Rehabilitacija poškodb hrbtenjače s pomočjo eksoskeletov : diplomsko delo

Krajnc, Jan (author), Lampe, Tomaž (mentor), Pavlović, Monika (co-mentor), Fošnarič, Miha (reviewer)

Uvod: Poškodba hrbtenjače je običajno uničujoče stanje prizadetosti povezane s trajno ali popolno izgubo motorično-senzoričnih in avtonomnih funkcij ter visoko stopnjo smrtnosti. Globalna ocena incidence poškodbe hrbtenjače je med 40 in 80 novih primerov na milijon prebivalcev letno. Poškodba hrbtenjače povzroča patološko hojo zaradi pareze, spastičnosti in senzorične motnje spodnjih udov. Uspešnega zdravljenja še ne poznamo, zato je rehabilitacija glavni pristop pomoči za doseganje posameznikove samostojne hoje. Za tradicionalno rehabilitacijsko terapijo je potrebno veliko intenzivnega dela, saj morajo terapevti s pacienti opravljati ponavljajoče se gibe (npr. premik spodnjega uda med hojo). Rehabilitacijski eksoskeleti lahko replicirajo ponavljajoče gibe in s tem razbremenijo fizično naporno delo terapevtov. Namen: Namen diplomskega dela je na podlagi pregleda strokovne in znanstvene literature ter patentov predstaviti ortotično oskrbo pacientov s poškodbo hrbtenjače, kot tudi izdelkov, ki se za to uporabljajo. Ugotoviti želim uporabnost eksoskeletov in njihovo učinkovitost. Metode dela: Opravljen je bil pregled strokovne in znanstvene literature ter patentov. Za pregled literature sta bili uporabljeni podatkovni bazi PubMed in ScienceDirect v obdobju med 24. in 27. 11. 2020, za pregled patentov pa iskalnik Google patents. Za iskanje literature in patentov je bil uporabiljen iskalni niz v angleškem jeziku »spinal cord injury AND rehabilitation AND exoskeleton«. Rezultati: Vključenih je 9 raziskav, v katerih so avtorji opisovali učinke uporabe eksoskeletov. Ugotovili so, da je uporaba eksoskeletov v rehabilitaciji učinkovita, saj pozitivno vpliva na čustveno stanje pacientov in izboljšan rezultate funkcijskih testov. Prav tako uporaba eksoskeletov lahko zmanjša vplive sekundarnih obolenj in pripomore k boljši kvaliteti življenja pacientov s poškodbo hrbtenjače. Razprava in zaključek: Z eksoskeleti lahko osebe z okvaro motoričnih funkcij spodnjih udov varno in samostojno hodijo po ravnih površinah in stopnicah ter varno sedajo in vstajajo. Potrebno pa je upoštevati, da rezultati, pridobljeni iz kliničnih raziskav, temeljijo na majhnem številu preiskovancev ter opazovanju kratkoročnih učinkov uporabe (do 12 tednov). Direktno primerjavo študij otežujejo nestandardizirani postopki vrednotenja, pridobljeni rezultati pa so zaradi raznolikosti preiskovancev in njihovega okolja nekonsistentni. Za ugotavljanje dolgoročnih učinkov so potrebne dodatne raziskave.

• Language: Slovenian
• Keywords: diplomska dela, ortotika in protetika, poškodba hrbtenjače, rehabilitacija, zunanji skelet, ortoza za spodnje ude
• Work type: Bachelor thesis/paper
• Typology: 2.11 - Undergraduate Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [J. Krajnc]
• Year: 2021
• Number of pages: 26 str.
• PID: 20.500.12556/RUL-127579
• UDC: 617.3
• COBISS.SI-ID: 67894275
• Publication date in RUL: 16.06.2021

Secondary language

• Language: English
• Title: Exoskeletal rehabilitation for spinal-cord injury : diploma work

Abstract

Introduction: Spinal cord injury is usually a devastating state of disability associated with permanent loss of motor-sensory autonomic function and a high mortality rate. The worldwide incidence for spinal cord injury is between 40 and 80 new cases per million people per year. Spinal cord injury causes a pathological gait pattern due to paresis, spasticity, and sensory dysfunction of the lower limbs. A successful cure for spinal cord injury has not yet been discovered, so rehabilitation is the main approach to achieve independent walking for patients. Conventional rehabilitation for spinal cord injuries requires a lot of intense physical work by therapists, as they have to manually initiate the patient's repetitive movements (e.g., leg movements during walking). Rehabilitation exoskeletons can accurately reproduce these repetitive movements and relieve therapists from much of the physical work. Purpose: The purpose of this thesis is to review the professional and scientific literature, to represent the orthotic care for patients with spinal cord injuries, review exoskeletons available on the market, and determine the effectiveness of exoskeleton use. Methods: For the purposes of this thesis professional and scientific literature and patents were reviewed in the period between 24. and 27. 11. 2020, using PubMed, ScienceDirect, and Google Patents databases to find scientific literature and patents. The keywords used to search for articles and patents were: "spinal cord injury AND rehabilitation AND exoskeleton". Results: This thesis studies the content of 9 scientific articles in which the authors described the effects of using exoskeletons. They concluded that exoskeletons are effective rehabilitation tools that can improve functional test results and have positive effects on the patient's emotional state. In addition, exoskeletons could help reduce secondary health problems and improve overall quality of life. Discussion and conclusion: Lower limb exoskeletons are assistive devices for ehabilitation and ambulatory use for individuals with spinal cord injuries. They allow people with lower limb motor dysfunction to sit, stand, and walk safely and independently. However, the results in the reviewed scientific articles are based on a small number of subjects and short-term studies (sessions up to 12 weeks). In addition, the studies are not standardized, making comparison difficult, and the results derived are inconsistent due to the diversity of subjects and their environments. More research is needed to determine long-term effects.

• Keywords: diploma theses, orthotics and prosthetics spinal cord injury, rehabilitation, exoskeleton, lower limb orthosis