Novel tilt table with integrated robotic stepping mechanism: design principles and clinical application

Patients with severe neurological, orthopedic or cardio-pulmonary disorders including spinal cord injury (SCI) and traumatic brain injury (TBI) are often forced to lie in bed for a comparable long time. This may cause many complications, one of the most prominent problems being the instability of the cardio-pulmonary system due to venous pooling in the lower extremity when transferred from the horizontal to the upright position. Any kind of mobilization of these patients would help to prevent these effects from happening. The most commonly used method for mobilization therapy of these patients is to passively move the lower extremities. To date commercially available continuous passive motion devices are inadequate to achieve the expected results. Therefore a novel device for an automated stepping training ("Erigo") was developed with the possibility of simultaneous verticalization of the patients. The first clinical application of this robotic device in high (cervical) complete spinal cord injured patients and a case study of a traumatic brain injured patient would be presented.