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      Robotic exoskeletons: The current pros and cons

      review-article
      World Journal of Orthopedics
      Baishideng Publishing Group Inc
      Spinal cord injury, Exoskeleton, Robotics, Rehabilitation, Locomotion

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          Abstract

          Robotic exoskeletons have emerged as rehabilitation tool that may ameliorate several of the existing health-related consequences after spinal cord injury (SCI). However, evidence to support its clinical application is still lacking considering their prohibitive cost. The current mini-review is written to highlight the main limitations and potential benefits of using exoskeletons in the rehabilitation of persons with SCI. We have recognized two main areas relevant to the design of exoskeletons and to their applications on major health consequences after SCI. The design prospective refers to safety concerns, fitting time and speed of exoskeletons. The health prospective refers to factors similar to body weight, physical activity, pressure injuries and bone health. Clinical trials are currently underway to address some of these limitations and to maximize the benefits in rehabilitation settings. Future directions highlight the need to use exoskeletons in conjunction with other existing and emerging technologies similar to functional electrical stimulation and brain-computer interface to address major limitations. Exoskeletons have the potential to revolutionize rehabilitation following SCI; however, it is still premature to make solid recommendations about their clinical use after SCI.

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          Most cited references34

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          Brain-computer interfaces for communication and rehabilitation.

          Brain-computer interfaces (BCIs) use brain activity to control external devices, thereby enabling severely disabled patients to interact with the environment. A variety of invasive and noninvasive techniques for controlling BCIs have been explored, most notably EEG, and more recently, near-infrared spectroscopy. Assistive BCIs are designed to enable paralyzed patients to communicate or control external robotic devices, such as prosthetics; rehabilitative BCIs are designed to facilitate recovery of neural function. In this Review, we provide an overview of the development of BCIs and the current technology available before discussing experimental and clinical studies of BCIs. We first consider the use of BCIs for communication in patients who are paralyzed, particularly those with locked-in syndrome or complete locked-in syndrome as a result of amyotrophic lateral sclerosis. We then discuss the use of BCIs for motor rehabilitation after severe stroke and spinal cord injury. We also describe the possible neurophysiological and learning mechanisms that underlie the clinical efficacy of BCIs.
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            Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline

            To describe the process and outcomes of using a new evidence base to develop scientific guidelines that specify the type and minimum dose of exercise necessary to improve fitness and cardiometabolic health in adults with spinal cord injury (SCI).
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              Effects of spinal cord injury on body composition and metabolic profile - part I.

              Several body composition and metabolic-associated disorders such as glucose intolerance, insulin resistance, and lipid abnormalities occur prematurely after spinal cord injury (SCI) and at a higher prevalence compared to able-bodied populations. Within a few weeks to months of the injury, there is a significant decrease in total lean mass, particularly lower extremity muscle mass and an accompanying increase in fat mass. The infiltration of fat in intramuscular and visceral sites is associated with abnormal metabolic profiles. The current review will summarize the major changes in body composition and metabolic profiles that can lead to comorbidities such as type 2 diabetes mellitus and cardiovascular diseases after SCI. It is crucial for healthcare specialists to be aware of the magnitude of these changes. Such awareness may lead to earlier recognition and treatment of metabolic abnormalities that may reduce the co-morbidities seen over the lifetime of persons living with SCI.
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                Author and article information

                Contributors
                Journal
                World J Orthop
                WJO
                World Journal of Orthopedics
                Baishideng Publishing Group Inc
                2218-5836
                18 September 2018
                18 September 2018
                : 9
                : 9
                : 112-119
                Affiliations
                Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, Richmond, VA 23249, United States
                Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA 23249, United States. ashraf.gorgey@ 123456va.gov
                Author notes

                Author contributions: Gorgey AS solely contributed to this paper.

                Correspondence to: Ashraf S Gorgey, PhD, Academic Research, Associate Professor, Physiotherapist, Research Scientist, Spinal Cord Injury and Disorders Center, Hunter Holmes McGuire VAMC, 1201 Broad Rock Boulevard, Richmond, VA 23249, United States. ashraf.gorgey@ 123456va.gov

                Telephone: +1-804-6755000 Fax: +1-804-6755223

                Article
                jWJO.v9.i9.pg112
                10.5312/wjo.v9.i9.112
                6153133
                30254967
                051b0448-20ff-4da0-ae39-201094ee9d8a
                ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                : 3 April 2018
                : 2 July 2018
                : 10 July 2018
                Categories
                Minireviews

                spinal cord injury,exoskeleton,robotics,rehabilitation,locomotion

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