Locomotor training using an overground robotic exoskeleton in long-term manual wheelchair users with a chronic spinal cord injury living in the community: Lessons learned from a feasibility study in terms of recruitment, attendance, learnability, performance and safety.

The study was small, single-site, and had no control group, so it cannot show that the program caused the walking speed gain. Only long-term manual wheelchair users with motor complete spinal cord injury who met strict body-size and range-of-motion criteria were included, so results may not apply to people with incomplete spinal cord injury, recent injury, or more severe musculoskeletal limitations. The recruitment rate was 28.6%, and limited ankle range of motion was a common reason for exclusion, so many interested people may not be suitable without pre-training. One participant had bilateral calcaneus fractures after the first training session, and the cause was uncertain, so safety screening cannot be assumed adequate. Acceptance and satisfaction were not formally reported, so attendance may not reflect how most people feel about the program. Walking speed results excluded one participant with C6 tetraplegia, so the reported speed gain does not describe every enrolled participant.

Funded by Rick Hansen Institute, Fonds de Recherche du Québec - Santé, and Canadian Foundation for Innovation. No author conflict-of-interest statement is provided in the supplied text.

Do not read the faster walking speed as proof that the exoskeleton alone improves function. The program also included therapist supervision and a walking aid, and the contribution of any single component cannot be separated. This was a single-group feasibility study with no control group, and one serious fracture occurred.