Exoskeleton-based exercises for overground gait and balance rehabilitation in spinal cord injury: a systematic review of dose and dosage parameters.
Patrik Nepomuceno, Wagner H Souza, Maureen Pakosh and 2 others
PMID 38705999WHAT IT FOUND
Most studies using exoskeletons for walking and balance in spinal cord injury reported improvements.
Typical effective protocols involved 60-minute sessions, three times a week, for eight to twelve weeks. However, study designs varied widely, and many did not report training intensity or dropouts.
Key findings
01Seventeen of the nineteen included studies reported statistically significant improvements or gains above the minimal clinically important difference in gait, balance, or cardiorespiratory outcomes.
02The most frequent protocol parameters across studies were 60-minute sessions, three times a week, for eight to twelve weeks.
03Protocols focused on cardiorespiratory rehabilitation were longer on average than those focused on functional restoration.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The review did not assess the risk of bias or quality of the included studies. Many studies did not report exercise intensity, which is a key factor in rehabilitation effectiveness. Donning and doffing times were inconsistently reported, making it difficult to know if the 60-minute session duration included setup time. The studies varied widely in the specific exoskeleton devices used, making it hard to generalize findings to one device. The review could not analyze results based on participant characteristics like injury level or severity due to the small number of studies. Six of the nineteen studies received partial or total support from industry manufacturers.
Declared interests
Six of the nineteen included studies were partially or totally supported by industry manufacturers, including equipment loans, trial funding, and employee collaboration in manuscript production.
The easy way to misread this
Do not assume that the recommended 60-minute, three-times-a-week protocol is the only effective dose. Some studies showed significant improvements with shorter, more intensive interventions, and others required longer durations. The variability in study designs and lack of reporting on exercise intensity means these recommendations are averages, not strict requirements.