The impact of robot-assisted training on gait, balance, and endurance in patients with partial spinal cord injuries: insights from rehabilitation

This study evaluated the effectiveness of robotic-assisted gait training in improving gait function, balance, and endurance in individuals with chronic spinal cord injury (SCI). It compared robotic-assisted therapy with conventional rehabilitation and examined the impact of training frequency. A randomized controlled trial was conducted at specialized SCI rehabilitation centers. Seventy-five participants aged 19–40 with chronic partial SCI American Spinal Injury Association Impairment Scale (AIS) grades B, C, or D were enrolled in this randomized controlled trial. A pre-registered athletic subgroup consisting of 45 individuals with intensive competitive sports backgrounds (≥ 4 sessions/week pre-injury) was designated for subgroup analysis. The remaining 30 participants were physically active non-athletes (2–3 sessions/week pre-injury). Participants were divided into three groups: L1 (robotic-assisted gait training once weekly), L2 (robotic-assisted gait training twice weekly), and C (conventional rehabilitation). Functional outcomes were assessed using the 10-Meter Walk Test (10MWT), 6-Minute Walk Test (6MWT), Walking Index for Spinal Cord Injury II (WISCI II), Lower Extremity Motor Score (LEMS), Timed Up and Go Test (TUG), and stabilometry before and after the intervention. The L2 group demonstrated the greatest improvements: TUG time decreased by 7.7 ± 3.0 s (17.2 ± 2.5 s PRE vs. 9.5 ± 1.8 s POST; −44.8%, η² = 0.18), and 6MWT distance increased by 43.5 ± 16.2 m (35.5 ± 4.8 m PRE vs. 79 ± 14 m POST; +122.5%, η² = 0.25). These absolute improvements substantially exceed established MCID thresholds and were accompanied by clinically meaningful gains in quality of life. Robotic-assisted therapy, particularly at higher training frequencies, significantly outperformed conventional rehabilitation, especially in AIS D patients. Robotic-assisted gait training effectively improves gait function, endurance, and balance, with enhanced benefits observed at higher training frequencies. Higher training frequency demonstrated clinically meaningful improvements across all participants. While improvements were observed across the cohort, future adequately powered trials are needed to systematically investigate whether athlete-specific training histories influence responsiveness to different Lokomat frequencies.