BACKGROUND Powered exoskeletons provide a way to stand and walk for people with severe spinal cord injury. Here, we used the ReWalk exoskeleton to determine the training dosage required for walking proficiency, the sensory and motor changes in the nervous system with training, and the functionality of the device in a home-like environment. METHODS Participants with chronic (> 1 yr) motor complete or incomplete spinal cord injury, who were primarily wheelchair users, were trained to walk in the ReWalk for 12 weeks. Measures were taken before, during, immediately after, and 2-3 months after training. Measures included walking progression, sitting balance, skin sensation, spasticity, and strength of the corticospinal tracts. RESULTS Twelve participants were enrolled with 10 completing training. Training progression and walking ability: The progression in training indicated about 45 sessions to reach 80% of final performance in training. By the end of training, participants walked at speeds of 0.28-0.60 m/s, and distances of 0.74-1.97 km in 1 h. The effort of walking was about 3.3 times that for manual wheelchair propulsion. One non-walker with an incomplete injury became a walker without the ReWalk after training. Sensory and motor measures: Sitting balance was improved in some, as seen from the limits of stability and sway speed. Neuropathic pain showed no long term changes. Change in spasticity was mixed with suggestion of differences between those with high versus low spasticity prior to training. The strength of motor pathways from the brain to back extensor muscles remained unchanged. Adverse events: Minor adverse events were encountered by the participants and trainer (skin abrasions, non-injurious falls). Field testing: The majority of participants could walk on uneven surfaces outdoors. Some limitations were encountered in home-like environments. CONCLUSION For individuals with severe SCI, walking proficiency in the ReWalk requires about 45 sessions of training. The training was accompanied by functional improvements in some, especially in people with incomplete injuries. TRIAL REGISTRATION NCT02322125 Registered 22 December 2014.

中文翻译：

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脊髓损伤后动力外骨骼中地面行走的再训练：一项前瞻性队列研究，旨在检查功能获得性和神经可塑性。

背景技术动力外骨骼为患有严重脊髓损伤的人提供了站立和行走的方式。在这里，我们使用ReWalk外骨骼来确定步行熟练程度，训练后神经系统的感觉和运动变化以及在类似家庭环境中设备的功能所需的训练剂量。方法对患有慢性（> 1年）运动完全或不完全脊髓损伤的参与者（主要是轮椅使用者）进行了训练，使其能够在ReWalk中行走12周。在训练前，训练中，训练后和训练后2-3个月采取措施。测量包括步行进程，坐姿平衡，皮肤感觉，痉挛和皮质脊髓束的强度。结果12名参与者参加了10项完整的培训。训练进度和步行能力：训练的进度表明，大约有45次训练，达到了训练中最终成绩的80％。到训练结束时，参与者在1小时内的行走速度为0.28-0.60 m / s，距离为0.74-1.97 km。步行的力量约为手动轮椅推进力的3.3倍。一名未完全受伤的非步行者在训练后成为没有ReWalk的步行者。感觉和运动指标：从稳定性和摇摆速度的局限性来看，坐姿平衡有所改善。神经性疼痛无长期变化。痉挛的变化与训练前高痉挛与低痉挛之间的差异暗示着。从大脑到后伸肌的运动通路的强度保持不变。不良事件：参与者和教练员遇到了些许不利事件（皮肤擦伤，无伤害跌倒）。现场测试：大多数参与者可能会在户外不平坦的地面上行走。在类似家庭的环境中遇到了一些限制。结论对于患有严重SCI的人，在ReWalk中的步行能力需要进行约45次训练。培训伴随着一些功能的改善，特别是在不完全受伤的人中。试用注册NCT02322125，2014年12月22日注册。培训伴随着一些功能的改善，特别是在不完全受伤的人中。试用注册NCT02322125，2014年12月22日注册。培训伴随着一些功能的改善，特别是在不完全受伤的人中。试用注册NCT02322125，2014年12月22日注册。