{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T06:58:44Z","timestamp":1775804324471,"version":"3.50.1"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Rehabil. Sci."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Incomplete paraplegia presents complex rehabilitation challenges due to its multisystemic impact on motor function, bone health, and metabolic regulation. This case report evaluates the effects of robotic exoskeleton rehabilitation addressing a critical gap in understanding the multidimensional outcomes of this emerging technology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>An 18-year-old male with traumatic L2 AIS C paraplegia underwent 20 sessions of robotic exoskeleton training (Atalante exoskeleton) during 60\u2005min of therapy (20-min setup, 20-min walking, 10-min squats and recovery) combined with conventional physiotherapy over six months. Conventional therapy complemented exoskeleton training by addressing residual strength deficits through resisted knee extension (3\u2009\u00d7\u200910 reps at 60% 1-RM) and functional mobility via overground gait training with knee-ankle-foot orthoses (KAFOs) (2\u00d7\/week, 10\u2005m walks. Comprehensive assessments included isokinetic dynamometry (CYBEX), bone densitometry (DXA), AIS impairment scale, and functional mobility tests (Timed Up and Go, 10-meter walk test). Results demonstrated neurological improvement (AIS L2\u2013L3 motor score improved from 4\/5 to 5\/5, with light touch improving from 78 to 84) and gait capacity recovery (300\u2005m with crutches). Musculoskeletal outcomes revealed a 21.7% improvement in right hip extensor torque (69\u219284 Nm), though still 19.2% below the patient's own 6-month post-injury baseline value (104 Nm), while bone mineral density showed site-specific effects (lumbar spine: +50%, T-score \u22122.6\u21920.8; femur: T-score \u22123.3\u2192\u22121.3). Notably, functional gains correlated with hip torque recovery (TUG: r\u2009=\u2009\u22120.71), but bilateral deficit worsened (12%\u219242%), and visceral fat increased dramatically (359%) despite functional improvements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case demonstrates that exoskeleton training effectively enhances mobility and bone health through weight-bearing stimulation, particularly at lumbar spine. However, the paradoxical metabolic changes and persistent neuromuscular asymmetries reveal critical limitations of current robotic rehabilitation approaches. These findings support the concept of spinal cord injury as a multisystem disorder requiring integrated interventions that combine exoskeleton training with nutritional strategies and asymmetric muscle training. The case provides novel insights for developing comprehensive rehabilitation protocols that address both functional recovery and secondary health complications in incomplete paraplegia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fresc.2026.1616983","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T06:03:35Z","timestamp":1775801015000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Robotic exoskeleton rehabilitation in incomplete L2 paraplegia: functional gains contrast with metabolic challenges \u2013 a multidimensional case report"],"prefix":"10.3389","volume":"7","author":[{"given":"Rafael Francisco","family":"Vieira de Melo","sequence":"first","affiliation":[{"name":"Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo","place":["Sao Paulo, SP, Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela Mitiyo Odagiri","family":"Utiyama","sequence":"additional","affiliation":[{"name":"Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo","place":["Sao Paulo, SP, Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priscila Fabiano","family":"Carvalho","sequence":"additional","affiliation":[{"name":"Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo","place":["Sao Paulo, SP, Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e9 Tadeu","family":"Sugawara","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Legal, Bioetica, Medicina do Trabalho e Medicina Fisica e Reabilitacao, Faculdade de Medicina FMUSP, Universidade de Sao Paulo","place":["Sao Paulo, SP, Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linamara Rizzo","family":"Battistella","sequence":"additional","affiliation":[{"name":"Departamento de Medicina Legal, Bioetica, Medicina do Trabalho e Medicina Fisica e Reabilitacao, Faculdade de Medicina FMUSP, Universidade de Sao Paulo","place":["Sao Paulo, SP, Brazil"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.46292\/sci22-00036","article-title":"The International Standards for Neurological Classification of Spinal Cord Injury: classification accuracy and challenges","volume":"29","author":"Snider","year":"2023","journal-title":"Top Spinal Cord Inj Rehabil"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2915","DOI":"10.3390\/jcm13102915","article-title":"Evaluation and rehabilitation after adult lumbar spine 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