State-of-the-Art in Robotic Rehabilitation for Spinal Cord Injury Patients: A Literature Review.

Spinal cord injury (SCI) causes severe motor, sensory, and functional impairments, often leading to long-term disability. Conventional rehabilitation is labor-intensive and resource-demanding, whereas robotic rehabilitation enables repetitive, task-specific, and intensive training that promotes neuroplasticity. Evidence from clinical and randomized studies shows that upper limb robotic systems, including end-effector and exoskeleton types, improve motor outcomes, especially in the subacute phase. Moreover, hybrid approaches that integrate functional electrical stimulation or spinal cord stimulation appear to provide additional benefits. For lower extremity rehabilitation, ambulatory exoskeletons such as ReWalk, Ekso, Indego, HAL, Rex, Arke, and HANK have been demonstrated to offer safe and feasible gait training, with reported improvements in walking independence, balance, and stride parameters, although enhancements in gait speed remain modest. Preliminary evidence also suggests that exoskeleton-assisted walking may positively influence bowel and urinary function; however, current data are limited. Overall, robotic rehabilitation appears to be a safe and feasible adjunct to conventional therapy, offering moderate improvements in motor function and quality of life in patients with SCI. Nevertheless, further high-quality clinical trials and the integration of neuromodulatory techniques are required to more clearly establish its efficacy and define its role in routine clinical practice.