Student Competition (Clinical/Best Practice Implementation) ID 1986706

Exoskeletons are promising tools for motor rehabilitation in spinal cord injury/disease (SCI/D); however, optimal therapeutic dose parameters are unknown. This study aimed to identify the dose and dosage of exoskeleton training for functional gait restoration in individuals with SCI/D. A systematic review (inception-03/31/2022) included CINAHL Complete Embase, Emcare Nursing, MedLine and Web of Science databases. Studies with ≥ 5 adults (≥16 years, any level/nature) who underwent exoskeleton-based overground gait rehabilitation and reporting 3 of 4 dose (e.g., session duration and number of sessions) and dosage (e.g., frequency of sessions, intervention duration) parameters, and at least one gait outcome measure were included. Of 977 studies, 964 were excluded. With 19 studies remaining, 13 included functional restoration as their therapeutic intent. Of those, 11 reported statistically significant changes and were considered for recommendation. The functional restoration ranged from 10 to 51.5 sessions, 2 to 5 sessions a week, for 3 to 12 weeks, with a duration of 45-90-minutes per session. Altogether, the data suggest that exoskeleton-based functional gait restoration would be best achieved using protocols that encompass 60-minute sessions, 3 times a week, for over 8 weeks (total of 24 sessions). Despite the high variability of dose and dosage parameters reported, significant improvements in functional performance were associated with overground exoskeleton use in most studies. The lack of therapeutic standards, however, compromises translation to clinical settings. This review provides evidence-based clinical practice recommendations for functional restoration in individuals with SCI/D to inform future functional restoration training paradigms.