Claire Shackleton, Robert Evans, Delva Shamley, Sacha West, Yumna Albertus
Division of Exercise Science & Sports Medicine Division, 7708 Cape Town, South Africa
DOI: 10.2340/16501977-2601

Objectives: To evaluate the effectiveness of over-ground robotic locomotor training in individuals with spinal cord injuries with regard to walking performance, cardiovascular demands, secondary health complications and user-satisfaction.
Data sources: PubMed, Cochrane, Web of Science, Scopus, EBSCOhost and Engineering Village.
Study selection: Trials in which robotic locomotor training was used for a minimum of 3 participants with spinal cord injury.
Data extraction: Independent extraction of data by 2 reviewers using a pre-established data abstraction table. Quality of evidence assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
Data synthesis: Total of 27 non-controlled studies representing 308 participants. Most studies showed decreases in exertion ratings, pain and spasticity and reported positive well-being post-intervention. Seven studies were included in meta-analyses on walking performance, showing significant improvements post-intervention (p < 0. 05), with pooled effects for the 6-min walking test and 10-metre walking test of–0. 94 (95% confidence interval (95% CI) –1. 53,–0. 36) and –1. 22 (95% CI –1. 87,–0. 57), respectively. The Timed Up and Go Test showed a positive pooled effect of 0. 74 (95% CI 0. 36, 1. 11). Improvements in walking parameters were seen with an increase in session number; however, no significant cardiovascular changes were found over time.
Conclusion: Robotic locomotor training shows promise as a tool for improving neurological rehabilitation; however, there is limited evidence regarding its training benefits. Further high-powered, randomized controlled trials, with homogenous samples, are required to investigate these effects.

The benefits of using robotic suits for rehabilitation in patients with spinal cord injury have been tested in many studies. This review assessed the findings of these studies with regards to how over-ground robotic training could improve walking parameters, cardiovascular fitness and health outcomes for people with spinal cord injuries. Twenty-seven studies met the inclusion criteria for an in-depth analysis. The results showed that walking parameters were improved after the training interventions, but that there were no changes in cardiovascular outcomes. Health outcomes, including pain and muscle spasms, decreased after the intervention. This highlights that robotic walking has the potential to advance care for patients with spinal cord injuries by improving walking capacity, reducing pain and muscle tightness, and improving psychological well-being. However, the available evidence could be enhanced by further research using larger sample sizes, randomized control designs, sensitive interventions and tests.

Appendix S1
Table SI
Table SII
Figure S1