Potential Effects of an Exoskeleton-Assisted Overground Walking Program for Individuals With Spinal Cord Injury Who Uses a Wheelchair on Imaging and Serum Markers of Bone Strength: Pre-Post Study.
Alec Bass, Suzanne N Morin, Michael Guidea and 4 others
PMID 38163294WHAT IT FOUND
A 16-week exoskeleton walking program showed mixed bone results in 10 people with spinal cord injury.
Femoral neck bone mineral content increased, but femoral cortical thickness decreased. No control group was used, so these changes cannot be confirmed as treatment effects.
Key findings
01Left femoral neck bone mineral content increased significantly and meaningfully following the intervention.
02Estimated cortical thickness at the femur decreased, raising concerns about possible negative effects on bone strength.
03Serum vitamin D levels increased, but this was likely due to the study timing moving from winter to summer rather than the intervention itself.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The sample size was very small (10 participants), which reduced statistical power and increased the chance of false negatives. There was no control group, so it is impossible to know if the observed changes differ from natural variability or what would have happened without the intervention. The 16-week duration may have been too short to capture complete bone turnover cycles, which can take up to 6 months. Half of the participants had preserved bone mineral density, meaning they were less likely to show bone health improvements than those with osteoporosis. Follow-up assessments were not possible due to the pandemic, so longer-term effects or latent adaptations were not captured.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the increases in bone strength indices as proof that this program prevents fractures. The study had no control group, a very small sample, and showed a concerning decrease in cortical thickness. These mixed results are preliminary and cannot support clinical recommendations for bone protection.