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Energy cost and psychological impact of robotic-assisted gait training in people with spinal cord injury: effect of two different types of devices



In the last years, there has been an intense technological development of robotic devices for gait rehabilitation in spinal cord injury (SCI) patients. The aim of the present study was to evaluate energy cost and psychological impact during a rehabilitation program with two different types of robotic rehabilitation systems (stationary system on a treadmill, Lokomat, and overground walking system, Ekso GT).


Fifteen SCI patients with different injury levels underwent robot-assisted gait training sessions, divided into 2 phases: in the first phase, all subjects completed 3 sessions both Lokomat and Ekso GT. Afterwards, participants were randomly assigned to Lokomat or the Ekso for 17 sessions. A questionnaire, investigating the subjective psychological impact (SPI) during gait training, was administered. The functional outcome measures were oxygen consumption (VO2), carbon dioxide production (VCO2), metabolic equivalent of task (MET), walking economy, and heart rate (HR).


The metabolic responses (7.73 ± 1.02 mL/kg/min) and MET values (3.20 ± 1.01) during robotic overground walking resulted to be higher than those during robotic treadmill walking (3.91 ± 0.93 mL/kg/min and 1.58 ± 0.44; p < 0.01). Both devices showed high scores in emotion and satisfaction. Overground walking resulted in higher scores of fatigue, mental effort, and discomfort while walking with Lokomat showed a higher score in muscle relaxation. All patients showed improvements in walking economy due to a decrease in energy cost with increased speed and workload.


Overground robotic-assisted gait training in rehabilitation program needs higher cognitive and cardiovascular efforts than robot-assisted gait training on a treadmill.

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The study was partly funded within the research project “Clinical and healthcare strategies for improving quality of life in persons affected by spinal cord injuries: Tuscany regional network and use of innovative technological devices” (RF-2011-02346770) by the Italian Ministry of Health under “Ricerca Finalizzata e Giovani Ricercatori 2011–2012.”

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Correspondence to Silvia Corbianco.

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The study was approved by the local Ethical Committee of Pisa University Hospital in accordance with the code of Ethics of the World Medical Association (Declaration of Helsinki).

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Corbianco, S., Cavallini, G., Dini, M. et al. Energy cost and psychological impact of robotic-assisted gait training in people with spinal cord injury: effect of two different types of devices. Neurol Sci 42, 3357–3366 (2021).

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  • Spinal cord injury
  • Robotic rehabilitation
  • Lokomat
  • Ekso
  • Oxygen consumption
  • Psychological impact