Wearable powered overground exoskeleton reduces dose-dependently the spasticity in individuals with spinal cord injury

Study design: A multicenter retrospective pre-post cohort study. Objective: This study aimed to evaluate the dose-dependent effects of overground exoskeleton-assisted gait training on spasticity and functional independence in individuals with SCI. Setting: IRCCS San Raffaele Rome, San Raffaele Sulmona, Centro Neurolesi Bonino Pulejo IRCCS in Messina, and Montecatone Rehabilitation Institute in Imola. Methods: Seventy-four participants with SCI underwent a minimum of five gait training sessions using the Ekso™ exoskeleton. Primary outcomes included changes in spasticity, measured via the aggregated Modified Ashworth Scale (MAS), and functional independence, assessed by the Spinal Cord Independence Measure (SCIM) III. Secondary analyses explored the influence of treatment dosage. Results: Significant reductions in spasticity were observed across all muscle groups (proximal, intermediate, and distal) post-intervention (p < 0.0001). SCIM scores also showed substantial improvements (p < 0.0001), indicating enhanced functional independence. Participants receiving ≥15 sessions demonstrated greater gains compared to those with fewer sessions (p < 0.05). Conclusions: Overground exoskeleton-assisted gait training effectively reduces spasticity and improves functional independence in individuals with SCI, with greater benefits observed at higher session frequencies. These findings support the integration of wearable powered exoskeletons into standard rehabilitation protocols for SCI.