Table 1.
Shows robotic and virtual reality devices for both motor and cognitive rehabilitation in SCI patients.
| Type of Intervention | Device/Tool | Outcome | Description |
|---|---|---|---|
| Robotic | Erigo (Hocoma, Volketswil, Switzerland) |
Verticalization | Erigo consists of a robotic oscillating table that allows early and progressive robotic verticalization in the acute post-SCI phases and is combined with allowing cyclical leg movement. The tilting table, from 45° to 90°, can be adapted by therapists according to the patient’s needs, and it is also possible to customize the step speed. In addition to verticalization, the device helps to improve the cardiovascular system by activating the muscles and promoting venous return. |
| Lokomat (Hocoma, Volketswil, Switzerland) |
Gait training | The Lokomat is a robotic exoskeleton equipped with a treadmill and a weight relief system. It is a tethered exoskeleton with powered orthoses at the hip and knee, passive ankle control during the swing phase, and variable levels of assistance. It can be fitted with a VR screen (Lokomat Pro) to enhance patients’ motivation during training. Additionally, the Free D model allows pelvic movement, simulating physiological human gait. | |
| Ekso-GT/-NR (Ekso Bionics, San Rafael, CA, USA) |
Gait training | The Ekso, in contrast, is an untethered exoskeleton designed as a wearable powered orthosis at the hip and knee joints. Patient-initiated walking is facilitated through lateral weight-shifting movements. This untethered design allows flexibility in mobility. The Ekso provides adaptable assistance based on individual patient needs, accommodating unilateral or bilateral support. It is specifically intended for individuals with functional upper extremity strength and spinal cord injury levels T4-L5, as well as C7-T3 (AIS D), making it a versatile solution for diverse rehabilitation scenarios. | |
| Indego (Ekso Bionics, San Rafael, CA, USA) |
Gait training | The Indego, a hip–knee exoskeleton, is a dynamic and powered wearable device designed specifically for gait training. Engineered for individuals with spinal cord injuries at C7 and lower levels within rehabilitation facilities, and T3 and lower levels for home and community use, the Indego provides a versatile solution for diverse settings. Activation of walking is initiated by the individual’s intentional center of pressure (COP) movement, either in the anterior direction to commence walking, sit–stand maneuvers, or in the posterior direction to initiate stopping or stand–sit transitions. This sophisticated exoskeleton thus responds to the user’s intentional cues, promoting an intuitive and personalized gait-training experience. | |
| G-EO System (Reha Technology, Olten, Switzerland) |
Gait training | Gait training with the G-EO System involves a robotic end effector system that replicates the movements of walking, as well as ascending and descending stairs. The patient’s feet are securely fastened to platforms capable of multidirectional movements, facilitated by six engines aiding in various directions—upwards, downwards, forwards, and backwards. This innovative system offers a comprehensive approach to gait simulation, promoting a dynamic and effective training experience for patients. | |
| Virtual reality | BTs Nirvana (BTS Bioengineering, Milano, Italy) |
Motor and cognitive functions | BTS-Nirvana is a semi-immersive virtual reality (VR) system composed of computer software, two markerless optoelectronic infrared sensors, a video camera, and a projector connected to a large screen. Users interact fully with the virtual environment through their movements, effortlessly captured by the infrared sensors. The proposed activities include exercises that require patients to perform specific actions, such as reaching, touching, or grabbing projected objects, as well as interacting with projected images on the floor, such as balls, providing dual-task activities that involve both motor and cognitive aspects. |
| VRRS (Khymeia, Padua, Italy) |
Balance, language, and cognitive functions | The Virtual Reality Rehabilitation System (VRRS) is designed around a central hub, connectable via USB, accompanied by a set of specialized peripherals meticulously synchronized and seamlessly integrated with the system. VRRS is outfitted with exercise modules catering to cognitive, language, postural, and motor rehabilitation. Therapists have the capability to select and incorporate virtual exercises into the rehabilitation program, shaping the difficulty level in correlation to the timing of execution and the nature of the activity. This adaptable and comprehensive system allows for tailored rehabilitation programs to meet individual patient needs. | |
| CAREN (Motek, Amsterdam, The Netherlands) |
Gait training, balance, and cognitive functions | The Computer Assisted Rehabilitation Environment (CAREN) is comprised of an electro-hydraulic 2 m diameter motion platform, offering manipulation across 6 degrees of freedom. During each session, the patient stands on this dynamic platform, featuring force plates beneath a double-banded treadmill capable of reaching speeds of up to 5 m/s. The platform’s movement is either user-driven or preprogrammed, synchronized with function curves defining specific pathways within the virtual environment. Additionally, the device incorporates a 180° screen, providing varying levels of virtual reality immersion, ranging from flat video and dual-channel audio to a fully enveloping 360-surround sound dome enclosure. | |
| Telerehabilitation | VRRS-HomeKit (Khymeia, Padua, Italy) |
Motor functions (lower and upper limbs, balance) and cognitive functions | The Virtual Reality Rehabilitation System (VRRS) HomeKit is a portable device featuring a tablet that facilitates virtual exercises for patients. Interaction occurs with 2D scenarios and objects using the touchscreen or various sensors. For instance, the K-wand is employed for movement tracking and orientation, manipulated by the patient during catching and reaching exercises for upper limbs. Additionally, a pair of K-sensors, comprising sensors on wearable strips of varying sizes, is utilized for conducting full-body motor tele-training activities. |