500 Section - Wearable Powered Overground Exoskeleton Reduces Spasticity Dose-Dependently in Individuals with Spinal Cord Injury

Objectives : Spasticity is a frequent and disabling consequence of spinal cord injury, limiting mobility and independence. Wearable powered overground exoskeletons are emerging as a promising intervention to address spasticity while supporting gait training. This study aimed to evaluate whether exoskeleton-assisted gait training reduces spasticity and improves functional independence, and whether these effects vary according to treatment dosage.

Design: Multicenter retrospective pre–post cohort study. Individuals with spinal cord injury completed a series of overground gait training sessions with a powered exoskeleton. All participants underwent at least five sessions. Spasticity was quantified using the Modified Ashworth Scale (MAS), aggregated across multiple muscle groups, and functional independence was assessed using the Spinal Cord Independence Measure (SCIM). Dose–response analyses compared outcomes between individuals receiving higher versus lower session frequencies.

Results: Significant reductions in spasticity were observed across proximal, intermediate, and distal muscle groups following training (MAS, p < 0.0001). Functional independence also improved significantly (SCIM, p < 0.0001). Participants who completed fifteen or more sessions exhibited greater reductions in MAS scores and larger SCIM improvements compared with those receiving fewer sessions (p < 0.05), supporting a dose-dependent treatment effect.

Conclusion:

Overground exoskeleton-assisted gait training effectively reduces spasticity and enhances functional independence in individuals with spinal cord injury. Higher training dosages result in greater benefits, indicating a clear dose–response relationship. These findings highlight the therapeutic potential of wearable powered exoskeletons and support their integration into structured rehabilitation programs. Further research should explore long-term effects and optimal dosing strategies.