Study (D&B total score) | Number of participants (Sex) | Individuals features | Exoskeleton Intervention | Comparison Intervention | Evaluations | Follow-up | Drop out | ||
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Exoskeleton: Ekso | |||||||||
Subacute | n-RCT | Tsai et al. 2020 (15) | 30 (24 M, 6F) | LOI: C-T-L AIS A(3), B(3), C(13), D(11) Age: mean 46.8 years (intervention group), mean 52 years (control group) TSI: mean 21.3 days (intervention group), mean 17.4 days (control group) | Part of minimum 15 h of CPT x week | CPT | Each session: up time, walk time, steps (reported as mean across all training sessions) Pre and Post training: UEMS, LEMS, FIM | NP | NR |
McIntosh et al. 2020 (10) | 11 (8 M, 3F) | LOI: C6-L2 AIS A(5), C(5), D(1) Age: mean 41 years TSI: 3–15 weeks | 1 h × 3 days/week × 25 sessions (in associaton with CPT) | NO | Each session: up time, walk time, steps number; Pre and Post each session: VAS_p; Sitting vs standing vs prior to sitting: BP, HR; Sitting, session mid-time, prior to resitting: BRPE (1–10); Sessions 2, 13, 25: 6MWT, 10MWT | NP | 1 | ||
Chronic | RCT | Chang et al. 2018 (18) | 7 (5 M, 2F) | LOI: C4-T12 AIS C(2), D(5) Age: mean 56 years intervention group), mean 60 years (control group) TSI: 15 years (intervention group), 7 years (control group) | 1 h × 5 days/week × 3 weeks | CPT | Pre and Post training: stride length, step length, cadence, 6MWT, 10MWT, LEMS, TUG | NP | 2 |
n-RCT | Gagnon et al. 2018 (A) (14) | 14 (9 M, 5F) | LOI: C6-T10 AIS A(14) Age: mean 38.7 years TSI: mean 7.4 years | 1 h × 3 days/week × 18 sessions | NO | Each session: up time, walk time, steps number, level of assistance provided by trained assistant during walking Pre and Post training: 10MWT | NP | 1 | |
Escalona et al. 2018 (11) | 13 (8 M, 5F) | LOI: C6-T10 AIS A(13) Age: mean 38.1 years TSI: mean 5.1 years | 2–3 days/week × 18 sessions | NO | Single evaluation at last session while sitting, standing, walking: VO2, VCO2, VE, VT, RER, RR, HR Single evaluation at last session after walking: BRPE (1–10) | NP | 0 | ||
Sale et al. 2016 (A) (11) | 3 (2 M, 1F) | LOI: T6-L1 AIS A(2), C(1) Age: mean 36 years TSI: Chronics | 50 min × 3–4 days/week × 20 sessions | NO | Pre and Post training: velocity, cadence, step width, step length, stance time, double support time, Satisfaction Questionnaire, 6MWT indoor, 6MWT outdoor, 10MWT, TUG, VAS_p, VAS fatigue, BRPE(1–10) | NP | 0 | ||
Alamro et al. 2018 (10) | 16 (8 ABs, 8 SCI) (11 M, 5F) | LOI: C7-T4 AIS A(6), B(2) Age: mean 38.7 years TSI: 1–25 years | 1 session: 3 walking conditions | Ekso-OG, Ekso on treadmill and Lokomat | Single evaluation: trunk muscle activation, trunk acceleration | NP | 0 | ||
Karelis et al. 2017 (10) | 5 (4 M, 1F) | LOI: C7-T10 AIS A(5) Age: mean 60.4 years TSI: mean 7.6 years | 1 h × 3 days/week × 6 weeks | NO | Pre and Post training: Body Weight, BMI, Total lean body mass, Arm lean body mass, Leg lean body mass, Appendicular lean body mass, Trunk lean body mass, Total fat mass, Arm fat mass, Leg fat mass, Appendicular fat mass, Trunk fat mass, Total bone mineral density, Leg bone mineral density, Tibia Bone mineral density, Cross-sectional area of the calf Muscle, Subcutaneous adipose tissue, Intramuscular adipose tissue | NP | 0 | ||
Ramanujam et al. 2018 (A) (10) | 8 (4 Abs, 4 SCI) (6 M, 2F) | LOI: C5-T10 AIS A(2), C(2) Age: mean 41.75 years (individuals with SCI) 27.25 years (ABs) TSI: 0.5–9.5 years | 1 session | AB: walking without Ekso at self-selected, fast and slow speeds and with Ekso in "Passive" and "Active" conditions | Single evaluation: walking velocity, stance time, swing time, mean knee and hip ROM, EMG lower limbs | NP | NR | ||
Gagnon et al. 2018 (B) (9) | 14 (9 M, 5F) | LOI: C6-T10 AIS A, B, C Age: mean 38.7 years TSI: mean 7.4 years | Questionnaire after 1 h × 2–3 days/week × 18 sessions | NO | Post training: questionnaire | NP | NR | ||
Ramanujam et al. 2018 (B) (9) | 12 (4 Abs, 8 SCI) (9 M, 3F) | LOI: C4-T11 AIS NR (incomplete) Age: mean 39.12 years TSI: mean 6.38 years | 3–4 days/week × 100 h | AB: walking with Ekso | Pre and Post training: stride time, step time, stance time, double support time, stride length, step length, step frequency, walking speed | NP | NR | ||
Kressler et al. 2014 (A) (8) | 3 (2 M, 1F) | LOI: T1-T10 AIS A(3) Age: mean 30.33 years TSI: ≥ 1 yr | 1 h × 3 days/week × 6 weeks | NO | Pre, Mid and Post training: 10MWT, 2MWT, SCATS, ISCIBPD, NRS_p, EMG, %VO2 peak, EE | NP | NR | ||
Kressler et al. 2019 (B) (7) | 2 (1 M, 1F) | LOI: T6-T12 AIS NR (incomplete) Age: mean 45 years TSI: 2–9 years | 1 session walking with Ekso and 1 session walking without Ekso | Overground walking | Single evaluation for each session: VO2, HR, EE | NP | NR | ||
Cahill et al. 2018 (2) | 4 (3 M, 1F) | LOI: NR AIS NR (2 complete, 2 incomplete) Age: mean 41 years TSI: mean 5 years | 13–25 months | NO | Post training: semi-structured interview | NP | NR | ||
Subacute + chronic | n-RCT | Baunsgaard et al. 2018 (A) (13) | 52 (36 M, 16F) | LOI: C1-L2 AIS A and B (36), C and D (16) Age: mean 35.8 years TSI: 0.2–10.8 years | 3 days/week × 8 weeks | NO | Each session: up time, walk time, steps number, BRPE(6–20) Pre, Mid and Post training: up time, walk time, steps number, 10MWT, TUG, BBS, WISCI II, LEMS, HR and BP (before and after 10 min of walking) | 4 weeks: LEMS, 10MWT, TUG, BBS, WISCI II | 8 |
Baunsgaard et al. 2018 (B) (13) | 52 (36 M, 16F) | LOI: C1-L2 AIS A and B (36), C and D (16) Age: mean 35.8 years TSI: 0.2–10.8 years | 20–60 min × 3 days/week × 8 weeks | NO | After each session, Pre, Mid and Post training: ISCIPBDS, MAS Pre and Post trainingt: hip, knee and ankle flexor/extensor ROM, SCIM III, ISCIBDS for bowel, bladder and QoL | 4 weeks: ROM, SCIM III, ISCIBDS for bowel, bladder and QoL | NR | ||
Stampacchia et al. 2016 (11) | 21 (17 M, 4F) | LOI: C7-L2 AIS A(12), B(2), D(7) Age: mean 48.1 years TSI: 2–330 months | 40 min × 1 session | NO | Pre and Post single session: MAS, PSFS, NRS_sp, NRS_p Post session: PGIC, ad hoc questionnaire for subjective experience | NP | NR | ||
Kozlowski et al. 2015 (10) | 7 (7 M) | LOI: C4-L1 AIS A(3), B(1), C(3) Age: mean 36 years TSI: 0.4–7.4 years | 2 h × 1–2 days/week x up to 24 sessions | NO | Number of sessions needed to achieve a rating of “minimal assistance” and to achieve “contact guard” for walking and stand/sit Each session (only best performance was reported): walk time, up time, steps number, walk distance during longest walk and 2MWT, donning/doffing assistance Sitting, session mid-time, after resitting: BP, HR, METs, BRPE(6–20) | NP | NR | ||
Kolakowsky-Hayner et al. 2013 (7) | 7 (5 M, 2F) | LOI: T4-T12 AIS A(7) Age: mean 29.8 years TSI: 65–578 days | 1 h × 1 day/week × 6 weeks | NO | Each session: up time, walk time, step length, distance, don/doff time, level of assistance provided by trained assistant during walking, SPS, loss of balance | NP | 1 | ||
Unspecified TSI | n-RCT | Sale et al. 2018 (B) (10) | 8 (6 M, 2F) | LOI: T1-L2 AIS A(3), B(4), C(1) Age: mean 43.25 years TSI: NR | 45 min × 5–6 days/week × 20 sessions | NO | Pre and Post each session: HR, BP Pre and Post training: 6MWT indoor/outdoor, BRPE, 10MWT, cadence, stride length, walking velocity, stance phase, swing phase, double support, pelvis tilt initial contact, ROM pelvis tilt, hip, knee and ankle flexion/extension ROM, TUG, VAS_p, VAS fatigue, Satisfaction Questionnaire | NP | 0 |
Total of Ekso studies | 275 (199 M, 76F) | LOI: Cervical (49), Thoracic (84), Lumbar (11), NR (115) AIS: A + B(164), C + D(95) Age: mean 42.55 years (individuals with SCI), mean 27.5 years (ABs) TSI: subacute (98), chronic (153), NR (8) | |||||||
Exoskeleton: ReWalk | |||||||||
Chronic | n-RCT | Asselin et al. 2015 (14) | 8 (7 M, 1F) | LOI: T2-T11 AIS A(7) B(1) Age: mean 46.2 years TSI: 5.9 years | 60–90 min × 1 session | NO | Single evaluation while sitting, standing and walking: VO2, HR After walking: BRPE(6–20) | NP | NR |
Khan et al. 2019 (14) | 12 (8 M, 4F) | LOI: C6-T10 AIS A(6), B(2), C(3), D(1) Age: mean 37.5 years TSI: mean 7.6 years | 12 weeks | NO | Each session: total steps number, steps without stopping, walking distance, walking speed Pre and Post each session: NRS_p Pre and Post training: UEMS, LEMS, MEP, sensory key-points ISNCSCI Pre, Mid and Post training: CoP limits of stability and sway speed Weekly: SCATS, McGill Pain Questionnaire Pain Rating Index Post training: 10MWT, 6MWT During 6MWT and wheelchair propulsion: PCI | Between 2 and 3 months: 10MWT, 6MWT, CoP limits of stability and sway speed | 3 | ||
Platz et al. 2016 (14) | 7 (5 M, 2F) | LOI: T-L AIS A(6), C(1) Age: mean 48.3 years TSI: mean 11.4 years | 1 h × 5 days/week × 4–5 weeks | NO | Number of session to achieve with physical help/verbal assistance/no assistance: sit to stand, stand to sit, standing balance 1 min with crutches, walk 10 mt straight, walk 10 m straight and in curve, ascend, turn around, descend 12 stairs, walk 500 m outdoor Pre and Post training: REPAS, LEMS, UEMS, ASIA sensory examination, SCIM, SF-12v2 | 1 month: SF-12v2 | 0 | ||
van Dijsseldonk et al. 2019 (13) | 20 (12 M, 8F) | LOI: T AIS A(19), B(1) Age: mean 37 years TSI: mean 8 years | 1.5 h × 3 days/week × 8 weeks | NO | Pre and Post training and every 2 weeks (2,4,6): evaluation of potential predictors (neurological lesion level, age, gender, age at injury onset, time since injury, physical activity level, level of anxiety and BMI) | NP | 4 | ||
Chun et al. 2020 (12) | 11 (10 M, 1F) | LOI: T2-T11 AIS A(9), B(2) Age: 18–65 years TSI: 1–15 years | 30–90 min × 3–4 days/week × 12–14 weeks | NO | Pre and Post training: Modified Lynch Gastrointestinal Survey, Bristol Stool Scale, SCI-QOL Bowel Management DIfficulties | NP | 1 | ||
Yang et al. 2015 (12) | 12 (10 M, 2F) | LOI: C8-T11 AIS A(9), B(2), C(1) Age: 16–75 years TSI: 1–20 years | 1–2 h x mean 55 sessions | NO | Best performance: correlation between level of assistance provided by trained assistant during walking versus 6MWT and 10MWT | NP | NR | ||
Benson et al. 2016 (11) | 10 (10 M) | LOI: C8-L1 AIS A(7), C(3) Age: mean 31.7 years TSI: 1–21 years | 2 h × 2 days/week × 10 weeks | NO | Pre and Post each session: HR, BP, AS, VAS_p, VAS fatigue Pre and Post Training: ISNCSCI, 10MWT, 6MWT, TUG, ADAPSS, ATD-PA | NP | 5 | ||
Fineberg et al. 2013 (11) | 9 (3 AB, 6 SCI) (7 M, 2F) | LOI: T1-T11 AIS A(5), B(1) Age: mean 44.83 years individuals with SCI), 41.67 years (ABs) TSI: 1.5–14 years | 1–2 h × 3 days/week × 5–6 months | AB walking wit ReWalk | Single evaluation after reaching the ability to walk 10 m: vGRF, walking velocity | NP | NR | ||
Guanziroli et al. 2019 (11) | 15 (11 M, 4F) | LOI: T4-L5 AIS A(15) Age: mean 39.3 years TSI: 6 months-15 years | 1 h × 3 days/week × 8 weeks (at least) | Comparison between two generations of ReWalk software | Single evaluation after training: 6MWT, 10MWT, STS-time | NP | 2 | ||
Zeilig et al. 2012 (11) | 6 (6 M) | LOI: T5-T12 AIS A(6) Age: mean 33.16 years TSI: 3–7 years | 50 min × 13.7 ± 5.8 sessions | NO | Pre and Post Training: VAS fatigue, VAS_p Each session: HR, BP, VAS fatigue, VAS_p Post Training (comparison between high vs low lesions): 10MWT, 6MWT, TUG, Satisfaction Questionnaire | NP | 2 | ||
Esquenazi et al. 2012 (10) | 12 (8 M, 4F) | LOI: T3-T12 AIS A(12) Age: mean 38.6 years TSI: 1–24 years | 75–90 min × 3 days/week × 8 weeks | NO | Pre and Post each session: HR, BP, AS, VAS_p, VAS fatigue Post Training: Satisfaction Questionnaire, 6MWT, 10MWT | 12–15 months (data not analyzed) | 0 | ||
Lonini et al. 2016 (9) | 11 (6 AB—5 SCI) (6 M, 5F) | LOI: T8-T10 AIS A(5) Age: mean 36.9 years TSI: 10 months-7 years | 1 h × 3 days/week × 6–12 weeks | Expert users: 6 ABs and 1 individual with SCI | Each session: steps frequency, steps number, EE, trunk angle Pre and Post training: 10MWT, Hip and Knee Flexion, Swing Time, Step Delay, Walking Speed | NP | 0 | ||
Manns et al. 2019 (6) | 11 (7 M, 4F) | LOI: NR AIS NR Age: mean 37.5 years TSI: mean 7.8 years | 60–90 min × 4 days/week × 12 weeks | NO | Pre and Post training: semi-structured interviews on "contributing, changing and learning" | 2 months: semi-structured interview on "contributing, changing and learning" | NR | ||
Talaty et al. 2013 (3) | 12 | LOI: C7-T12 AIS NR Age: NR TSI: Chronics | 60–90 min × 3 days/week × 24 sessions | NO | Single evaluation near training conclusion: comparison among fast vs medium vs slow velocity of flexion/extension ROM of trunk, hip, knee and ankle | NP | NR | ||
Total of ReWalk studies | 156 (107 M, 37F, 12 NR) | LOI: Cervical (7), Thoracic (107), Lumbar (3), NR (30) AIS: A + B(115), C + D(9), NR(23) Age: mean 39.18 years (individuals with SCI), mean 39.79 years (ABs) TSI: chronic (147) | |||||||
Exoskeleton: Indego | |||||||||
Chronic | n-RCT | Evans et al. 2015 (9) | 5 (4 M, 1F) | LOI: T6-T12 AIS A(5) Age: mean 42 years TSI: Chronics | 2 sessions | NO | Comparison between 1 session of 6MWT at comfortable speed vs 1 session of 6MWT at "fast but safe" speed: 6MWT, % Vo2 peak, Vo2 average,HR peak, Walking economy, MET | NP | NR |
Subacute + chronic | n-RCT | Juszczak et al. 2018 (10) | 45 (37 M, 8F) | LOI: T1-L2 AIS A(30), B(5), C(10) Age: mean 35 years TSI: Subacute/Chronics | 3–4 days/week × 8 weeks | NO | Before each session: NRS_p, NRS_sp Pre and Mid and Post training: donning/doffing time, NRS spasticity, MAS, indoor/outdoor BRPE (6–20), SWLS, Self reported Bowel and Bladder perception | NP | NR |
Unspecified TSI | n-RCT | Tefertiller et al. 2018 (12) | 32 (27 M, 5F) | LOI: T4-L2 AIS A(21), B(5), C(6) Age: mean 37 years TSI: NR | 3 days/week × 8 weeks | NO | Mid and Post training: indoor/outdoor 10MWT, 6MWT, TUG, Donn/doff time Single evaluation between Mid and Post training: 600MWT | NP | 0 |
Hartigan et al. 2015 (9) | 16 (13 M, 3F) | LOI: C5-L1 AIS A(11), B(3), C(2) Age: 18–51 years TSI: NR | 1.5 h × 5 sessions | NO | Last session: 10MWT, 6MWT, level of assistance provided by trained assistant during walking, donn/doff time | NP | NR | ||
Total of Indego studies | 98 (81 M, 17F) | LOI: Cervical (3), Thoracic (17), Lumbar (1), NR (77) AIS: A + B(80), C + D(18) Age: mean 38 years TSI: chronic (5), NR (93) | |||||||
Exoskeleton: HAL | |||||||||
Subacute | n-RCT | Yatsugi et al. 2018 (12) | 9 (6 M, 3F) | LOI: C2-L5 AIS incomplete Age: mean 53.6 years TSI: Subacute | 50 min x mean 5 sessions x mean 6 days | NO | Pre and Post training: 10MWT, Cadence, GARS-M, BI, WISCI II, Maximun lateral trunk swing angle during gait | NP | NR |
Kubota et al. 2019 (11) | 8 (4 M, 4F) | LOI: T2-T12 AIS D(8) Age: mean 60.9 years TSI: Subacute | 1 h × 2–3 days/week × 10 sessions (in association with CPT) | NO | Each session, Pre and Post-training: 10MWT, Cadence, Step lenght, WISCI II, LEMS, FIM | NP | 0 | ||
Total of HAL studies | 17 (10 M, 7F) | LOI: Thoracic (14), Lumbar (3) AIS: C + D(17) Age: mean 57.25 years TSI: subacute (17) | |||||||
Exoskeleton: Rex | |||||||||
Chronic | n-RCT | Birch et al. 2017 (9) | 20 (14 M, 6F) | LOI: C4-L5 AIS A and B (11), C and D (9) Age: mean 40.9 years TSI: 1–52 years | 3–4 h × 1 session | NO | Single evaluation: time to transfer into device, level of assistance provided by trained assistant to perform 2 excersises with upper extremities, TUG, Acceptability questionnaire | NP | NR |