900 Section - A Case Study on the Improvement of Gait Efficiency in an Incomplete Spinal Cord Injury Patient Using Transcutaneous Spinal Cord Stimulation Combined with EksoGT Robotic Gait Training

Spinal cord injury (SCI) rehabilitation remains challenging, with recovery often plateauing despite advances in robotic-assisted gait training (RAGT). Transcutaneous spinal cord stimulation (tSCS) has emerged as a promising adjunct, yet its combined application with overground exoskeleton training has not been well studied in Asia.This case study, conducted as part of an ongoing six-participant pilot clinical trial, aimed to evaluate the feasibility, safety, and potential efficacy of integrating tSCS with RAGT using the EksoGT™ exoskeleton in an individual with chronic, incomplete SCI.

Case Description:

The participant underwent two intervention phases: Phase I with RAGT alone and Phase II combining RAGT with tSCS. Assessments included International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor and sensory scores, gait performance (10MWT, WISCI-II, SCI-TCT), kinematic and electromyographic analyses, corticospinal motor conduction time (CMCT), and patient-reported outcomes.

Discussions:

The participant demonstrated improvement in gait speed from 0.26 to 0.41 m/s, surpassing the minimal clinically important difference and approaching the critical threshold for limited community ambulation. Notably, Phase II was associated with enhanced gait symmetry, reduced reliance on exoskeletal assistance, improved interlimb coordination, and decreased CMCT (21.9 to 19.7 ms). Electromyography and kinematic data supported improvements in voluntary motor recruitment, truncal stability, and gait efficiency. The participant also reported reduced spasticity and voluntarily lowered baclofen intake, consistent with objective findings. No adverse events were observed, and tSCS was well tolerated.

Conclusions:

This case study provides early evidence that combining tSCS with RAGT is feasible, safe, and potentially more effective than RAGT alone in promoting motor recovery, sensory integration, and gait efficiency in chronic, incomplete SCI. These results highlight the synergistic potential of multimodal neuromodulation and task-specific rehabilitation, underscoring the need for larger, long-term randomized trials to optimize protocols and confirm clinical applicability.