{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:06:37Z","timestamp":1792454797924,"version":"4.5.0"},"reference-count":65,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Spinal cord injury (SCI) is an acute, devastating neurologic condition that results in permanent progressive motor deficits, sensory disturbances, and autonomic dysfunctions, which limit function, participation, and quality of life. Although substantial progress has been made during the last several decades for both early trauma care and rehabilitation protocols following SCI, long-term neurological recovery remains unpredictable and often incomplete. This manuscript summarizes mechanistic and clinical evidence regarding robotic-assisted rehabilitation (RAR) and spinal neuromodulation (SN), which have been published since 2010 until the present time in a structured narrative review of the literature on these two emerging areas for neurorehabilitation after SCI. RAR provides high-intensity, task-specific training that consistently results in improvements in functional outcomes such as balance, coordination, and independence; however, its impact is limited when it comes to walking speed or voluntary motor control. SN (particularly epidural stimulation) can activate the residual neural pathways to standing up and stepping even after a complete injury but effects are typically stimulus dependent, with heterogeneous clinical results that often lack strong long-term evidence due in part to variability in patient selection, stimulation parameters and rehabilitation protocols. However, there is emerging mechanistic data supporting combining modulation of excitability through SN approaches along with structured sensorimotor training as an approach for enhancing recovery. Collectively, these findings support a shift toward more physiology-driven neurorehabilitation strategies and the need for future research to improve clinical translation and outcome predictability by patient stratification using standardized intervention protocols that include longitudinal evaluation.<\/jats:p>","DOI":"10.3390\/jcm15093401","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T12:31:56Z","timestamp":1777465916000},"page":"3401","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Robotic-Assisted Rehabilitation and Spinal Neuromodulation After Spinal Cord Injury: From Mechanisms to Trial-Informed Practice"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1570-3502","authenticated-orcid":false,"given":"Valerio","family":"Pisani","sequence":"first","affiliation":[{"name":"Spinal Center, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy"},{"name":"Spinal Rehabilitation (SpiRe) Lab, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"Covella","sequence":"additional","affiliation":[{"name":"Spinal Center, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Di Fonzo","sequence":"additional","affiliation":[{"name":"Spinal Center, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Di Pasquale","sequence":"additional","affiliation":[{"name":"Spinal Center, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy"},{"name":"Spinal Rehabilitation (SpiRe) Lab, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Garcovich","sequence":"additional","affiliation":[{"name":"Spinal Center, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuela","family":"Lena","sequence":"additional","affiliation":[{"name":"Spinal Center, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy"},{"name":"Spinal Rehabilitation (SpiRe) Lab, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1809-7386","authenticated-orcid":false,"given":"Marta","family":"Mascanzoni","sequence":"additional","affiliation":[{"name":"Department of Human Sciences, LUMSA University of Rome, 00193 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Scivoletto","sequence":"additional","affiliation":[{"name":"Spinal Unit, CTO \u201cAndrea Alesini\u201d Hospital, 00145 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1097\/BRS.0000000000004417","article-title":"Spinal Cord Injury: The Global Incidence, Prevalence, and Disability from the Global Burden of Disease Study","volume":"47","author":"Ding","year":"2022","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"8","DOI":"10.5312\/wjo.v6.i1.8","article-title":"Rehabilitation of Spinal Cord Injuries","volume":"6","author":"Nas","year":"2015","journal-title":"World J. Orthop."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/1743-0003-10-5","article-title":"The Physiological Basis of Neurorehabilitation\u2014Locomotor Training after Spinal Cord Injury","volume":"10","author":"Hubli","year":"2013","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1152\/physrev.00015.2019","article-title":"Current Principles of Motor Control, with Special Reference to Vertebrate Locomotion","volume":"100","author":"Grillner","year":"2020","journal-title":"Physiol. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.wneu.2024.01.167","article-title":"Exoskeleton-Assisted Rehabilitation and Neuroplasticity in Spinal Cord Injury","volume":"185","author":"He","year":"2024","journal-title":"World Neurosurg."},{"key":"ref_6","doi-asserted-by":"crossref","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","year":"2011","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Hofstoetter, U.S., and Minassian, K. (2022). Transcutaneous Spinal Cord Stimulation: Advances in an Emerging Non-Invasive Strategy for Neuromodulation. J. Clin. Med., 11.","DOI":"10.3390\/jcm11133836"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1093\/brain\/awt262","article-title":"Restoration of Sensorimotor Functions after Spinal Cord Injury","volume":"137","author":"Dietz","year":"2014","journal-title":"Brain"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1038\/s41393-022-00751-8","article-title":"Walking Improvement in Chronic Incomplete Spinal Cord Injury with Exoskeleton Robotic Training (WISE): A Randomized Controlled Trial","volume":"60","author":"Edwards","year":"2022","journal-title":"Spinal Cord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"eadn5564","DOI":"10.1126\/scirobotics.adn5564","article-title":"Augmenting Rehabilitation Robotics with Spinal Cord Neuromodulation: A Proof of Concept","volume":"10","author":"Hankov","year":"2025","journal-title":"Sci. Robot."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1038\/s41591-018-0175-7","article-title":"Neuromodulation of Lumbosacral Spinal Networks Enables Independent Stepping after Complete Paraplegia","volume":"24","author":"Gill","year":"2018","journal-title":"Nat. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1186\/s12984-025-01649-1","article-title":"Comparative Efficacy of Robotic Exoskeleton and Conventional Gait Training in Patients with Spinal Cord Injury: A Meta-Analysis of Randomized Controlled Trials","volume":"22","author":"Liu","year":"2025","journal-title":"J. NeuroEng. Rehabil."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1056\/NEJMoa1803588","article-title":"Recovery of Over-Ground Walking after Chronic Motor Complete Spinal Cord Injury","volume":"379","author":"Angeli","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2064","DOI":"10.1038\/s41467-023-37845-7","article-title":"A Case Study of Percutaneous Epidural Stimulation to Enable Motor Control in Two Men after Spinal Cord Injury","volume":"14","author":"Gorgey","year":"2023","journal-title":"Nat. Commun."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1089\/neu.2023.0403","article-title":"Standing Reactive Postural Responses of Lower Limbs with and without Self-Balance Assistance in Individuals with Spinal Cord Injury Receiving Epidural Stimulation","volume":"41","author":"Bowersock","year":"2024","journal-title":"J. Neurotrauma"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Cano-de-la-Cuerda, R., Bl\u00e1zquez-Fern\u00e1ndez, A., Marcos-Ant\u00f3n, S., S\u00e1nchez-Herrera-Baeza, P., Fern\u00e1ndez-Gonz\u00e1lez, P., Collado-V\u00e1zquez, S., Jim\u00e9nez-Antona, C., and Laguarta-Val, S. (2024). Economic Cost of Rehabilitation with Robotic and Virtual Reality Systems in People with Neurological Disorders: A Systematic Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13061531"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Flores, A., L\u00f3pez-Santos, D., and Garc\u00eda-Al\u00edas, G. (2021). When Spinal Neuromodulation Meets Sensorimotor Rehabilitation: Lessons Learned from Animal Models to Regain Manual Dexterity after a Spinal Cord Injury. Front. Rehabil. Sci., 2.","DOI":"10.3389\/fresc.2021.755963"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1097\/PHM.0b013e318269d9a3","article-title":"The ReWalk Powered Exoskeleton to Restore Ambulatory Function to Individuals with Thoracic-Level Motor-Complete Spinal Cord Injury","volume":"91","author":"Esquenazi","year":"2012","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1310\/sci2102-93","article-title":"Mobility Outcomes Following Five Training Sessions with a Powered Exoskeleton","volume":"21","author":"Hartigan","year":"2015","journal-title":"Top. Spinal Cord. Inj. Rehabil."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.brainresbull.2008.09.018","article-title":"Robotic training and spinal cord plasticity","volume":"78","author":"Edgerton","year":"2009","journal-title":"Brain Res. Bull."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1038\/s41393-024-00970-1","article-title":"Effect on Functional Outcome of Robotic Assisted Rehabilitation versus Conventional Rehabilitation in Patients with Complete Spinal Cord Injury: A Prospective Comparative Study","volume":"62","author":"Khande","year":"2024","journal-title":"Spinal Cord."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1016\/j.apmr.2025.04.015","article-title":"Overground Robotic Exoskeleton Gait Training in People with Incomplete Spinal Cord Injury During Inpatient Rehabilitation: A Randomized Control Trial","volume":"106","author":"Swank","year":"2025","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_23","first-page":"455","article-title":"Clinical Effectiveness and Safety of Powered Exoskeleton-Assisted Walking in Patients with Spinal Cord Injury: Systematic Review with Meta-Analysis","volume":"9","author":"Miller","year":"2016","journal-title":"Med. Devices"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s12984-015-0074-9","article-title":"Spinal Cord Injury Research Evidence (SCIRE) Research Team. Gait Speed Using Powered Robotic Exoskeletons after Spinal Cord Injury: A Systematic Review and Correlational Study","volume":"12","author":"Louie","year":"2015","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Pro\u0144czuk, M., Skalski, D., \u0141osinska, K., Markowski, J., Pilch, J., Toborek, M., and Maszczyk, A. (2026). The impact of robot-assisted training on gait, balance, and endurance in patients with partial spinal cord injuries: Insights from rehabilitation. J. Neuroeng. Rehabil., Epub ahead of printing.","DOI":"10.1186\/s12984-026-01977-w"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"806","DOI":"10.2340\/16501977-2372","article-title":"Exoskeleton Gait Training after Spinal Cord Injury: An Exploratory Study on Secondary Health Conditions","volume":"50","author":"Baunsgaard","year":"2018","journal-title":"J. Rehabil. Med."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Pournajaf, S., Morone, G., Felzani, G., Pellicciari, L., Cocco, E.S., Manzia, C.M., Simoncini, L., Calabr\u00f2, R.S., and Franceschini, M. (2026). Wearable powered overground exoskeleton reduces dose-dependently the spasticity in individuals with spinal cord injury. Spinal Cord, Epub ahead of printing.","DOI":"10.1038\/s41393-026-01181-6"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Ilies, A.B., Cheregi, C., Thowayeb, H.H., Wendt, J.R., Horgos, M.S., and Lazar, L. (2025). Lokomat-Assisted Robotic Rehabilitation in Spinal Cord Injury: A Biomechanical and Machine Learning Evaluation of Functional Symmetry and Predictive Factors. Bioengineering, 12.","DOI":"10.3390\/bioengineering12070752"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1080\/10790268.2023.2200362","article-title":"Feasibility, Safety, and Functional Outcomes Using the Neurologically Controlled Hybrid Assistive Limb Exoskeleton (HAL\u00ae) Following Acute Incomplete and Complete Spinal Cord Injury\u2014Results of 50 Patients","volume":"46","author":"Aach","year":"2023","journal-title":"J. Spinal Cord Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s12984-017-0274-6","article-title":"Results of the First Interim Analysis of the RAPPER II Trial in Patients with Spinal Cord Injury: Ambulation and Functional Exercise Programs in the REX Powered Walking Aid","volume":"14","author":"Birch","year":"2017","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1080\/10790268.2021.1983314","article-title":"Exoskeleton Use in Acute Rehabilitation Post Spinal Cord Injury: A Qualitative Study Exploring Patients\u2019 Experiences","volume":"45","author":"Charbonneau","year":"2022","journal-title":"J. Spinal Cord Med."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Chen, S., Wang, Z., Li, Y., Tang, J., Wang, X., Huang, L., Fang, Z., Xu, T., Xu, J., and Guo, F. (2022). Safety and Feasibility of a Novel Exoskeleton for Locomotor Rehabilitation of Subjects with Spinal Cord Injury: A Prospective, Multi-Center, and Cross-over Clinical Trial. Front. Neurorobot., 16.","DOI":"10.3389\/fnbot.2022.848443"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s12938-026-01532-7","article-title":"Walking rehabilitation in incomplete spinal cord injury: Evaluating the impact of robotic exoskeleton-assisted training","volume":"25","author":"Khadour","year":"2026","journal-title":"Biomed. Eng. Online"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s12984-017-0232-3","article-title":"Robot-Assisted Gait Training (Lokomat) Improves Walking Function and Activity in People with Spinal Cord Injury: A Systematic Review","volume":"14","author":"Nam","year":"2017","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"031001","DOI":"10.1088\/1741-2560\/13\/3\/031001","article-title":"Powered Exoskeletons for Bipedal Locomotion after Spinal Cord Injury","volume":"13","author":"Brantley","year":"2016","journal-title":"J. Neural. Eng."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Lillelund S\u00f8rensen, S., J\u00f8nsson, A.B., Harvey, L.A., Biering-S\u00f8rensen, F., and Nielsen, J.F. (2026). A robotic-assisted intervention (ROBERT\u00ae) to enhance muscle strength in the hip flexor muscles following spinal cord injury: A pilot within-person randomized controlled trial. J. Spinal Cord. Med., Epub ahead of printing.","DOI":"10.1080\/10790268.2025.2488573"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1007\/s13311-018-0642-3","article-title":"Robotic Rehabilitation and Spinal Cord Injury: A Narrative Review","volume":"15","author":"Mekki","year":"2018","journal-title":"Neurotherapeutics"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Rejc, E., Angeli, C.A., and Harkema, S.J. (2015). Effects of Lumbosacral Spinal Cord Epidural Stimulation for Standing after Chronic Complete Paralysis in Humans. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0133998"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1089\/neu.2023.0265","article-title":"Recovery of Volitional Motor Control and Overground Walking in Participants with Chronic Clinically Motor Complete Spinal Cord Injury: Restoration of Rehabilitative Function with Epidural Spinal Stimulation (RESTORES) Trial-A Preliminary Study","volume":"41","author":"Wan","year":"2024","journal-title":"J. Neurotrauma"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Chalif, J.I., Chavarro, V.S., Mensah, E., Johnston, B., Fields, D.P., Chalif, E.J., Chiang, M., Sutton, O., Yong, R., and Trumbower, R. (2024). Epidural Spinal Cord Stimulation for Spinal Cord Injury in Humans: A Systematic Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13041090"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1016\/j.neurom.2025.01.005","article-title":"Safety and Effectiveness of Multisite Transcutaneous Spinal Cord Stimulation Combined with Activity-Based Therapy When Delivered in a Community Rehabilitation Setting: A Real-World Pilot Study","volume":"28","author":"Suggitt","year":"2025","journal-title":"Neuromodulation"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"pzab228","DOI":"10.1093\/ptj\/pzab228","article-title":"Multisite Transcutaneous Spinal Stimulation for Walking and Autonomic Recovery in Motor-Incomplete Tetraplegia: A Single-Subject Design","volume":"102","author":"Samejima","year":"2022","journal-title":"Phys. Ther."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1080\/10790268.2024.2383377","article-title":"Functional outcomes and participants\u2019 perspectives during short-term application of spinal stimulation in individuals with spinal cord injury","volume":"48","author":"Veith","year":"2025","journal-title":"J. Spinal Cord. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e361","DOI":"10.1016\/j.wneu.2023.06.050","article-title":"Utilizing Neuromodulation in the Treatment of Spinal Cord Injury: An Assessment of Clinical Trials from the National ClinicalTrials.Gov Database","volume":"177","author":"Abraham","year":"2023","journal-title":"World Neurosurg."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Rybka, V., Sediva, K., Spackova, L., Kolar, P., Bradac, O., and Kriz, J. (2025). Effect of Epidural Spinal Cord Stimulation in Individuals with Sensorimotor Complete Spinal Cord Injury: A Pilot Study. Front. Syst. Neurosci., 19.","DOI":"10.3389\/fnsys.2025.1622033"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1186\/s40001-025-02689-y","article-title":"Neuromodulation Techniques for the Treatment of Spinal Cord Injury: Current Progress, Challenges, and Future Prospects","volume":"30","author":"Wenqiang","year":"2025","journal-title":"Eur. J. Med. Res."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Al\u00e9n, L., Kumru, H., Castillo-Escario, Y., Benito-Penalva, J., Medina-Casanovas, J., Gerasimenko, Y.P., Edgerton, V.R., Garc\u00eda-Al\u00edas, G., and Vidal, J. (2023). Transcutaneous Cervical Spinal Cord Stimulation Combined with Robotic Exoskeleton Rehabilitation for the Upper Limbs in Subjects with Cervical SCI: Clinical Trial. Biomedicines, 11.","DOI":"10.3390\/biomedicines11020589"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1038\/nature20118","article-title":"A Brain\u2013Spine Interface Alleviating Gait Deficits after Spinal Cord Injury in Primates","volume":"539","author":"Capogrosso","year":"2016","journal-title":"Nature"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1126\/science.1217416","article-title":"Restoring Voluntary Control of Locomotion after Paralyzing Spinal Cord Injury","volume":"336","author":"Heutschi","year":"2012","journal-title":"Science"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Lu, Y., Shang, Z., Zhang, W., Pang, M., Hu, X., Dai, Y., Shen, R., Wu, Y., Liu, C., and Luo, T. (2024). Global incidence and characteristics of spinal cord injury since 2000-2021: A systematic review and meta-analysis. BMC Med., 22.","DOI":"10.1186\/s12916-024-03514-9"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1146\/annurev-neuro-061010-113746","article-title":"Recovery of Locomotion after Spinal Cord Injury: Some Facts and Mechanisms","volume":"34","author":"Rossignol","year":"2011","journal-title":"Annu. Rev. Neurosci."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Hu, X., Feng, J., Lu, J., Pang, R., Zhang, A., Liu, J., Gou, X., Bai, X., Wang, J., and Chang, C. (2024). Effects of Exoskeleton-Assisted Walking on Bowel Function in Motor-Complete Spinal Cord Injury Patients: Involvement of the Brain\u2013Gut Axis (a Pilot Study). Front. Neurosci., 18.","DOI":"10.3389\/fnins.2024.1395671"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"jrm00222","DOI":"10.2340\/16501977-2864","article-title":"Exoskeleton Gait Training to Improve Lower Urinary Tract Function in People with Motor-Complete Spinal Cord Injury: A Randomized Pilot Trial","volume":"53","author":"Williams","year":"2021","journal-title":"J. Rehabil. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1186\/s12984-021-00880-w","article-title":"Exoskeleton-Assisted Walking Improves Pulmonary Function and Walking Parameters among Individuals with Spinal Cord Injury: A Randomized Controlled Pilot Study","volume":"18","author":"Xiang","year":"2021","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1016\/j.apmr.2021.03.018","article-title":"Robotic Locomotor Training Leads to Cardiovascular Changes in Individuals with Incomplete Spinal Cord Injury Over a 24-Week Rehabilitation Period: A Randomized Controlled Pilot Study","volume":"102","author":"Evans","year":"2021","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"57","DOI":"10.3233\/NRE-130928","article-title":"Improved Motor Performance in Chronic Spinal Cord Injury Following Upper-Limb Robotic Training","volume":"33","author":"Cortes","year":"2013","journal-title":"NeuroRehabilitation"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"445","DOI":"10.5535\/arm.2019.43.4.445","article-title":"Effects of Combined Upper Limb Robotic Therapy in Patients with Tetraplegic Spinal Cord Injury","volume":"43","author":"Jung","year":"2019","journal-title":"Ann. Rehabil. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1109\/TNSRE.2018.2854605","article-title":"Modeling and Simulation of a Lower Extremity Powered Exoskeleton","volume":"26","author":"Fournier","year":"2018","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Jaszczuk, P., Bratelj, D., Capone, C., Rudnick, M., P\u00f6tzel, T., Verma, R.K., and Fiechter, M. (2025). Advances in Neuromodulation and Digital Brain\u2013Spinal Cord Interfaces for Spinal Cord Injury. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26136021"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1109\/TNSRE.2024.3364517","article-title":"Multi Degree-of-Freedom Hybrid FES and Robotic Control of the Upper Limb","volume":"32","author":"Dunkelberger","year":"2024","journal-title":"IEEE Trans. Neural Syst. Rehabil. Eng."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1508","DOI":"10.1016\/j.apmr.2011.01.024","article-title":"Balance and Ambulation Improvements in Individuals with Chronic Incomplete Spinal Cord Injury Using Locomotor Training-Based Rehabilitation","volume":"93","author":"Harkema","year":"2012","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1146\/annurev-neuro-070918-050436","article-title":"Dexterous Hand Movements and Their Recovery after Central Nervous System Injury","volume":"42","author":"Isa","year":"2019","journal-title":"Annu. Rev. Neurosci."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1038\/s41393-019-0319-8","article-title":"Neurochemical biomarkers in spinal cord injury","volume":"57","author":"Kwon","year":"2019","journal-title":"Spinal Cord"},{"key":"ref_64","doi-asserted-by":"crossref","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":"Aach","year":"2015","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1007\/s10439-020-02611-z","article-title":"Robotic Rehabilitation in Spinal Cord Injury: A Pilot Study on End-Effectors and Neurophysiological Outcomes","volume":"49","author":"Filoni","year":"2021","journal-title":"Ann. Biomed. Eng."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3401\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T04:21:33Z","timestamp":1778214093000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3401"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":65,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15093401"],"URL":"https:\/\/doi.org\/10.3390\/jcm15093401","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,29]]}}}