{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T17:41:18Z","timestamp":1787852478040,"version":"build-2784847793"},"reference-count":80,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,5]]},"abstract":"\n Objective<\/jats:title>\n Age and lesion level are believed to represent outcome predictors in rehabilitation of patients with chronic spinal cord injury (SCI). The Hybrid Assistive Limb (HAL) exoskeleton enables patients to perform a voluntary controlled gait pattern via an electromyography-triggered neuromuscular feedback system, and has been introduced as a temporary gait training tool in patients with SCI. The aim of this prospective pre- and postintervention study was to examine functional outcomes as a function of age and lesion level in patients with chronic incomplete SCI (iSCI) or chronic complete SCI (cSCI) with zones of partial preservation (ZPP) by using the HAL as a temporary training tool.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Fifty-five participants with chronic iSCI or cSCI (mean time since injury 6.85 \u00b1 5.12 years) were classified according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) and divided by age (< 50 or \u2265 50 years), independent of lesion level, and also into 4 homogeneous groups according to lesion level. The subgroups were as follows: Subgroup 1, tetraplegic iSCI (n = 13) (C2\u20138, AIS C [n = 8] and AIS D [n = 5]); Subgroup 2, paraplegic iSCI with spastic motor behavior (n = 15) (T2\u201312, AIS C [n = 8] and AIS D [n = 7]); Subgroup 3, paraplegic cSCI with complete motor paraplegia and absence of spastic motor behavior (n = 18) (T11\u2013L4 [AIS A], and ZPP from L-3 to S-1); and Subgroup 4, paraplegic iSCI with absence of spastic motor behavior (n = 9) (T12\u2013L3, AIS C [n = 8] and AIS D [n = 1]). The training paradigm consisted of 12 weeks of HAL-assisted treadmill training (5 times\/week). Baseline status was documented prior to intervention by using the AIS grade, Walking Index for SCI II (WISCI II) score, the 10-meter walk test (10MWT), and the 6-minute walk test (6MinWT). Training effects were assessed after 6 and 12 weeks of therapy, without HAL assistance.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Overall, a time reduction of 47% in the 10MWT, self-selected speed (10MWTsss) (< 50 years = 56% vs \u2265 50 years = 37%) and an increase of 50% in the 6MinWT were documented. The WISCI II scores showed a mean gain of 1.69 levels. At the end of the study, 24 of 55 patients (43.6%) were less dependent on walking aids. Age had a nonsignificant negative influence on the 10MWTsss. Despite a few nonsignificant subgroup differences, participants improved across all tests. Namely, patients with iSCI who had spastic motor behavior improved to a nonsignificant, lesser extent in the 6MinWT.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The HAL-assisted treadmill training leads to functional improvements in chronic iSCI or cSCI, both in and out of the exoskeleton. An improvement of approximately 50% in the 10MWTsss and in gait endurance (6MinWT) can be expected from such training. The influences of SCI lesion level and age on functional outcome were nonsignificant in the present study. Older age (\u2265 50 years) may be associated with smaller improvements in the 10MWTsss. An iSCI in paraplegic patients with spastic motor behavior may be a nonsignificant negative predictor in gait endurance improvements.<\/jats:p>\n \n Clinical trial registration no.: DRKS00010250 (\n https:\/\/drks-neu.uniklinik-freiburg.de\/drks_web\/setLocale_DE.do<\/jats:ext-link>\n )\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2017.2.focus171","type":"journal-article","created":{"date-parts":[[2017,5,2]],"date-time":"2017-05-02T15:57:03Z","timestamp":1493740623000},"page":"E15","source":"Crossref","is-referenced-by-count":67,"title":["Against the odds: what to expect in rehabilitation of chronic spinal cord injury with a neurologically controlled Hybrid Assistive Limb exoskeleton. A subgroup analysis of 55 patients according to age and lesion level"],"prefix":"10.3171","volume":"42","author":[{"given":"Dennis","family":"Grasm\u00fccke","sequence":"first","affiliation":[{"name":"Spinal Cord Injuries Unit"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amrei","family":"Zieriacks","sequence":"additional","affiliation":[{"name":"Spinal Cord Injuries Unit"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Jansen","sequence":"additional","affiliation":[{"name":"Spinal Cord Injuries Unit"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Fisahn","sequence":"additional","affiliation":[{"name":"Department of General and Trauma Surgery, and"},{"name":"Swedish Neuroscience Institute, Swedish Medical Center, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Sczesny-Kaiser","sequence":"additional","affiliation":[{"name":"Department of Neurology, BG University Hospital Bergmannsheil, Ruhr University, Bochum"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Wessling","sequence":"additional","affiliation":[{"name":"Department of Tumour and Revision Surgery, Orthopaedic Hospital Volmarstein, Wetter, Germany; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renate C.","family":"Meindl","sequence":"additional","affiliation":[{"name":"Spinal Cord Injuries Unit"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A.","family":"Schildhauer","sequence":"additional","affiliation":[{"name":"Department of General and Trauma Surgery, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirko","family":"Aach","sequence":"additional","affiliation":[{"name":"Spinal Cord Injuries Unit"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"2847","DOI":"10.1016\/j.spinee.2014.03.042","article-title":"Voluntary driven exoskeleton as a new tool for rehabilitation in chronic spinal cord injury: a pilot study","volume":"14","author":"Aach M","year":"2014","unstructured":"Aach M, Cruciger O, Sczesny-Kaiser M, H\u00f6ffken O, Meindl RCh, Tegenthoff M, : Voluntary driven exoskeleton as a new tool for rehabilitation in chronic spinal cord injury: a pilot study. Spine J 14:2847\u20132853, 20142470467710.1016\/j.spinee.2014.03.042"},{"key":"b2","series-title":"Unfallchirurg","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1007\/s00113-014-2616-1","article-title":"[Exoskeletons for rehabilitation of patients with spinal cord injuries. Options and limitations.]","volume":"118","author":"Aach M","year":"2015","unstructured":"Aach M, Meindl RC, Ge\u00dfmann J, Schildhauer TA, Citak M, Cruciger O: [Exoskeletons for rehabilitation of patients with spinal cord injuries. Options and limitations.] Unfallchirurg 118:130\u2013137, 2015 (Ger)10.1007\/s00113-014-2616-125672637"},{"key":"b3","series-title":"J Rehabil Res Dev","first-page":"693","article-title":"Treadmill training of paraplegic patients using a robotic orthosis","volume":"37","author":"Colombo G","year":"2000","unstructured":"Colombo G, Joerg M, Schreier R, Dietz V: Treadmill training of paraplegic patients using a robotic orthosis. J Rehabil Res Dev 37:693\u2013700, 200011321005"},{"key":"b4","series-title":"Spinal Cord","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1038\/sj.sc.3101154","article-title":"Driven gait orthosis for improvement of locomotor training in paraplegic patients","volume":"39","author":"Colombo G","year":"2001","unstructured":"Colombo G, Wirz M, Dietz V: Driven gait orthosis for improvement of locomotor training in paraplegic patients. Spinal Cord 39:252\u2013255, 200110.1038\/sj.sc.310115411438840"},{"key":"b5","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1212\/WNL.0000000000000645","article-title":"Locomotion training using voluntary driven exoskeleton (HAL) in acute incomplete SCI","volume":"83","author":"Cruciger O","year":"2014","unstructured":"Cruciger O, Tegenthoff M, Schwenkreis P, Schildhauer TA, Aach M: Locomotion training using voluntary driven exoskeleton (HAL) in acute incomplete SCI. Neurology 83:474, 20142507489210.1212\/WNL.0000000000000645"},{"key":"b6","series-title":"J Neurotrauma","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1089\/neu.2007.0468","article-title":"Recovery from a spinal cord injury: significance of compensation, neural plasticity, and repair","volume":"25","author":"Curt A","year":"2008","unstructured":"Curt A, Van Hedel HJ, Klaus D, Dietz V: Recovery from a spinal cord injury: significance of compensation, neural plasticity, and repair. J Neurotrauma 25:677\u2013685, 200810.1089\/neu.2007.046818578636"},{"key":"b7","series-title":"Ann Neurol","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1002\/ana.410370506","article-title":"Locomotor capacity of spinal cord in paraplegic patients","volume":"37","author":"Dietz V","year":"1995","unstructured":"Dietz V, Colombo G, Jensen L, Baumgartner L: Locomotor capacity of spinal cord in paraplegic patients. Ann Neurol 37:574\u2013582, 199510.1002\/ana.4103705067755351"},{"key":"b8","series-title":"Lancet Neurol","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1016\/S1474-4422(06)70522-1","article-title":"Neurological aspects of spinal-cord repair: promises and challenges","volume":"5","author":"Dietz V","year":"2006","unstructured":"Dietz V, Curt A: Neurological aspects of spinal-cord repair: promises and challenges. Lancet Neurol 5:688\u2013694, 20061685757410.1016\/S1474-4422(06)70522-1"},{"key":"b9","series-title":"Spinal Cord","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1038\/sj.sc.3100590","article-title":"Locomotor pattern in paraplegic patients: training effects and recovery of spinal cord function","volume":"36","author":"Dietz V","year":"1998","unstructured":"Dietz V, Wirz M, Curt A, Colombo G: Locomotor pattern in paraplegic patients: training effects and recovery of spinal cord function. Spinal Cord 36:380\u2013390, 199810.1038\/sj.sc.31005909648193"},{"key":"b10","series-title":"Ann N Y Acad Sci","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1111\/j.1749-6632.1998.tb09062.x","article-title":"Evidence for a spinal central pattern generator in humans","volume":"860","author":"Dimitrijevic MR","year":"1998","unstructured":"Dimitrijevic MR, Gerasimenko Y, Pinter MM: Evidence for a spinal central pattern generator in humans. Ann N Y Acad Sci 860:360\u2013376, 199810.1111\/j.1749-6632.1998.tb09062.x9928325"},{"key":"b11","series-title":"Spinal Cord","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1038\/sj.sc.3101223","article-title":"Walking index for spinal cord injury (WISCI II): scale revision","volume":"39","author":"Dittuno PL","year":"2001","unstructured":"Dittuno PL, Ditunno JF Jr: Walking index for spinal cord injury (WISCI II): scale revision. Spinal Cord 39:654\u2013656, 2001 (Erratum in Spinal Cord 47:349, 2009)10.1038\/sj.sc.310122311781863"},{"key":"b12","series-title":"Global Spine J","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1055\/s-0036-1593805","article-title":"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","volume":"6","author":"Fisahn C","year":"2016","unstructured":"Fisahn C, Aach M, Jansen O, Moisi M, Mayadev A, Pagarigan KT, : 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. Global Spine J 6:822\u2013841, 20162785366810.1055\/s-0036-1593805"},{"key":"b13","series-title":"Brain Res","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/0006-8993(75)90401-1","article-title":"How detailed is the central pattern generation for locomotion?","volume":"88","author":"Grillner S","year":"1975","unstructured":"Grillner S, Zangger P: How detailed is the central pattern generation for locomotion? Brain Res 88:367\u2013371, 197510.1016\/0006-8993(75)90401-11148835"},{"key":"b14","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"1938","DOI":"10.1016\/S0140-6736(11)60547-3","article-title":"Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study","volume":"377","author":"Harkema S","year":"2011","unstructured":"Harkema S, Gerasimenko Y, Hodes J, Burdick J, Angeli C, Chen Y, : Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study. Lancet 377:1938\u20131947, 20112160127010.1016\/S0140-6736(11)60547-3"},{"key":"b15","series-title":"Arch Phys Med Rehabil","doi-asserted-by":"publisher","first-page":"1588","DOI":"10.1016\/j.apmr.2012.04.032","article-title":"Locomotor training: as a treatment of spinal cord injury and in the progression of neurologic rehabilitation","volume":"93","author":"Harkema SJ","year":"2012","unstructured":"Harkema SJ, Hillyer J, Schmidt-Read M, Ardolino E, Sisto SA, Behrman AL: Locomotor training: as a treatment of spinal cord injury and in the progression of neurologic rehabilitation. Arch Phys Med Rehabil 93:1588\u20131597, 20122292045610.1016\/j.apmr.2012.04.032"},{"key":"b16","first-page":"29","article-title":"Muscle Function Testing","author":"Janda V","year":"1983","unstructured":"Janda V: Muscle Function Testing. Londons: Butterworths, 1983, p 29"},{"key":"b17","series-title":"J Neurophysiol","doi-asserted-by":"publisher","first-page":"2264","DOI":"10.1152\/jn.00871.2013","article-title":"Locomotor training improves premotoneuronal control after chronic spinal cord injury","volume":"111","author":"Knikou M","year":"2014","unstructured":"Knikou M, Mummidisetty CK: Locomotor training improves premotoneuronal control after chronic spinal cord injury. J Neurophysiol 111:2264\u20132275, 201410.1152\/jn.00871.201324598526"},{"key":"b18","series-title":"Curr Opin Neurol","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1097\/01.wco.0000200544.29915.cc","article-title":"Motor learning: its relevance to stroke recovery and neurorehabilitation","volume":"19","author":"Krakauer JW","year":"2006","unstructured":"Krakauer JW: Motor learning: its relevance to stroke recovery and neurorehabilitation. Curr Opin Neurol 19:84\u201390, 20061641568210.1097\/01.wco.0000200544.29915.cc"},{"key":"b19","series-title":"Top Spinal Cord Inj Rehabil","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1310\/sci1301-32","article-title":"A systematic review of the efficacy of gait rehabilitation strategies for spinal cord injury","volume":"13","author":"Lam T","year":"2007","unstructured":"Lam T, Eng JJ, Wolfe DL, Hsieh JT, Whittaker M: A systematic review of the efficacy of gait rehabilitation strategies for spinal cord injury. Top Spinal Cord Inj Rehabil 13:32\u201357, 20072291583510.1310\/sci1301-32"},{"key":"b20","series-title":"Spinal Cord","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1038\/sj.sc.3102010","article-title":"Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: clinical trial design","volume":"45","author":"Lammertse D","year":"2007","unstructured":"Lammertse D, Tuszynski MH, Steeves JD, Curt A, Fawcett JW, Rask C, : Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: clinical trial design. Spinal Cord 45:232\u2013242, 200710.1038\/sj.sc.310201017179970"},{"key":"b21","series-title":"Spinal Cord","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1038\/sj.sc.3100432","article-title":"International Standards for Neurological and Functional Classification of Spinal Cord Injury","volume":"35","author":"Maynard FM Jr","year":"1997","unstructured":"Maynard FM Jr, Bracken MB, Creasey G, Ditunno JF Jr, Donovan WH, Ducker TB, : International Standards for Neurological and Functional Classification of Spinal Cord Injury. Spinal Cord 35:266\u2013274, 199710.1038\/sj.sc.31004329160449"},{"key":"b22","series-title":"Cochrane Database Syst Rev","first-page":"CD006676","article-title":"Locomotor training for walking after spinal cord injury","volume":"11","author":"Mehrholz J","year":"2012","unstructured":"Mehrholz J, Kugler J, Pohl M: Locomotor training for walking after spinal cord injury. Cochrane Database Syst Rev 11:CD006676, 201223152239"},{"key":"b23","series-title":"Arch Phys Med Rehabil","doi-asserted-by":"publisher","first-page":"2297","DOI":"10.1016\/j.apmr.2013.06.023","article-title":"Effects of locomotor training after incomplete spinal cord injury: a systematic review","volume":"94","author":"Morawietz C","year":"2013","unstructured":"Morawietz C, Moffat F: Effects of locomotor training after incomplete spinal cord injury: a systematic review. Arch Phys Med Rehabil 94:2297\u20132308, 201310.1016\/j.apmr.2013.06.02323850614"},{"key":"b24","series-title":"J Neurophysiol","doi-asserted-by":"publisher","first-page":"2225","DOI":"10.1152\/jn.90532.2008","article-title":"Interlimb coordination in rhythmic leg movements: spontaneous and training-induced manifestations in human infants","volume":"100","author":"Musselman KE","year":"2008","unstructured":"Musselman KE, Yang JF: Interlimb coordination in rhythmic leg movements: spontaneous and training-induced manifestations in human infants. J Neurophysiol 100:2225\u20132234, 200810.1152\/jn.90532.200818650307"},{"key":"b25","series-title":"J Neurophysiol","doi-asserted-by":"publisher","first-page":"1247","DOI":"10.1152\/jn.00891.2006","article-title":"Loading the limb during rhythmic leg movements lengthens the duration of both flexion and extension in human infants","volume":"97","author":"Musselman KE","year":"2007","unstructured":"Musselman KE, Yang JF: Loading the limb during rhythmic leg movements lengthens the duration of both flexion and extension in human infants. J Neurophysiol 97:1247\u20131257, 200710.1152\/jn.00891.200617151226"},{"key":"b26","series-title":"Annu Rev Physiol","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1146\/annurev.physiol.62.1.723","article-title":"Neural adaptation in the generation of rhythmic behavior","volume":"62","author":"Pearson KG","year":"2000","unstructured":"Pearson KG: Neural adaptation in the generation of rhythmic behavior. Annu Rev Physiol 62:723\u2013753, 200010.1146\/annurev.physiol.62.1.72310845109"},{"key":"b27","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"399","DOI":"10.3171\/jns.1988.69.3.0399","article-title":"Late neurological changes following traumatic spinal cord injury","volume":"69","author":"Piepmeier JM","year":"1988","unstructured":"Piepmeier JM, Jenkins NR: Late neurological changes following traumatic spinal cord injury. J Neurosurg 69:399\u2013402, 1988340423810.3171\/jns.1988.69.3.0399"},{"key":"b28","series-title":"Arch Phys Med Rehabil","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1053\/apmr.2001.9396","article-title":"Validity and reliability comparison of 4 mobility measures in patients presenting with neurologic impairment","volume":"82","author":"Rossier P","year":"2001","unstructured":"Rossier P, Wade DT: Validity and reliability comparison of 4 mobility measures in patients presenting with neurologic impairment. Arch Phys Med Rehabil 82:9\u201313, 200110.1053\/apmr.2001.939611239279"},{"key":"b29","article-title":"Motor Control and Learning: A Behavioral Emphasis","author":"Schmidt RA","year":"2005","unstructured":"Schmidt RA, Lee TD: Motor Control and Learning: A Behavioral Emphasis, ed 4. Champaign, IL: Human Kinetics, 2005"},{"key":"b30","series-title":"J Neuroeng Rehabil","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s12984-015-0058-9","article-title":"HAL\u00ae exoskeleton training improves walking parameters and normalizes cortical excitability in primary somatosensory cortex in spinal cord injury patients","volume":"12","author":"Sczesny-Kaiser M","year":"2015","unstructured":"Sczesny-Kaiser M, H\u00f6ffken O, Aach M, Cruciger O, Grasm\u00fccke D, Meindl R, : HAL\u00ae exoskeleton training improves walking parameters and normalizes cortical excitability in primary somatosensory cortex in spinal cord injury patients. J Neuroeng Rehabil 12:68, 201510.1186\/s12984-015-0058-9"},{"key":"b31","series-title":"J Neurotrauma","doi-asserted-by":"publisher","first-page":"2405","DOI":"10.1089\/neu.2010.1660","article-title":"Role of spared pathways in locomotor recovery after body-weight-supported treadmill training in contused rats","volume":"28","author":"Singh A","year":"2011","unstructured":"Singh A, Balasubramanian S, Murray M, Lemay M, Houle J: Role of spared pathways in locomotor recovery after body-weight-supported treadmill training in contused rats. J Neurotrauma 28:2405\u20132416, 20112156868610.1089\/neu.2010.1660"},{"key":"b32","series-title":"J Neurophysiol","doi-asserted-by":"publisher","first-page":"2164","DOI":"10.1152\/jn.00308.2014","article-title":"Locomotor training alters the behavior of flexor reflexes during walking in human spinal cord injury","volume":"112","author":"Smith AC","year":"2014","unstructured":"Smith AC, Mummidisetty CK, Rymer WZ, Knikou M: Locomotor training alters the behavior of flexor reflexes during walking in human spinal cord injury. J Neurophysiol 112:2164\u20132175, 201410.1152\/jn.00308.201425122715"},{"key":"b33","series-title":"Adv Robot","first-page":"1441","article-title":"Intention-based walking support for paraplegia patients with Robot Suit HAL","volume":"21","author":"Suzuki K","year":"2007","unstructured":"Suzuki K, Mito G, Kawamoto H, Hasegawa Y, Sankai Y: Intention-based walking support for paraplegia patients with Robot Suit HAL. Adv Robot 21:1441\u20131469, 2007"},{"key":"b34","series-title":"J Spinal Cord Med","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1179\/2045772312Y.0000000058","article-title":"Relationship of physical therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab project","volume":"35","author":"Teeter L","year":"2012","unstructured":"Teeter L, Gassaway J, Taylor S, LaBarbera J, McDowell S, Backus D, : Relationship of physical therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab project. J Spinal Cord Med 35:503\u2013526, 201210.1179\/2045772312Y.000000005823318034"},{"key":"b35","series-title":"Neurorehabil Neural Repair","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1177\/1545968308320640","article-title":"Walking during daily life can be validly and responsively assessed in subjects with a spinal cord injury","volume":"23","author":"van Hedel HJ","year":"2009","unstructured":"van Hedel HJ, Dietz V: Walking during daily life can be validly and responsively assessed in subjects with a spinal cord injury. Neurorehabil Neural Repair 23:117\u2013124, 200910.1177\/1545968308320640"},{"key":"b36","series-title":"Neurol Res","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1179\/016164107X230775","article-title":"Standardized assessment of walking capacity after spinal cord injury: the European network approach","volume":"30","author":"van Hedel HJ","year":"2008","unstructured":"van Hedel HJ, Wirz M, Dietz V: Standardized assessment of walking capacity after spinal cord injury: the European network approach. Neurol Res 30:61\u201373, 200810.1179\/016164107X230775"},{"key":"b37","series-title":"Arch Phys Med Rehabil","first-page":"756","article-title":"Prediction of ambulatory performance based on motor scores derived from standards of the American Spinal Injury Association","volume":"75","author":"Waters RL","year":"1994","unstructured":"Waters RL, Adkins R, Yakura J, Vigil D: Prediction of ambulatory performance based on motor scores derived from standards of the American Spinal Injury Association. Arch Phys Med Rehabil 75:756\u2013760, 19948024420"},{"key":"b38","series-title":"Phys Med Rehabil Clin N Am","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.pmr.2005.10.008","article-title":"Robotic orthoses for body weight-supported treadmill training","volume":"17","author":"Winchester P","year":"2006","unstructured":"Winchester P, Querry R: Robotic orthoses for body weight-supported treadmill training. Phys Med Rehabil Clin N Am 17:159\u2013172, 20061651734910.1016\/j.pmr.2005.10.008"},{"key":"b39","series-title":"Arch Phys Med Rehabil","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1016\/j.apmr.2004.08.004","article-title":"Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: a multicenter trial","volume":"86","author":"Wirz M","year":"2005","unstructured":"Wirz M, Zemon DH, Rupp R, Scheel A, Colombo G, Dietz V, : Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: a multicenter trial. Arch Phys Med Rehabil 86:672\u2013680, 20051582791610.1016\/j.apmr.2004.08.004"},{"key":"b40","series-title":"Prog Brain Res","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/S0079-6123(06)57017-7","article-title":"The education and re-education of the spinal cord","volume":"157","author":"Wolpaw JR","year":"2006","unstructured":"Wolpaw JR: The education and re-education of the spinal cord. Prog Brain Res 157:261\u2013280, 20061716791610.1016\/S0079-6123(06)57017-7"},{"key":"b1","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"2847","DOI":"10.1016\/j.spinee.2014.03.042","article-title":"Voluntary driven exoskeleton as a new tool for rehabilitation in chronic spinal cord injury: a pilot study","volume":"14","author":"Aach M","year":"2014","unstructured":"Aach M, Cruciger O, Sczesny-Kaiser M, H\u00f6ffken O, Meindl RCh, Tegenthoff M, : Voluntary driven exoskeleton as a new tool for rehabilitation in chronic spinal cord injury: a pilot study. Spine J 14:2847\u20132853, 20142470467710.1016\/j.spinee.2014.03.042"},{"key":"b2","series-title":"Unfallchirurg","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1007\/s00113-014-2616-1","article-title":"[Exoskeletons for rehabilitation of patients with spinal cord injuries. Options and limitations.]","volume":"118","author":"Aach M","year":"2015","unstructured":"Aach M, Meindl RC, Ge\u00dfmann J, Schildhauer TA, Citak M, Cruciger O: [Exoskeletons for rehabilitation of patients with spinal cord injuries. Options and limitations.] Unfallchirurg 118:130\u2013137, 2015 (Ger)10.1007\/s00113-014-2616-125672637"},{"key":"b3","series-title":"J Rehabil Res Dev","first-page":"693","article-title":"Treadmill training of paraplegic patients using a robotic orthosis","volume":"37","author":"Colombo G","year":"2000","unstructured":"Colombo G, Joerg M, Schreier R, Dietz V: Treadmill training of paraplegic patients using a robotic orthosis. J Rehabil Res Dev 37:693\u2013700, 200011321005"},{"key":"b4","series-title":"Spinal Cord","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1038\/sj.sc.3101154","article-title":"Driven gait orthosis for improvement of locomotor training in paraplegic patients","volume":"39","author":"Colombo G","year":"2001","unstructured":"Colombo G, Wirz M, Dietz V: Driven gait orthosis for improvement of locomotor training in paraplegic patients. Spinal Cord 39:252\u2013255, 200110.1038\/sj.sc.310115411438840"},{"key":"b5","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1212\/WNL.0000000000000645","article-title":"Locomotion training using voluntary driven exoskeleton (HAL) in acute incomplete SCI","volume":"83","author":"Cruciger O","year":"2014","unstructured":"Cruciger O, Tegenthoff M, Schwenkreis P, Schildhauer TA, Aach M: Locomotion training using voluntary driven exoskeleton (HAL) in acute incomplete SCI. Neurology 83:474, 20142507489210.1212\/WNL.0000000000000645"},{"key":"b6","series-title":"J Neurotrauma","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1089\/neu.2007.0468","article-title":"Recovery from a spinal cord injury: significance of compensation, neural plasticity, and repair","volume":"25","author":"Curt A","year":"2008","unstructured":"Curt A, Van Hedel HJ, Klaus D, Dietz V: Recovery from a spinal cord injury: significance of compensation, neural plasticity, and repair. J Neurotrauma 25:677\u2013685, 200810.1089\/neu.2007.046818578636"},{"key":"b7","series-title":"Ann Neurol","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1002\/ana.410370506","article-title":"Locomotor capacity of spinal cord in paraplegic patients","volume":"37","author":"Dietz V","year":"1995","unstructured":"Dietz V, Colombo G, Jensen L, Baumgartner L: Locomotor capacity of spinal cord in paraplegic patients. Ann Neurol 37:574\u2013582, 199510.1002\/ana.4103705067755351"},{"key":"b8","series-title":"Lancet Neurol","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1016\/S1474-4422(06)70522-1","article-title":"Neurological aspects of spinal-cord repair: promises and challenges","volume":"5","author":"Dietz V","year":"2006","unstructured":"Dietz V, Curt A: Neurological aspects of spinal-cord repair: promises and challenges. Lancet Neurol 5:688\u2013694, 20061685757410.1016\/S1474-4422(06)70522-1"},{"key":"b9","series-title":"Spinal Cord","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1038\/sj.sc.3100590","article-title":"Locomotor pattern in paraplegic patients: training effects and recovery of spinal cord function","volume":"36","author":"Dietz V","year":"1998","unstructured":"Dietz V, Wirz M, Curt A, Colombo G: Locomotor pattern in paraplegic patients: training effects and recovery of spinal cord function. Spinal Cord 36:380\u2013390, 199810.1038\/sj.sc.31005909648193"},{"key":"b10","series-title":"Ann N Y Acad Sci","doi-asserted-by":"publisher","first-page":"360","DOI":"10.1111\/j.1749-6632.1998.tb09062.x","article-title":"Evidence for a spinal central pattern generator in humans","volume":"860","author":"Dimitrijevic MR","year":"1998","unstructured":"Dimitrijevic MR, Gerasimenko Y, Pinter MM: Evidence for a spinal central pattern generator in humans. Ann N Y Acad Sci 860:360\u2013376, 199810.1111\/j.1749-6632.1998.tb09062.x9928325"},{"key":"b11","series-title":"Spinal Cord","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1038\/sj.sc.3101223","article-title":"Walking index for spinal cord injury (WISCI II): scale revision","volume":"39","author":"Dittuno PL","year":"2001","unstructured":"Dittuno PL, Ditunno JF Jr: Walking index for spinal cord injury (WISCI II): scale revision. Spinal Cord 39:654\u2013656, 2001 (Erratum in Spinal Cord 47:349, 2009)10.1038\/sj.sc.310122311781863"},{"key":"b12","series-title":"Global Spine J","doi-asserted-by":"publisher","first-page":"822","DOI":"10.1055\/s-0036-1593805","article-title":"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","volume":"6","author":"Fisahn C","year":"2016","unstructured":"Fisahn C, Aach M, Jansen O, Moisi M, Mayadev A, Pagarigan KT, : 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. Global Spine J 6:822\u2013841, 20162785366810.1055\/s-0036-1593805"},{"key":"b13","series-title":"Brain Res","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/0006-8993(75)90401-1","article-title":"How detailed is the central pattern generation for locomotion?","volume":"88","author":"Grillner S","year":"1975","unstructured":"Grillner S, Zangger P: How detailed is the central pattern generation for locomotion? Brain Res 88:367\u2013371, 197510.1016\/0006-8993(75)90401-11148835"},{"key":"b14","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"1938","DOI":"10.1016\/S0140-6736(11)60547-3","article-title":"Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study","volume":"377","author":"Harkema S","year":"2011","unstructured":"Harkema S, Gerasimenko Y, Hodes J, Burdick J, Angeli C, Chen Y, : Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study. Lancet 377:1938\u20131947, 20112160127010.1016\/S0140-6736(11)60547-3"},{"key":"b15","series-title":"Arch Phys Med Rehabil","doi-asserted-by":"publisher","first-page":"1588","DOI":"10.1016\/j.apmr.2012.04.032","article-title":"Locomotor training: as a treatment of spinal cord injury and in the progression of neurologic rehabilitation","volume":"93","author":"Harkema SJ","year":"2012","unstructured":"Harkema SJ, Hillyer J, Schmidt-Read M, Ardolino E, Sisto SA, Behrman AL: Locomotor training: as a treatment of spinal cord injury and in the progression of neurologic rehabilitation. Arch Phys Med Rehabil 93:1588\u20131597, 20122292045610.1016\/j.apmr.2012.04.032"},{"key":"b16","first-page":"29","article-title":"Muscle Function Testing","author":"Janda V","year":"1983","unstructured":"Janda V: Muscle Function Testing. Londons: Butterworths, 1983, p 29"},{"key":"b17","series-title":"J Neurophysiol","doi-asserted-by":"publisher","first-page":"2264","DOI":"10.1152\/jn.00871.2013","article-title":"Locomotor training improves premotoneuronal control after chronic spinal cord injury","volume":"111","author":"Knikou M","year":"2014","unstructured":"Knikou M, Mummidisetty CK: Locomotor training improves premotoneuronal control after chronic spinal cord injury. J Neurophysiol 111:2264\u20132275, 201410.1152\/jn.00871.201324598526"},{"key":"b18","series-title":"Curr Opin Neurol","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1097\/01.wco.0000200544.29915.cc","article-title":"Motor learning: its relevance to stroke recovery and neurorehabilitation","volume":"19","author":"Krakauer JW","year":"2006","unstructured":"Krakauer JW: Motor learning: its relevance to stroke recovery and neurorehabilitation. Curr Opin Neurol 19:84\u201390, 20061641568210.1097\/01.wco.0000200544.29915.cc"},{"key":"b19","series-title":"Top Spinal Cord Inj Rehabil","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1310\/sci1301-32","article-title":"A systematic review of the efficacy of gait rehabilitation strategies for spinal cord injury","volume":"13","author":"Lam T","year":"2007","unstructured":"Lam T, Eng JJ, Wolfe DL, Hsieh JT, Whittaker M: A systematic review of the efficacy of gait rehabilitation strategies for spinal cord injury. Top Spinal Cord Inj Rehabil 13:32\u201357, 20072291583510.1310\/sci1301-32"},{"key":"b20","series-title":"Spinal Cord","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1038\/sj.sc.3102010","article-title":"Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: clinical trial design","volume":"45","author":"Lammertse D","year":"2007","unstructured":"Lammertse D, Tuszynski MH, Steeves JD, Curt A, Fawcett JW, Rask C, : Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: clinical trial design. Spinal Cord 45:232\u2013242, 200710.1038\/sj.sc.310201017179970"},{"key":"b21","series-title":"Spinal Cord","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1038\/sj.sc.3100432","article-title":"International Standards for Neurological and Functional Classification of Spinal Cord Injury","volume":"35","author":"Maynard FM Jr","year":"1997","unstructured":"Maynard FM Jr, Bracken MB, Creasey G, Ditunno JF Jr, Donovan WH, Ducker TB, : International Standards for Neurological and Functional Classification of Spinal Cord Injury. Spinal Cord 35:266\u2013274, 199710.1038\/sj.sc.31004329160449"},{"key":"b22","series-title":"Cochrane Database Syst Rev","first-page":"CD006676","article-title":"Locomotor training for walking after spinal cord injury","volume":"11","author":"Mehrholz J","year":"2012","unstructured":"Mehrholz J, Kugler J, Pohl M: Locomotor training for walking after spinal cord injury. Cochrane Database Syst Rev 11:CD006676, 201223152239"},{"key":"b23","series-title":"Arch Phys Med Rehabil","doi-asserted-by":"publisher","first-page":"2297","DOI":"10.1016\/j.apmr.2013.06.023","article-title":"Effects of locomotor training after incomplete spinal cord injury: a systematic review","volume":"94","author":"Morawietz C","year":"2013","unstructured":"Morawietz C, Moffat F: Effects of locomotor training after incomplete spinal cord injury: a systematic review. Arch Phys Med Rehabil 94:2297\u20132308, 201310.1016\/j.apmr.2013.06.02323850614"},{"key":"b24","series-title":"J Neurophysiol","doi-asserted-by":"publisher","first-page":"2225","DOI":"10.1152\/jn.90532.2008","article-title":"Interlimb coordination in rhythmic leg movements: spontaneous and training-induced manifestations in human infants","volume":"100","author":"Musselman KE","year":"2008","unstructured":"Musselman KE, Yang JF: Interlimb coordination in rhythmic leg movements: spontaneous and training-induced manifestations in human infants. J Neurophysiol 100:2225\u20132234, 200810.1152\/jn.90532.200818650307"},{"key":"b25","series-title":"J Neurophysiol","doi-asserted-by":"publisher","first-page":"1247","DOI":"10.1152\/jn.00891.2006","article-title":"Loading the limb during rhythmic leg movements lengthens the duration of both flexion and extension in human infants","volume":"97","author":"Musselman KE","year":"2007","unstructured":"Musselman KE, Yang JF: Loading the limb during rhythmic leg movements lengthens the duration of both flexion and extension in human infants. J Neurophysiol 97:1247\u20131257, 200710.1152\/jn.00891.200617151226"},{"key":"b26","series-title":"Annu Rev Physiol","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1146\/annurev.physiol.62.1.723","article-title":"Neural adaptation in the generation of rhythmic behavior","volume":"62","author":"Pearson KG","year":"2000","unstructured":"Pearson KG: Neural adaptation in the generation of rhythmic behavior. Annu Rev Physiol 62:723\u2013753, 200010.1146\/annurev.physiol.62.1.72310845109"},{"key":"b27","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"399","DOI":"10.3171\/jns.1988.69.3.0399","article-title":"Late neurological changes following traumatic spinal cord injury","volume":"69","author":"Piepmeier JM","year":"1988","unstructured":"Piepmeier JM, Jenkins NR: Late neurological changes following traumatic spinal cord injury. J Neurosurg 69:399\u2013402, 1988340423810.3171\/jns.1988.69.3.0399"},{"key":"b28","series-title":"Arch Phys Med Rehabil","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1053\/apmr.2001.9396","article-title":"Validity and reliability comparison of 4 mobility measures in patients presenting with neurologic impairment","volume":"82","author":"Rossier P","year":"2001","unstructured":"Rossier P, Wade DT: Validity and reliability comparison of 4 mobility measures in patients presenting with neurologic impairment. Arch Phys Med Rehabil 82:9\u201313, 200110.1053\/apmr.2001.939611239279"},{"key":"b29","article-title":"Motor Control and Learning: A Behavioral Emphasis","author":"Schmidt RA","year":"2005","unstructured":"Schmidt RA, Lee TD: Motor Control and Learning: A Behavioral Emphasis, ed 4. Champaign, IL: Human Kinetics, 2005"},{"key":"b30","series-title":"J Neuroeng Rehabil","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s12984-015-0058-9","article-title":"HAL\u00ae exoskeleton training improves walking parameters and normalizes cortical excitability in primary somatosensory cortex in spinal cord injury patients","volume":"12","author":"Sczesny-Kaiser M","year":"2015","unstructured":"Sczesny-Kaiser M, H\u00f6ffken O, Aach M, Cruciger O, Grasm\u00fccke D, Meindl R, : HAL\u00ae exoskeleton training improves walking parameters and normalizes cortical excitability in primary somatosensory cortex in spinal cord injury patients. J Neuroeng Rehabil 12:68, 201510.1186\/s12984-015-0058-9"},{"key":"b31","series-title":"J Neurotrauma","doi-asserted-by":"publisher","first-page":"2405","DOI":"10.1089\/neu.2010.1660","article-title":"Role of spared pathways in locomotor recovery after body-weight-supported treadmill training in contused rats","volume":"28","author":"Singh A","year":"2011","unstructured":"Singh A, Balasubramanian S, Murray M, Lemay M, Houle J: Role of spared pathways in locomotor recovery after body-weight-supported treadmill training in contused rats. J Neurotrauma 28:2405\u20132416, 20112156868610.1089\/neu.2010.1660"},{"key":"b32","series-title":"J Neurophysiol","doi-asserted-by":"publisher","first-page":"2164","DOI":"10.1152\/jn.00308.2014","article-title":"Locomotor training alters the behavior of flexor reflexes during walking in human spinal cord injury","volume":"112","author":"Smith AC","year":"2014","unstructured":"Smith AC, Mummidisetty CK, Rymer WZ, Knikou M: Locomotor training alters the behavior of flexor reflexes during walking in human spinal cord injury. J Neurophysiol 112:2164\u20132175, 201410.1152\/jn.00308.201425122715"},{"key":"b33","series-title":"Adv Robot","first-page":"1441","article-title":"Intention-based walking support for paraplegia patients with Robot Suit HAL","volume":"21","author":"Suzuki K","year":"2007","unstructured":"Suzuki K, Mito G, Kawamoto H, Hasegawa Y, Sankai Y: Intention-based walking support for paraplegia patients with Robot Suit HAL. Adv Robot 21:1441\u20131469, 2007"},{"key":"b34","series-title":"J Spinal Cord Med","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1179\/2045772312Y.0000000058","article-title":"Relationship of physical therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab project","volume":"35","author":"Teeter L","year":"2012","unstructured":"Teeter L, Gassaway J, Taylor S, LaBarbera J, McDowell S, Backus D, : Relationship of physical therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab project. J Spinal Cord Med 35:503\u2013526, 201210.1179\/2045772312Y.000000005823318034"},{"key":"b35","series-title":"Neurorehabil Neural Repair","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1177\/1545968308320640","article-title":"Walking during daily life can be validly and responsively assessed in subjects with a spinal cord injury","volume":"23","author":"van Hedel HJ","year":"2009","unstructured":"van Hedel HJ, Dietz V: Walking during daily life can be validly and responsively assessed in subjects with a spinal cord injury. Neurorehabil Neural Repair 23:117\u2013124, 200910.1177\/1545968308320640"},{"key":"b36","series-title":"Neurol Res","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1179\/016164107X230775","article-title":"Standardized assessment of walking capacity after spinal cord injury: the European network approach","volume":"30","author":"van Hedel HJ","year":"2008","unstructured":"van Hedel HJ, Wirz M, Dietz V: Standardized assessment of walking capacity after spinal cord injury: the European network approach. Neurol Res 30:61\u201373, 200810.1179\/016164107X230775"},{"key":"b37","series-title":"Arch Phys Med Rehabil","first-page":"756","article-title":"Prediction of ambulatory performance based on motor scores derived from standards of the American Spinal Injury Association","volume":"75","author":"Waters RL","year":"1994","unstructured":"Waters RL, Adkins R, Yakura J, Vigil D: Prediction of ambulatory performance based on motor scores derived from standards of the American Spinal Injury Association. Arch Phys Med Rehabil 75:756\u2013760, 19948024420"},{"key":"b38","series-title":"Phys Med Rehabil Clin N Am","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1016\/j.pmr.2005.10.008","article-title":"Robotic orthoses for body weight-supported treadmill training","volume":"17","author":"Winchester P","year":"2006","unstructured":"Winchester P, Querry R: Robotic orthoses for body weight-supported treadmill training. Phys Med Rehabil Clin N Am 17:159\u2013172, 20061651734910.1016\/j.pmr.2005.10.008"},{"key":"b39","series-title":"Arch Phys Med Rehabil","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1016\/j.apmr.2004.08.004","article-title":"Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: a multicenter trial","volume":"86","author":"Wirz M","year":"2005","unstructured":"Wirz M, Zemon DH, Rupp R, Scheel A, Colombo G, Dietz V, : Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: a multicenter trial. Arch Phys Med Rehabil 86:672\u2013680, 20051582791610.1016\/j.apmr.2004.08.004"},{"key":"b40","series-title":"Prog Brain Res","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/S0079-6123(06)57017-7","article-title":"The education and re-education of the spinal cord","volume":"157","author":"Wolpaw JR","year":"2006","unstructured":"Wolpaw JR: The education and re-education of the spinal cord. Prog Brain Res 157:261\u2013280, 20061716791610.1016\/S0079-6123(06)57017-7"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/42\/5\/article-pE15.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/42\/5\/article-pE15.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/42\/5\/article-pE15.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T08:21:00Z","timestamp":1780734060000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/42\/5\/article-pE15.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,5]]},"references-count":80,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2017.2.focus171","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,5]]}}}