Table 3 Participants and intervention data classified according to EXOs and time since injury

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