{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T10:45:21Z","timestamp":1794307521640,"version":"4.9.0"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Spinal Cord"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>A multicenter retrospective pre-post cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to evaluate the dose-dependent effects of overground exoskeleton-assisted gait training on spasticity and functional independence in individuals with SCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>IRCCS San Raffaele Rome, San Raffaele Sulmona, Centro Neurolesi Bonino Pulejo IRCCS in Messina, and Montecatone Rehabilitation Institute in Imola.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Seventy-four participants with SCI underwent a minimum of five gait training sessions using the Ekso\u2122 exoskeleton. Primary outcomes included changes in spasticity, measured via the aggregated Modified Ashworth Scale (MAS), and functional independence, assessed by the Spinal Cord Independence Measure (SCIM) III. Secondary analyses explored the influence of treatment dosage.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Significant reductions in spasticity were observed across all muscle groups (proximal, intermediate, and distal) post-intervention (p\u2009&lt;\u20090.0001). SCIM scores also showed substantial improvements (p\u2009&lt;\u20090.0001), indicating enhanced functional independence. Participants receiving \u226515 sessions demonstrated greater gains compared to those with fewer sessions (p\u2009&lt;\u20090.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overground exoskeleton-assisted gait training effectively reduces spasticity and improves functional independence in individuals with SCI, with greater benefits observed at higher session frequencies. These findings support the integration of wearable powered exoskeletons into standard rehabilitation protocols for SCI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41393-026-01181-6","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T13:35:35Z","timestamp":1773063335000},"page":"686-695","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Wearable powered overground exoskeleton reduces dose-dependently the spasticity in individuals with spinal cord injury"],"prefix":"10.1038","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8749-2236","authenticated-orcid":false,"given":"Sanaz","family":"Pournajaf","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3602-4197","authenticated-orcid":false,"given":"Giovanni","family":"Morone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Felzani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Pellicciari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5825-5707","authenticated-orcid":false,"given":"Elena Sofia","family":"Cocco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlotta Maria","family":"Manzia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Simoncini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rocco Salvatore","family":"Calabr\u00f2","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Franceschini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"1181_CR1","doi-asserted-by":"publisher","first-page":"jrm00241","DOI":"10.2340\/16501977-2877","volume":"54","author":"B Biering-Soerensen","year":"2022","unstructured":"Biering-Soerensen B, Stevenson V, Bensmail D, Grabljevec K, Mart\u00ednez Moreno M, Pucks-Faes E, et al. European expert consensus on improving patient selection for the management of disabling spasticity with intrathecal baclofen and\/or botulinum toxin type A. J Rehabil Med. 2022;54:jrm00241. https:\/\/doi.org\/10.2340\/16501977-2877","journal-title":"J Rehabil Med"},{"key":"1181_CR2","doi-asserted-by":"publisher","first-page":"2563","DOI":"10.3390\/healthcare11182563","volume":"11","author":"W Raffaeli","year":"2023","unstructured":"Raffaeli W, Felzani G, Tenti M, Greco L, D\u2019Eramo MP, Proietti S, et al. A nutritional supplement as adjuvant of gabapentinoids for adults with neuropathic pain following spinal cord injury and stroke: preliminary results. Healthcare. 2023;11:2563. https:\/\/doi.org\/10.3390\/healthcare11182563","journal-title":"Healthcare"},{"key":"1181_CR3","doi-asserted-by":"publisher","first-page":"911","DOI":"10.1097\/PHM.0b013e318269d9a3","volume":"91","author":"A Esquenazi","year":"2012","unstructured":"Esquenazi A, Talaty M, Packel A, Saulino M. The ReWalk powered exoskeleton to restore ambulatory function to individuals with thoracic-level motor-complete spinal cord injury. Am J Phys Med Rehabil. 2012;91:911\u201321. https:\/\/doi.org\/10.1097\/PHM.0b013e318269d9a3","journal-title":"Am J Phys Med Rehabil"},{"key":"1181_CR4","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1055\/s-0036-1593805","volume":"6","author":"C Fisahn","year":"2016","unstructured":"Fisahn C, Aach M, Jansen O, Moisi M, Mayadev A, Pagarigan KT, et al. The effectiveness and safety of exoskeletons as assistive and rehabilitation devices in the treatment of neurologic gait disorders in patients with spinal cord injury: a systematic review. Glob Spine J. 2016;6:822\u201341. https:\/\/doi.org\/10.1055\/s-0036-1593805","journal-title":"Glob Spine J"},{"key":"1181_CR5","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1177\/1545968313508473","volume":"28","author":"JF Yang","year":"2014","unstructured":"Yang JF, Musselman KE, Livingstone D, Brunton K, Hendricks G, Hill D, et al. Repetitive mass practice or focused precise practice for retraining walking after incomplete spinal cord injury? a pilot randomized clinical trial. Neurorehabil Neural Repair. 2014;28:314\u201324. https:\/\/doi.org\/10.1177\/1545968313508473","journal-title":"Neurorehabil Neural Repair"},{"key":"1181_CR6","doi-asserted-by":"publisher","first-page":"455","DOI":"10.2147\/MDER.S103102","volume":"9","author":"LE Miller","year":"2016","unstructured":"Miller LE, Zimmermann AK, Herbert WG. Clinical effectiveness and safety of powered exoskeleton-assisted walking in patients with spinal cord injury: systematic review with meta-analysis. Med Devices. 2016;9:455\u201366. https:\/\/doi.org\/10.2147\/MDER.S103102","journal-title":"Med Devices"},{"key":"1181_CR7","doi-asserted-by":"publisher","first-page":"609","DOI":"10.3233\/NRE-220061","volume":"5","author":"G Stampacchia","year":"2022","unstructured":"Stampacchia G, Gazzotti V, Olivieri M, Andrenelli E, Bonaiuti D, Calabro RS, et al. Gait robot-assisted rehabilitation in persons with spinal cord injury: a scoping review. NeuroRehabilitation. 2022;5:609\u201347. https:\/\/doi.org\/10.3233\/NRE-220061","journal-title":"NeuroRehabilitation"},{"key":"1181_CR8","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/s12984-023-01220-w","volume":"20","author":"J Gillespie","year":"2023","unstructured":"Gillespie J, Arnold D, Trammell M, Bennett M, Ochoa C, Driver S, et al. Utilization of overground exoskeleton gait training during inpatient rehabilitation: a descriptive analysis. J Neuroeng Rehabil. 2023;20:102. https:\/\/doi.org\/10.1186\/s12984-023-01220-w","journal-title":"J Neuroeng Rehabil"},{"key":"1181_CR9","doi-asserted-by":"publisher","first-page":"806","DOI":"10.2340\/16501977-2372","volume":"50","author":"CB Baunsgaard","year":"2018","unstructured":"Baunsgaard CB, Nissen UV, Brust AK, Frotzler A, Ribeill C, Kalke YB, et al. Exoskeleton gait training after spinal cord injury: an exploratory study on secondary health conditions. J Rehabil Med. 2018;50:806\u201313. https:\/\/doi.org\/10.2340\/16501977-2372","journal-title":"J Rehabil Med"},{"key":"1181_CR10","doi-asserted-by":"publisher","first-page":"439","DOI":"10.3390\/jcm12020439","volume":"12","author":"S Pournajaf","year":"2023","unstructured":"Pournajaf S, Calabr\u00f2 RS, Naro A, Goffredo M, Aprile I, Tamburella F, et al. Robotic versus conventional overground gait training in subacute stroke survivors: a multicenter controlled clinical trial. J Clin Med. 2023;12:439. https:\/\/doi.org\/10.3390\/jcm12020439","journal-title":"J Clin Med"},{"key":"1181_CR11","doi-asserted-by":"publisher","first-page":"104","DOI":"10.3390\/brainsci11010104","volume":"11","author":"F Molteni","year":"2021","unstructured":"Molteni F, Guanziroli E, Goffredo M, Calabr\u00f2 RS, Pournajaf S, Gaffuri M, et al. Gait recovery with an overground powered exoskeleton: a randomized controlled trial on subacute stroke subjects. Brain Sci. 2021;11:104. https:\/\/doi.org\/10.3390\/brainsci11010104","journal-title":"Brain Sci"},{"key":"1181_CR12","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2026.1625712","volume":"17","author":"R Ritzmann","year":"2026","unstructured":"Ritzmann R, De Pauw K, Wollesen B. Editorial: neuro-cognition in human movement: from fundamental experiments to bio-inspired innovation. Front Neurol. 2026;17:1625712. https:\/\/doi.org\/10.3389\/fneur.2026.1625712","journal-title":"Front Neurol"},{"key":"1181_CR13","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1097\/NPT.0000000000000303","volume":"44","author":"TG Hornby","year":"2020","unstructured":"Hornby TG, Reisman DS, Ward IG, Scheets PL, Miller A, Haddad D, et al. and the locomotor CPG appraisal team. clinical practice guideline to improve locomotor function following chronic stroke, incomplete spinal cord injury, and brain injury. J Neurol Phys Ther. 2020;44:49\u2013100. https:\/\/doi.org\/10.1097\/NPT.0000000000000303","journal-title":"J Neurol Phys Ther"},{"key":"1181_CR14","doi-asserted-by":"publisher","first-page":"2297","DOI":"10.1016\/j.apmr.2013.06.023","volume":"94","author":"C Morawietz","year":"2013","unstructured":"Morawietz C, Moffat F. Effects of locomotor training after incomplete spinal cord injury: a systematic review. Arch Phys Med Rehabil. 2013;94:2297\u2013308. https:\/\/doi.org\/10.1016\/j.apmr.2013.06.023","journal-title":"Arch Phys Med Rehabil"},{"key":"1181_CR15","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1177\/1545968307301872","volume":"21","author":"MT Jurkiewicz","year":"2007","unstructured":"Jurkiewicz MT, Mikulis DJ, McIlroy WE, Fehlings MG, Verrier MC. Sensorimotor cortical plasticity during recovery following spinal cord injury: a longitudinal fMRI study. Neurorehabil Neural Repair. 2007;21:527\u201338. https:\/\/doi.org\/10.1177\/1545968307301872","journal-title":"Neurorehabil Neural Repair"},{"key":"1181_CR16","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s12984-015-0058-9","volume":"12","author":"M Sczesny-Kaiser","year":"2015","unstructured":"Sczesny-Kaiser M, H\u00f6ffken O, Aach M, Cruciger O, Grasm\u00fccke D, Meindl R, et al. HAL\u00ae exoskeleton training improves walking parameters and normalizes cortical excitability in primary somatosensory cortex in spinal cord injury patients. J Neuroeng Rehabil. 2015;12:68. https:\/\/doi.org\/10.1186\/s12984-015-0058-9","journal-title":"J Neuroeng Rehabil"},{"key":"1181_CR17","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s12984-016-0162-5","volume":"13","author":"DR Louie","year":"2016","unstructured":"Louie DR, Eng JJ. Powered robotic exoskeletons in post-stroke rehabilitation of gait: a scoping review. J Neuroeng Rehabil. 2016;13:53 https:\/\/doi.org\/10.1186\/s12984-016-0162-5","journal-title":"J Neuroeng Rehabil"},{"key":"1181_CR18","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1080\/10790268.2021.1983314","volume":"45","author":"R Charbonneau","year":"2022","unstructured":"Charbonneau R, Loyola-Sanchez A, McIntosh K, MacKean G, Ho C. Exoskeleton use in acute rehabilitation post spinal cord injury: a qualitative study exploring patients\u2019 experiences. J Spinal Cord Med. 2022;45:848\u201356. https:\/\/doi.org\/10.1080\/10790268.2021.1983314","journal-title":"J Spinal Cord Med"},{"key":"1181_CR19","doi-asserted-by":"publisher","first-page":"834","DOI":"10.3390\/brainsci14080834","volume":"14","author":"MH Lee","year":"2024","unstructured":"Lee MH, Tian MY, Kim MK. The effe of overground robot exoskeleton gait training on gait outcomes, balance, and motor function in patients with stroke: a systematic review and meta-analysis of randomized controlled trials. Brain Sci. 2024;14:834. https:\/\/doi.org\/10.3390\/brainsci14080834","journal-title":"Brain Sci"},{"key":"1181_CR20","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.pmrj.2016.07.534","volume":"9","author":"A Esquenazi","year":"2017","unstructured":"Esquenazi A, Talaty M, Jayaraman A. Powered exoskeletons for walking assistance in persons with central nervous system injuries: a narrative review. PM R. 2017;9:46\u201362. https:\/\/doi.org\/10.1016\/j.pmrj.2016.07.534","journal-title":"PM R"},{"key":"1181_CR21","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/B978-0-12-819410-2.00017-5","volume":"184","author":"JH Martin","year":"2022","unstructured":"Martin JH. Neuroplasticity of spinal cord injury and repair. Handb Clin Neurol. 2022;184:317\u201330. https:\/\/doi.org\/10.1016\/B978-0-12-819410-2.00017-5","journal-title":"Handb Clin Neurol"},{"key":"1181_CR22","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1038\/s41393-022-00751-8","volume":"60","author":"DJ Edwards","year":"2022","unstructured":"Edwards DJ, Forrest G, Cortes M, Weightman MM, Sadowsky C, Chang SH, et al. Walking improvement in chronic incomplete spinal cord injury with exoskeleton robotic training (WISE): a randomized controlled trial. Spinal Cord. 2022;60:522\u201332. https:\/\/doi.org\/10.1038\/s41393-022-00751-8","journal-title":"Spinal Cord"},{"key":"1181_CR23","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1310\/sci17-00055","volume":"24","author":"M Juszczak","year":"2018","unstructured":"Juszczak M, Gallo E, Bushnik T. Examining the effects of a powered exoskeleton on quality of life and secondary impairments in people living with spinal cord injury. Top Spinal Cord Inj Rehabil. 2018;24:336\u201342.","journal-title":"Top Spinal Cord Inj Rehabil"},{"key":"1181_CR24","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1080\/10790268.2022.2052502","volume":"47","author":"IJW van Nes","year":"2024","unstructured":"van Nes IJW, van Dijsseldonk RB, van Herpen FHM, Rijken H, Geurts ACH, Keijsers NLW. Improvement of quality of life after 2-month exoskeleton training in patients with chronic spinal cord injury. J Spinal Cord Med. 2024;47:354\u201360. https:\/\/doi.org\/10.1080\/10790268.2022.2052502","journal-title":"J Spinal Cord Med"},{"key":"1181_CR25","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1016\/j.jocn.2020.09.070","volume":"81","author":"R De Luca","year":"2020","unstructured":"De Luca R, Maresca G, Balletta T, Cannav\u00f2 A, Leonardi S, Latella D, et al. Does overground robotic gait training improve non-motor outcomes in patients with chronic stroke? Findings from a pilot study. J Clin Neurosci. 2020;81:240\u20135. https:\/\/doi.org\/10.1016\/j.jocn.2020.09.070","journal-title":"J Clin Neurosci"},{"key":"1181_CR26","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s12984-022-01003-9","volume":"19","author":"F Tamburella","year":"2022","unstructured":"Tamburella F, Lorusso M, Tramontano M, Fadlun S, Masciullo M, Scivoletto G. Overground robotic training effects on walking and secondary health conditions in individuals with spinal cord injury: systematic review. J Neuroeng Rehabil. 2022;19:27 https:\/\/doi.org\/10.1186\/s12984-022-01003-9","journal-title":"J Neuroeng Rehabil"},{"key":"1181_CR27","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1310\/sci2102-93","volume":"21","author":"C Hartigan","year":"2015","unstructured":"Hartigan C, Kandilakis C, Dalley S, Clausen M, Wilson E, Morrison S, et al. Mobility outcomes following five training sessions with a powered exoskeleton. Top Spinal Cord Inj Rehabil. 2015;21:93\u20139. https:\/\/doi.org\/10.1310\/sci2102-93","journal-title":"Top Spinal Cord Inj Rehabil"},{"key":"1181_CR28","doi-asserted-by":"publisher","first-page":"710","DOI":"10.23736\/S1973-9087.19.05574-6","volume":"55","author":"M Goffredo","year":"2019","unstructured":"Goffredo M, Guanziroli E, Pournajaf S, Gaffuri M, Gasperini G, Filoni S, et al. Overground wearable powered exoskeleton for gait training in subacute stroke subjects: clinical and gait assessments. Eur J Phys Rehabil Med. 2019;55:710\u201321. https:\/\/doi.org\/10.23736\/S1973-9087.19.05574-6","journal-title":"Eur J Phys Rehabil Med"},{"key":"1181_CR29","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1093\/ptj\/67.2.206","volume":"67","author":"RW Bohannon","year":"1987","unstructured":"Bohannon RW, Smith MB. Interrater reliability of a modified ashworth scale of muscle spasticity. Phys Ther. 1987;67:206\u20137. https:\/\/doi.org\/10.1093\/ptj\/67.2.206","journal-title":"Phys Ther"},{"key":"1181_CR30","doi-asserted-by":"publisher","first-page":"1926","DOI":"10.1080\/09638280601046302","volume":"29","author":"M Itzkovich","year":"2007","unstructured":"Itzkovich M, Gelernter I, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, et al. The spinal cord independence measure (SCIM) version III: reliability and validity in a multi-center international study. Disabil Rehabil. 2007;29:1926\u201333.","journal-title":"Disabil Rehabil"},{"key":"1181_CR31","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.1089\/neu.2020.7473","volume":"38","author":"S Kirshblum","year":"2021","unstructured":"Kirshblum S, Snider B, Eren F, Guest J. Characterizing natural recovery after traumatic spinal cord injury. J Neurotrauma. 2021;38:1267\u201384.","journal-title":"J Neurotrauma"},{"key":"1181_CR32","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1186\/s12984-020-00752-9","volume":"17","author":"D Kinnett-Hopkins","year":"2020","unstructured":"Kinnett-Hopkins D, Mummidisetty CK, Ehrlich-Jones L, Crown D, Bond RA, Applebaum MH, et al. Users with spinal cord injury experience of robotic Locomotor exoskeletons: a qualitative study of the benefits, limitations, and recommendations. J Neuroeng Rehabil. 2020;17:124. https:\/\/doi.org\/10.1186\/s12984-020-00752-9","journal-title":"J Neuroeng Rehabil"},{"key":"1181_CR33","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1310\/sci2003-208","volume":"20","author":"C Balioussis","year":"2014","unstructured":"Balioussis C, Hitzig SL, Flett H, Noreau L, Craven BC. Identifying and classifying quality of life tools for assessing spasticity after spinal cord injury. Top Spinal Cord Inj Rehabil. 2014;20:208\u201324. https:\/\/doi.org\/10.1310\/sci2003-208","journal-title":"Top Spinal Cord Inj Rehabil"},{"key":"1181_CR34","doi-asserted-by":"publisher","first-page":"277","DOI":"10.3233\/NRE-161358","volume":"39","author":"G Stampacchia","year":"2016","unstructured":"Stampacchia G, Rustici A, Bigazzi S, Gerini A, Tombini T, Mazzoleni S. Walking with a powered robotic exoskeleton: subjective experience, spasticity and pain in spinal cord injured persons. NeuroRehabilitation. 2016;39:277\u201383. https:\/\/doi.org\/10.3233\/NRE-161358","journal-title":"NeuroRehabilitation"},{"key":"1181_CR35","doi-asserted-by":"publisher","first-page":"1878","DOI":"10.1016\/j.apmr.2014.04.026","volume":"95","author":"J Kressler","year":"2014","unstructured":"Kressler J, Thomas CK, Field-Fote EC, Sanchez J, Widerstr\u00f6m-Noga E, Cilien DC, et al. Understanding therapeutic benefits of overground bionic ambulation: exploratory case series in persons with chronic, complete spinal cord injury. Arch Phys Med Rehabil. 2014;95:1878\u201387.e4. https:\/\/doi.org\/10.1016\/j.apmr.2014.04.026","journal-title":"Arch Phys Med Rehabil"},{"key":"1181_CR36","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1186\/s12984-019-0585-x","volume":"16","author":"AS Khan","year":"2019","unstructured":"Khan AS, Livingstone DC, Hurd CL, Duchcherer J, Misiaszek JE, Gorassini MA, et al. Retraining walking over ground in a powered exoskeleton after spinal cord injury: a prospective cohort study to examine functional gains and neuroplasticity. J Neuroeng Rehabil. 2019;16:145. https:\/\/doi.org\/10.1186\/s12984-019-0585-x","journal-title":"J Neuroeng Rehabil"},{"key":"1181_CR37","doi-asserted-by":"publisher","first-page":"1646","DOI":"10.3390\/healthcare11111646","volume":"11","author":"G Morone","year":"2023","unstructured":"Morone G, Pirrera A, Iannone A, Giansanti D. Development and use of assistive technologies in spinal cord injury: a narrative review of reviews on the evolution, opportunities, and bottlenecks of their integration in the health domain. Healthcare. 2023;11:1646. https:\/\/doi.org\/10.3390\/healthcare11111646","journal-title":"Healthcare"}],"container-title":["Spinal Cord"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41393-026-01181-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41393-026-01181-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41393-026-01181-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T09:01:40Z","timestamp":1785920500000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41393-026-01181-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,9]]},"references-count":37,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["1181"],"URL":"https:\/\/doi.org\/10.1038\/s41393-026-01181-6","relation":{},"ISSN":["1362-4393","1476-5624"],"issn-type":[{"value":"1362-4393","type":"print"},{"value":"1476-5624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,9]]},"assertion":[{"value":"10 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 February 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 February 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 March 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that there are no conflicts of interest related to this article.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"This study protocol, adhering to the Declaration of Helsinki principles, was approved by the Local Ethics Committee (CET Lazio Area 5) on July 03, 2024, with the code number RP- 120\/SR\/24.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Ethics"}}]}}