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There is a paucity of research that has successfully implemented rehabilitation and\/or exercise training interventions to mitigate bone loss after acute SCI or reverse bone loss that has already occurred in chronic SCI. This paper describes a research protocol to compare the effect of exoskeletal-assisted walking (EAW) alone versus EAW plus transcutaneous spinal cord stimulation (EAW+tSCS) on bone density, geometry and strength in a cohort of chronic SCI participants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>After meeting eligibility criteria and completing baseline testing, sixteen participants will be block randomised into the EAW alone group or the EAW+tSCS combined group (n=8\u2009each group). Each group will receive a total of 108 overground training sessions (60\u2009min sessions, 3 times a week, for 36 weeks) for the 9-month training period. Imaging for bone density and geometry by dual-energy X-ray absorptiometry and peripheral quantitative CT will be performed prior to starting the intervention (baseline), after 72 training sessions, and again after 108 sessions in each of the intervention arms. CT imaging of both lower extremities will be performed at baseline and at the 9-month time point in each of the intervention arms. Finite element models of bone loading will be generated based on three-dimensional (3D) reconstruction of bone architecture from CT imaging prior to and 9 months after the intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This study is currently approved by the Kessler Foundation and James J. Peters VA Medical Center Institutional Review Board. A member of the research team will review and explain the study consent form and will have all eligible participants sign prior to participation in the study. Results from this study will be disseminated to clinicians and researchers in the SCI community at national and international conferences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT03096197\">NCT03096197<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-086062","type":"journal-article","created":{"date-parts":[[2024,9,17]],"date-time":"2024-09-17T21:25:29Z","timestamp":1726608329000},"page":"e086062","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Exoskeletal-assisted walking combined with transcutaneous spinal cord stimulation to improve bone health in persons with spinal cord injury: study protocol for a prospective randomised controlled trial"],"prefix":"10.1136","volume":"14","clinical-trial-number":[{"clinical-trial-number":"nct03096197","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03096197","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1929-5067","authenticated-orcid":false,"given":"Christopher M","family":"Cirnigliaro","sequence":"first","affiliation":[{"name":"Spinal Cord Damage Research Center, James J. Peters VA Medical Center, Bronx, NY, USA"},{"name":"Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, New Brunswick, NJ, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, New Jersey Institute for Technology, Newark, NJ, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gail F","family":"Forrest","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, New Brunswick, NJ, USA"},{"name":"Center for Spinal Stimulation and Center for Mobility and Rehabilitation Engineering, Kessler Foundation, West Orange, NJ, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann M","family":"Spungen","sequence":"additional","affiliation":[{"name":"Spinal Cord Damage Research Center, James J. 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