Exoskeleton Robot Gait Training and Its Impact on the Gut Microbiota-Brain Axis in Incomplete Spinal Cord Injury Patients: A Narrative Review of Rehabilitation Mechanisms

Oct 13, 2025Journal of multidisciplinary healthcare

How Walking with a Robot Exoskeleton May Affect Gut-Brain Communication in People with Partial Spinal Cord Injury

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Abstract

Exoskeleton robot-assisted gait training may improve motor function and restore microbial homeostasis in patients with incomplete spinal cord injury.

Significant occurs after spinal cord injury, featuring reduced microbial diversity and altered taxonomic representation.
Altered gut microbiome composition is associated with neuroinflammation, autonomic dysfunction, and impaired recovery.
Exoskeleton-mediated gait rehabilitation may regulate the autonomic nervous system and modify intestinal transit time.
These interventions could improve intestinal barrier integrity and modulate immune responses.
Microbiome changes may facilitate neuroplasticity and functional recovery through metabolites that influence brain activity.

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Exoskeleton robot-assisted gait training represents a significant advancement in neurorehabilitation for patients with incomplete spinal cord injury (iSCI). While its efficacy in improving motor function is increasingly documented, emerging evidence suggests these interventions may exert therapeutic effects through previously unrecognized physiological pathways involving the -brain axis. This review synthesizes current evidence regarding the bidirectional relationship between exoskeleton-based locomotor training and alterations in gut microbiome composition and function in the context of iSCI. Following spinal cord injury, significant occurs, characterized by reduced microbial diversity and altered taxonomic representation, which correlates with neuroinflammation, autonomic dysfunction, and impaired recovery. Exoskeleton-mediated gait rehabilitation appears to partially restore microbial homeostasis through multiple mechanisms, including autonomic nervous system regulation, altered intestinal transit time, modified intestinal barrier integrity, and immunomodulation. These microbiome modifications potentially facilitate neuroplasticity and functional recovery through microbiota-derived metabolites that traverse the blood-brain barrier or communicate via vagal afferents. The integration of metagenomic analysis with functional neuroimaging and detailed autonomic assessment in prospective studies represents a critical research direction. This emerging perspective extends beyond biomechanical rehabilitation, suggesting a comprehensive neurobiological effect that includes modulation of the microbiota-gut-brain axis, with significant implications for optimizing therapeutic strategies for individuals with incomplete spinal cord injury.

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Exoskeleton Robot Gait Training and Its Impact on the Gut Microbiota-Brain Axis in Incomplete Spinal Cord Injury Patients: A Narrative Review of Rehabilitation Mechanisms

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