500 Section - Unexpected Appetite Recovery Following Robotic Exoskeleton Training in Complete Spinal Cord Injury: a case report

Case Diagnosis: A 30-year-old male with complete thoracic spinal cord injury (T8 AIS A) resulting from traumatic injury in September 2022, presenting with complete loss of appetite perception since the time of injury despite normal taste sensation and scheduled eating patterns.

Case Description: The patient underwent 5 weeks of robotic exoskeleton-assisted walking training (5 sessions/week, 60 minutes/session) combined with conventional physiotherapy. Appetite assessment was conducted through patient self-reporting and clinical observation. The patient had previously engaged in high-intensity conventional physical therapy for 11 months without any return of hunger sensation. Remarkably, during the second week of exoskeleton training, the patient experienced a sudden return of appetite perception during a therapy session, accompanied by emotional relief and spontaneous meal consumption.

Discussions: The recovery of appetite perception during exoskeleton-assisted walking represents a novel finding in spinal cord injury rehabilitation. This phenomenon occurred despite evidence that exercise typically suppresses hunger acutely. The timing and context suggest that weight-bearing gait training may have stimulated visceral afferent pathways, potentially through vagal nerve activation or improved autonomic signaling. Alternative explanations include psychological factors related to the experience of walking again, though the patient had no significant psychological comorbidities. This case highlights the complex relationship between motor function, autonomic regulation, and visceral sensation in spinal cord injury, suggesting that robotic rehabilitation may have unexpected multisystem benefits beyond locomotor recovery.

Conclusions: Robotic exoskeleton training may facilitate appetite recovery in complete spinal cord injury, possibly through mechanisms involving autonomic nervous system modulation. This unexpected outcome warrants further investigation using validated appetite measures and controlled studies to determine underlying mechanisms and potential applications for managing autonomic dysfunction in spinal cord injury rehabilitation.