Earlier initiation of gait training with overground robotic exoskeleton after incomplete spinal cord injury: secondary analysis of a randomized controlled trial

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Purpose Early gait training supports walking recovery after incomplete spinal cord injury (iSCI). This study examined usual care (UC) and overground robotic exoskeleton (ORE) gait training to determine the role distinct approaches may have on initiating gait training during inpatient rehabilitation.Methods Patients with subacute iSCI [ASIA Impairment Scale (AIS) B, C, D] admitted to inpatient rehabilitation and meeting ORE criteria were randomized to UC or ORE, with a recommendation of up to 90 min of gait training per week. Primary outcomes included time (days) to gait training initiation, gait training frequency, and walking outcomes [CARE Tool items (“Walk 50 feet”, “Walk 150 feet”) and Walking Index for Spinal Cord Injury (WISCI-II)].Results Among 106 patients (mean age 51.5 ± 18.5 years, 78% male, 17.9% AIS B, 28.3% AIS C, 53.8% AIS D), ORE patients (n = 64) initiated gait training earlier than UC (n = 42) post-admission [12(8,20) vs. 14(9,29) days, p = 0.007] and post-injury [32(23,57) vs. 35.5(24,61) days, p = 0.031], with more frequent sessions [11(6,20) vs. 6.5(0,14), p = 0.003]. Moderate effect sizes were observed for patients with AIS C in 50- and 150-foot walking tasks (0.41, 0.34, respectively).Conclusion ORE may support earlier and more frequent gait training during rehabilitation, particularly benefiting patients with moderate severity iSCI.