Modulation of neuropathic pain and tactile perception in spinal cord injury during an exoskeleton training program

In our investigation, we explored the potential advantages of extended training with a powered exo-skeleton on tactile perception and neuropathic pain among individuals with spinal cord injuries (SCI). Nineteen participants with complete and incomplete spinal cord lesions below T4 were enlisted. Tac-tile threshold and neuropathic pain were evaluated using a computerized pressure algometer, Nu-merical Rating Scale (NRS), and Neuropathic Pain Questionnaire in Spinal Cord Injury (NPQSCI) at three intervals: before each training session (T0), after 9 sessions (T1), and after 18 sessions (T2) with the ReWalk exoskeleton. Results revealed notable enhancement in tactile sensitivity at T1 and T2, particularly in the upper limb. Likewise, pain intensity exhibited a reduction exceeding 30% across all sessions, as illustrated in the accompanying graph, notably pronounced in the lower limb. Additional-ly, a significant correlation emerged between pain intensity and improvements in tactile sensitivity, suggesting that the extent of tactile sensitivity enhancement varied with pain intensity. Hence, our study underscores the potential of prolonged exoskeleton utilization as a promising rehabilitation av-enue vis-à-vis conventional pharmacological approaches in mitigating neuropathic pain. These train-ing regimens facilitate adaptive neuroplasticity processes, pivotal in ameliorating key clinical manifes-tations of SCI. By aiding in the reconfiguration of altered brain-body representations, particularly for the upper legs, which assume a more active functional role compared to wheelchair use, exoskeleton training contributes to enhancing patients' autonomy and functional capacity.