate resistance forces which are essential for rehabilitation training. Lower body exoskeletons have the ability to control joint movement in the hip, knee, and ankle.

Benefits of Using Exoskeletons After Spinal Cord Injuries

Exoskeletons are advantageous for patients and therapists alike. They have the ability to reduce the burden on therapists and help with quantitative data collection and patient evaluation.

1. Gait Training:

Gait training consists of walking practice with the aim of helping the patient regain their normal walking gait. Using exoskeletons has the potential to make gait training easier and more convenient for therapists, given the numerous support features they offer. For instance, free-standing exoskeletons help patients to exercise in upright positions, which would be almost impossible and cumbersome without the use of exoskeletons. [8]

A 2008 gait training study carried out on two stroke survivors reports that “by the end of the training the gait pattern of the patients improved and became closer to a healthy subject’s gait pattern.” Improvement in this study was defined as “the increase in the size of the patients’ gait pattern, increased knee and ankle joint excursions and increase in their walking speeds on the treadmill.” [9] Exoskeletons also have unique features that help with rehabilitation. For example, the EksoNR has sensors that are made to monitor your patient’s leg movements and regulate their gait patterns. [10] 

2. Bladder and Bowel Function:

The use of exoskeletons may improve your patient’s bladder and bowel function. This is according to feedback that was received by researchers at the Spinal Cord Injury Model System Centers (SCIMS) from focus groups held with 30 therapists. They record that, “patients who gained the ability to stand and walk with an exoskeleton often developed better endurance, improved their bowel and bladder control, and were less likely to develop urinary tract infections.” [11]

Scientists believe that engaging patients in physical activities and maintaining upright postures may play a role in improving bowel motility. A 2019 study tested bowel management after exoskeleton training and reported an improvement of up to 80%. [12]

3. Improved Muscle Strength and Spasticity:

Incorporating exoskeletons in your physiotherapy treatment may help patients improve their muscle strength. A 2021 study examining the effects of exoskeletons in physiotherapy observed that the use of exoskeletons improved grip strength, quadriceps strength, and lower limb motor function. [8] This was also observed in a 2019 study that reported exoskeletons improved muscle strength after a Manual Muscle Strength Test, “total score from both sides were: P3 UEMS increased from 30 to 37, and LEMS from 23 to 25; P11 UEMS increased from 33 to 37, and LEMS from 27 to 30, where the maximum score for UEMS and LEMS is 50.” [13]

Another study conducted on patients who had a stroke concluded that the use of exoskeletons in therapy improved the tibialis anterior muscle strength and lower limb motor function of the patients. [14]

4. Improved Patient Moods:

Though not a significant benefit, the use of exoskeletons in therapy can help improve your patient’s moods. A 2021 study examining the effects of exoskeletons on patients with spinal cord injuries shows improved moods in one of the patients during the rehabilitation phase. It also reports a decrease in fatigue and an improved quality of life. [8] Since robotic exoskeletons are a “new” technology in rehabilitation, they can be exciting for patients and may motivate them to exercise more. Some therapists also report that exoskeletons offer extra psychological benefits to patients. For instance, patients reported psychological effects of having eye-to-eye conversations with others and also increased engagement in daily activities. [11]

5. Patient Independence:

Exoskeletons can help patients gain some independence in their day-to-day activities like moving and walking around. Before the invention of medical exoskeletons, patients had to rely on their therapists to move around and exercise. However, that is no longer the case. They can now exercise and ambulate on their own, which gives them a sense of independence. Physical therapist Kyle McIntosh says, “The exoskeleton lets patients take actual steps, which is not only more realistic but much less cumbersome,” McIntosh also says, “Every step is different with this device, so patients learn from their mistakes in real time. Patients really like to use the device; it gives them hope.” [6]

Conclusion

Rehabilitative technology has come a long way, from crutches to walkers to wheelchairs and now, robotic exoskeletons. Robotic-assisted rehabilitation holds a lot of promise for both patients and physical therapists alike. Several studies have shown the potential benefits of exercising in a free-standing exoskeleton for patients with spinal cord injuries. If you are a physical therapist, this is the next medical technology shift that will help you offer next-level therapy solutions for your patients.

Ekso Bionics has been at the forefront of creating the best quality medical exoskeletons for more than a decade now. Our EksoNR was one of the first FDA-approved medical exoskeletons for rehabilitation, and it continues to be the exoskeleton of choice for many mobility rehabilitation clinics. Please review our indications for use to determine eligibility. [15]

References: 

1. Spinal cord injury https://www.who.int/news-room/fact-sheets/detail/spinal-cord-injury#:~:text=Key%20facts,traffic%20crashes%2C%20falls%20or%20violence. }
2. Exoskeletal Assisted Rehabilitation After Spinal Cord Injury https://www.sciencedirect.com/topics/nursing-and-health-professions/exoskeleton-rehabilitation
3. Spinal Cord Injury https://www.ninds.nih.gov/health-information/disorders/spinal-cord-injury
4. Rehabilitation Therapies in Spinal Cord Injury Patients https://www.intechopen.com/chapters/72439
5. Robotic Rehabilitation and Spinal Cord Injury: a Narrative Review https://pubmed.ncbi.nlm.nih.gov/29987763/ 
6. Spinal cord injury patients may benefit from using exoskeleton earlier in treatment https://ucalgary.ca/news/spinal-cord-injury-patients-may-benefit-using-exoskeleton-earlier-treatment
7. Types And Classifications of Exoskeletons https://exoskeletonreport.com/2015/08/types-and-classifications-of-exoskeletons/
8. Physiotherapy using a free-standing robotic exoskeleton for patients with spinal cord injury: a feasibility study https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-021-00967-4
9. Robot Assisted Gait Training With Active Leg Exoskeleton (ALEX) https://ieeexplore.ieee.org/document/4663875
10. https://eksobionics.com/eksonr/ 
11. Robotic Exoskeletons May Provide Health Benefits for People with Spinal Cord Injuriesnhttps://naric.com/?q=en/content/robotic-exoskeletons-may-provide-health-benefits-people-spinal-cord-injuries
12. Changes in Bowel Function Following Exoskeletal-Assisted Walking in Persons with Spinal Cord Injury: An Observational Pilot Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7145720/
13. Retraining walking over ground in a powered exoskeleton after spinal cord injury: a prospective cohort study to examine functional gains and neuroplasticity https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6868817/
14. Impacts of a lower limb exoskeleton robot on the muscle strength of tibialis anterior muscle in stroke patients https://www.researchgate.net/publication/344023059_Impacts_of_a_lower_limb_exoskeleton_robot_on_the_muscle_strength_of_tibialis_anterior_muscle_in_stroke_patients/fulltext/5f519787a6fdcc9879c9cc2f/Impacts-of-a-lower-limb-exoskeleton-robot-on-the-muscle-strength-of-tibialis-anterior-muscle-in-stroke-patients.pdf