Journal CME March 2026: Metabolic intensity of gait training approaches in adults with spinal cord injury during inpatient rehabilitation: A substudy of a large randomized controlled trial-PM R - 2025 - Bosteder - Metabolic intensity of gait training approaches in adults with spinal cord injury during inpatient

PM R - 2025 - Bosteder - Metabolic intensity of gait training approaches in adults with spinal cord injury during inpatient

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This study investigated the metabolic intensity of two gait training approaches—overground robotic exoskeleton gait training (ORE) and usual care gait training (UC)—in adults with incomplete spinal cord injury (SCI) undergoing inpatient rehabilitation. Conducted as a substudy of a randomized controlled trial, it involved 10 participants (5 ORE, 5 UC) with diverse injury levels and severities, mostly male and averaging 45 years old. Using a wearable metabolic system (measuring oxygen consumption, VO2), metabolic intensity was assessed during initial and final gait training sessions.<br /><br />Both ORE and UC elicited moderate-to-high metabolic intensities, averaging about three metabolic equivalents (METs). The UC group had higher absolute metabolic intensity at both assessments, but the ORE group demonstrated a significant increase in metabolic intensity over time (VO2 increased by ~303 mL/min; effect size g=1.27), while the UC group’s intensity remained stable. The ORE group also showed improved functional gains, notably larger increases in transfer ability (CARE tool score) with a large effect size (g=1.05), and small improvements in walking metrics. The UC group had higher step counts at sessions and greater increases over time, but with a smaller effect size. Notably, the ORE group’s ratings of perceived exertion decreased despite increasing metabolic intensity, underscoring potential limitations of subjective exertion measures in SCI.<br /><br />Heart rate measurements were less reliable for intensity assessment due to autonomic dysregulation common in SCI patients, highlighting the value of direct metabolic monitoring. The study concluded that ORE can provide progressively increased metabolic intensity aligned with functional recovery, possibly overcoming limitations in UC where therapists may face constraints in scaling intensity. However, study limitations included small sample size, participant heterogeneity, and only two assessment points.<br /><br />Overall, this research supports the use of wearable metabolic technology to objectively measure and guide gait training intensity in SCI rehabilitation, suggesting that ORE offers a promising adaptive training modality that can enhance metabolic workload progressively during inpatient rehabilitation. Further larger-scale studies are recommended to confirm and expand these findings.

Keywords

overground robotic exoskeleton gait training

usual care gait training

incomplete spinal cord injury

metabolic intensity

oxygen consumption

metabolic equivalents (METs)

wearable metabolic system

functional recovery

perceived exertion

inpatient rehabilitation