Upper limb muscle strength and wheelchair-related abilities following an exoskeleton-assisted walking programme in individuals with chronic spinal cord injury: An exploratory study.

Only 10 participants completed, although 20 were planned, so the study could miss real effects and cannot explore subgroups. There was no control group and participants knew they were receiving the programme, so the faster natural wheelchair speed could reflect expectation or natural variation. All participants were long-term wheelchair users with chronic SCI, and many already had high upper-limb strength and wheelchair skill, so there was little room to improve. COVID-19 prevented the planned follow-up times, so measurements were only before and immediately after the programme. The wheelchair wheel attachment used for strength testing was not formally evaluated for measurement quality. Trunk motor function and other functional activities such as transfers were not assessed, so some effects may have been missed.

The authors declared no conflicts of interest. Funding came from the Fonds de recherche du Québec – Santé and the Canada Foundation for Innovation. Some authors received salary support from the Fonds de recherche du Québec – Santé.

Do not read the 14.5% faster natural wheelchair speed as proof that exoskeleton walking improves upper-limb strength or wheelchair skills broadly. No muscle outcome met all three criteria, only one wheelchair outcome did, and the study was uncontrolled with 10 participants.