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. 2025 Aug 14.
doi: 10.1002/pmrj.70007. Online ahead of print.

Metabolic intensity of gait training approaches in adults with spinal cord injury during inpatient rehabilitation: A substudy of a large randomized controlled trial

Katelyn D Bosteder  1 , Neha Chand  1 , Dannae Arnold  1   2 , Jaime Gillespie  1   2 , Lindsey Wynne  1   2 , Sara Baltz  1   2 , Monica Bennett  1 , Faith Meza  1   2 , Seema Sikka  2 , Simon Driver  1   2 , Chad Swank  1   2
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Metabolic intensity of gait training approaches in adults with spinal cord injury during inpatient rehabilitation: A substudy of a large randomized controlled trial

Katelyn D Bosteder et al. PM R. .

Abstract

Background: Gait training approaches that facilitate moderate-to-high intensities while adapting to individual capabilities can enhance walking recovery and cardiovascular fitness in persons with incomplete spinal cord injury (SCI).

Objective: To measure and compare the metabolic intensity of overground robotic exoskeleton gait training (ORE) and usual care gait training (UC) among patients with incomplete SCI during inpatient rehabilitation.

Design: Substudy of a prospective randomized control trial.

Setting: Inpatient rehabilitation hospital.

Participants: Patients >15 years of age with incomplete SCI.

Interventions: ORE and UC.

Main outcome measures: Metabolic intensity during gait training (oxygen consumption [VO2]) was measured during the initial and final gait training sessions in inpatient rehabilitation using a wearable metabolic system. Hedges' g effect sizes were calculated to estimate the magnitude of change in metabolic intensity between ORE and UC.

Results: Ten (n = 5 ORE, n = 5 UC) patients ([mean ± SD] 45.1 ± 9.5 years old, 90% male, 60% White, and 80% non-Hispanic) completed both metabolic assessments. Assessments were 30.7 ± 17.8 days post SCI, and the median (min-max) inpatient rehabilitation length of stay was 35.5 (27-51) days. Injury characteristics included incomplete American Spinal Injury Association Impairment Scale (AIS) C (60%), AIS D (40%), paraplegia (40%), and tetraplegia (60%). ORE metabolic intensity was 616.2 ± 340.9 mL/min during initial and 919.6 ± 480.1 mL/min during final assessments (change = 303.4 ± 314.4 mL/min). UC metabolic intensity was 1088.9 ± 582.8 mL/min during initial and 1098.8 ± 644.4 mL/min during final assessments (change = 9.8 ± 93.6 mL/min). Large effect sizes were observed in the increase in metabolic intensity (g = 1.27) from initial to final gait training sessions between groups.

Conclusions: ORE and UC elicited moderate-to-high metabolic intensity among patients with incomplete SCI in inpatient rehabilitation. Greater increases in metabolic intensity from initial to final assessments were observed in the ORE group, suggesting the potential for ORE to support progressive increases in training intensity alongside functional recovery during inpatient rehabilitation.

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