Who benefits most from exoskeleton walking therapy?
The strongest evidence points to people with incomplete spinal cord injuries (iSCI) — those who retain some movement or sensation below their injury level. In a randomized controlled trial of 25 participants with chronic iSCI, those who used an Ekso exoskeleton for 12 weeks (36 sessions) were significantly more likely to improve their clinical ambulation category from home-level to community-level walking speeds compared to those who received standard therapy or no gait training [2]. Specifically, over half of the exoskeleton group achieved this milestone, compared to only one-third in the active control group and none in the passive control group [2]. This means the device helped people walk fast enough to cross a street or navigate a grocery store — a real-world functional gain.
People with complete SCI (no motor function below the injury) also benefit, but differently. A retrospective study of 18 patients found that those with motor-complete injuries improved their Walking Index for Spinal Cord Injury (WISCI-II) scores from 0 (unable to walk) to an average of 3 (walking with a walker and moderate assistance) after about 18 weeks of exoskeleton training [1]. While this is a meaningful gain in mobility, it does not represent independent walking without the device. For these individuals, the exoskeleton functions as a powered orthosis that enables standing and stepping with crutches or a walker, providing cardiovascular exercise, improved bowel/bladder function, and psychological benefits [6].
How much walking improvement can someone expect?
The improvements are modest but real. Across multiple studies, average walking speed with an exoskeleton ranges from 0.31 to 0.39 meters per second [3][5] — about one-third the speed of a typical adult (1.4 m/s). However, this speed is enough for limited household or community ambulation. A systematic review of 28 studies involving 228 patients found that the average distance covered in a 6-minute walk test was 108.9 meters (about 119 yards) [5]. For context, that's roughly the length of a football field, which is sufficient for crossing a parking lot or moving through a clinic.
Importantly, training leads to improvements over time. In one study, patients with motor-complete SCI increased their step count from an average of 340 steps per session to 840 steps over 18 weeks — more than doubling their walking volume [1]. Those with motor-incomplete injuries showed even larger gains, improving their WISCI-II scores from near 0 to an average of 9 (walking with a walker and minimal assistance) [1]. A separate study of 33 people with incomplete SCI found that personalized exoskeleton training (up to 39 sessions) led to overall improvements in endurance and performance, with the largest gains seen in those with thoracic-level injuries [7].
What other benefits does exoskeleton training provide?
Exoskeleton training offers benefits beyond just walking. A pilot study of 42 patients with SCI found that those who trained with an Ekso exoskeleton showed significant improvements in body representation (how they perceived their own body) and quality of life compared to those who received conventional physical therapy [4]. Specifically, the exoskeleton group reported less psychological distress related to their body image and better perception of their legs, along with improved scores on the Short-Form-12 quality-of-life questionnaire [4].
The training also appears safe and may reduce certain secondary complications. In a multicenter study of 52 participants, researchers found that spasticity decreased immediately after each exoskeleton training session [6]. While pain levels did not change long-term, the training did not provoke new pain — a common concern with any new therapy [6]. Chronically injured participants also reported improved life satisfaction and small but significant gains in independence (measured by the Spinal Cord Independence Measure) after 8 weeks of training [6]. These findings suggest that exoskeleton therapy addresses the whole person, not just their walking ability.
Sources used in this answer
Clinical Delivery of Overground Exoskeleton Gait Training in Persons With Spinal Cord Injury Across the Continuum of Care: A Retrospective Analysis.
Patients with motor-complete SCI improved WISCI-II scores from 0 to 3, and those with motor-incomplete SCI improved from 0.2 to 9.0 after 18 weeks of exoskeleton training [1].
Walking improvement in chronic incomplete spinal cord injury with exoskeleton robotic training (WISE): a randomized controlled trial
In a randomized trial, over half of chronic iSCI participants using an exoskeleton improved from home to community walking speeds, versus none in the passive control group [4].
Biomechanical differences between able-bodied and spinal cord injured individuals walking in an overground robotic exoskeleton.
Walking speed in the ReWalk exoskeleton ranged from 0.32-0.39 m/s for both SCI and able-bodied users, with no difference in key biomechanical parameters between groups [6].
Body Representation in Patients with Severe Spinal Cord Injury: A Pilot Study on the Promising Role of Powered Exoskeleton for Gait Training
SCI patients who trained with an exoskeleton showed significantly greater improvements in body representation and quality of life compared to conventional therapy [7].
Wearable robotic exoskeleton for gait reconstruction in patients with spinal cord injury: A literature review
Across 28 studies, average exoskeleton walking speed was 0.31 m/s and 6-minute walk distance was 108.9 meters [10].
Exoskeleton gait training after spinal cord injury: An exploratory study on secondary health conditions.
Exoskeleton training reduced spasticity immediately after sessions and improved life satisfaction in chronically injured participants [11].
Personalized Exoskeleton Gait Training in Incomplete Spinal Cord Injury
Personalized exoskeleton training (up to 39 sessions) improved endurance and performance in 33 incomplete SCI patients, with greatest gains in thoracic-level injuries [14].