Advice

Expert comments

Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Three experts provided their comments, including 2 who were familiar with or had used this technology before.

Level of innovation

All experts thought that the ReStore Soft Exo‑Suit was a novel concept compared with current standard care. One expert noted that most exoskeletons designed to improve walking completely cover both legs and usually have a 'cage' around the pelvis. But ReStore is designed to improve movement of the paretic ankle joint (dorsiflexion and plantarflexion). One expert suggested that some robotic devices are available in the private clinics that are similar to ReStore with minor variations.

Potential patient impact

The ability to help restore a pre-stroke gait pattern was identified as an important benefit for people with gait deficits after stroke. ReStore helps people who lack correct movement in the affected ankle have a more normal walking pattern. It can feed back to people about their gait pattern and this could help their rehabilitation. One expert suggested that ReStore helped people walk more efficiently and improved their confidence in their abilities because they were able to walk a longer distance and practice more steps. The expert added that ReStore could be used in the community, depending on the availability of the service. Two experts considered that people who would benefit most from using the technology are those:

  • with paralysis on one side of their body (hemiplegia)

  • who have had a stroke

  • with a multilevel deficit who would need several therapists to help rehabilitate their standing and gait.

Potential system impact

All experts agreed that ReStore is likely to cost more than current standard care, but also that it could improve outcomes by, for example, reducing falls and improving balance and confidence. Two experts also suggested that ReStore could reduce the number of staff needed in therapy sessions because fewer would be needed to assist people. One expert thought that if there was evidence that ReStore improved neuromuscular recovery more than standard care, the resource impact of using the device would be lower, and the technology could be cost effective compared with standard care.

General comments

All experts considered that ReStore could be used as an addition to standard care. They thought skin and joint irritation were likely side effects. One expert reported 2 anecdotal adverse events: 1 person with pre-existing biomechanical issues who had pain from the footplate and another who had exacerbating hyperextension of the knee. Both stopped the ReStore session. Two experts noted the set-up time of ReStore was expected to be more than that of standard care; for instance, the initial assessments could take around 1.5 to 2 hours, and subsequent sessions could last about 1 hour.