ROBOT-ASSISTED LOCOMOTOR THERAPY IN THE REHABILITATION OF PATIENTS WITH SPINAL CORD INJURY

Thoracolumbar spinal cord injuries are associated with limited ability to attain an upright position, impaired balance, reduced exercise tolerance, and loss of independent walking. One of the promising approaches in motor rehabilitation is the use of robotic exoskeleton systems, which reproduce a near-physiological gait pattern and allow repeated performance of locomotor movements. Objective - to evaluate the effects of robot-assisted exoskeleton therapy on tolerance to vertical loading, balance, coordination, walking ability, and functional independence in pa­tients with thoracolumbar spinal cord injuries. Materials and Methods: the study included 78 patients aged 18–65 years with motor-incomplete spinal cord injuries at the Th10–L2 level classified as AIS C–D. The main group comprised 40 patients who received standard rehabilitation combined with exoskeleton-assisted therapy, while the comparison group included 38 patients who underwent standard restorative treatment. The treatment course consisted of 20 sessions lasting 30–45 minutes, performed five times per week. Effectiveness was assessed before treatment, after 4 weeks, and at 3 months using the duration of tolerated standing, the six-minute walk distance, 10-m walking speed, the Walking Index for Spinal Cord Injury II, computerized stabilography, and the Spinal Cord Independence Measure III. Results: after 3 months, tolerance to vertical loading increased from 8.7±3.1 to 35.2±8.4 minutes in the main group and from 8.9±3.2 to 23.6±7.3 minutes in the comparison group (p<0.001). The six-minute walk distance reached 158.2±43.6 and 112.4±38.9 m, respectively, while walking speed was 0.32±0.11 and 0.22±0.09 m/s (p<0.001). The Walking Index for Spinal Cord Injury II increased to 12.7±3.5 points in the main group compared with 9.4±3.3 points in the comparison group. The center-of-pressure sway area decreased by 49.8% in the main group and by 27.4% in the comparison group. The most pronounced improvement was observed in patients classified as AIS D and in those with a baseline strength of at least 3 points in the key lower-extremity muscle groups. Conclusion: the inclusion of exoskeleton-assisted therapy in the comprehensive rehabilitation of patients with thoracolumbar spinal cord injuries improves tolerance to vertical loading, balance, coordination, and walking ability, while also promoting greater func­tional independence.