Powered Exoskeleton for Ambulation in Patients with Lower-Limb Disabilities Form

500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 1 (401) 274-4848 WWW.BCBSRI.COM EFFECTIVE DATE: 11|01|2024 POLICY LAST REVIEWED: 05|07|2025 OVERVIEW The goal of the powered exoskeleton is to enable people who do not have volitional movement of their lower extremities to be able to fully bear weight while standing, to walk, and to navigate stairs. The devices have the potential to restore mobility and, thus, might improve functional status, quality of life, and health status for patients with spinal cord injury, multiple sclerosis, amyotrophic lateral sclerosis, Guillain-Barré syndrome, and spina bifida. MEDICAL CRITERIA Not applicable
PRIOR AUTHORIZATION Not applicable
POLICY STATEMENT Medicare Advantage Plans Use of a powered exoskeleton for ambulation in individuals with lower-limb disabilities is not covered as the evidence is insufficient to determine the effects of the technology on health outcomes.
Commercial Products Use of a powered exoskeleton for ambulation in individuals with lower-limb disabilities is considered not medically necessary as the evidence is insufficient to determine the effects of the technology on health outcomes. COVERAGE Benefits may vary between groups and contracts. Please refer to the appropriate Benefit Booklet, Evidence of Coverage or Subscriber Agreement for not covered/not medically necessary benefits/coverage.
BACKGROUND An exoskeleton is an external structure with joints and links that might be regarded as wearable robots designed around the shape and function of the human body. A powered exoskeleton, as described in this evidence review, consists of an exoskeleton-like framework worn by a person that includes a power source supplying energy for limb movement.
One type of powered lower-limb exoskeleton (eg, ReWalk, Indego) provides user-initiated mobility based on postural information. Standing, walking, sitting, and stair up/down modes are determined by a mode selector on a wristband. ReWalk includes an array of sensors and proprietary algorithms that analyze body movements (eg, tilt of the torso) and manipulate the motorized leg braces. The tilt sensor is used to signal the onboard computer when to take the next step. Patients using the powered exoskeleton must be able to use their hands and shoulders with forearm crutches or a walker to maintain balance. Instructions for ambulating with ReWalk1, are to place the crutches ahead of the body, and then bend the elbows slightly, shifting weight toward the front leg, leaning toward the front leg side. The rear leg will lift slightly off of the ground and then begin to move forward. Using the crutches to straighten up will enable the rear leg to continue moving forward. The process is repeated with the other leg.
Medical Coverage Policy | Powered Exoskeleton for Ambulation in Patients with Lower-Limb Disabilities

500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 2 (401) 274-4848 WWW.BCBSRI.COM

To move from a seated to standing position or vice versa, the desired movement is selected by the mode selector on the wrist. There is a 5-second delay to allow the individual to shift weight (forward for sit-to-stand and slightly backward for stand-to-sit) and to place their crutches in the correct position. If the user is not in an appropriate position, a safety mechanism will be triggered. Walking can only be enabled while standing, and the weight shift must be sufficient to move the tilt sensor and offload the back leg to allow it to swing forward. Continuous ambulation is accomplished by uninterrupted shifting onto the contralateral leg. The device can be switched to standing either via the mode selector or by not shifting weight laterally for 2 seconds, which triggers the safety mechanism to stop walking. Some patients have become proficient with ReWalk by the third week of training.

Regulatory Status In 2014, ReWalk™ (ReWalk Robotics, previously Argo Medical Technologies) was granted a de novo 510(k) classification (K131798) by the FDA. The new classification applies to this device and substantially equivalent devices of this generic type. ReWalk™ is the first external, powered, motorized orthosis (powered exoskeleton) used for medical purposes that is placed over a person’s paralyzed or weakened limbs for the purpose of providing ambulation. De novo classification allows novel products with moderate- or low-risk profiles and without predicates that would ordinarily require premarket approval as a Class III device to be down-classified in an expedited manner and brought to market with a special control as a Class II device.

The ReWalk™ is intended to enable individuals with spinal cord injury at levels T7 to L5 to perform ambulatory functions with supervision of a specially trained companion in accordance with the user assessment and training certification program. The device is also intended to enable individuals with spinal cord injury at levels T4 to T6 to perform ambulatory functions in rehabilitation institutions in accordance with the user assessment and training certification program. The ReWalk™ is not intended for sports or stair climbing.

Candidates for the device should have the following characteristics: • Hands and shoulders can support crutches or a walker • Healthy bone density • Skeleton does not suffer from any fractures • Able to stand using a device such as a standing frame • In general good health • Height is between 160 cm and 190 cm (5'3" to 6'2") • Weight does not exceed 100 kg (220 lbs).

In 2019, the ReWalk ReStore™, a lightweight, wearable, exo-suit, was approved for rehabilitation of individuals with lower limb disabilities due to stroke.

In 2016, Indego® (Parker Hannifin) was cleared for marketing by the FDA through the 510(k) process (K152416). The FDA determined that this device was substantially equivalent to existing devices, citing ReWalk™ as a predicate device. Indego® is “intended to enable individuals with spinal cord injury at levels T7 to L5 to perform ambulatory functions with supervision of a specially trained companion.” Indego® has also received marketing clearance for use in rehabilitation institutions.

In 2016, Ekso™ and Ekso GT™(Ekso Bionics® Inc) were cleared for marketing by the FDA through the 510(k) process (K143690). The ReWalk™ was the predicate device. Ekso is intended to perform ambulatory functions in rehabilitation institutions under the supervision of a trained physical therapist for the following populations with upper extremity motor function of at least 4/5 in both arms: individuals with hemiplegia due to stroke; individuals with spinal cord injuries at levels T4 to L5; individuals with spinal cord injuries at levels of C7 to T3.

In 2017, HAL for Medical Use (Lower Limb Type) (CYBERDYNE Inc.) was cleared for marketing by the FDA through the 510(k) process (K171909). The ReWalk™ was the predicate device. The HAL is intended to

500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 3 (401) 274-4848 WWW.BCBSRI.COM

be used inside medical facilities while under trained medical supervision for individuals with spinal cord injury at levels C4 to L5 (ASIA C, ASIA D) and T11 to L5 (ASIA A with Zones of Partial Preservation, ASIA B)

In 2020, Keeogo™ (B-Temia) exoskeleton was cleared for marketing by the FDA through the 510(k) process (K201539). The Honda Walking Assist Device was the predicate device. Keeogo is intended for use in stroke patients in rehabilitation settings.

In 2021, ExoAtlet-II® (ExoAtlet Asia Co. Ltd.) was cleared for marketing by the FDA through the 510(k) process (K201473). The Ekso/Ekso GT was the predicate device. ExoAtlet-II is intended to perform ambulatory functions in rehabilitation institutions under the supervision of a trained physical therapist for the following populations with upper extremity motor function of at least 4/5 in both arms: individuals with spinal cord injuries at levels T4 to L5, and individuals with spinal cord injuries at levels of C7 to T3 (ASIA D).

In 2022, GEMS-H® (Samsung Electronics Co. Ltd.) was cleared for marketing by the FDA through the 510(k) process (K213452). The Honda Walking Assist Device was the predicate device. GEMS-H is intended to help assist ambulatory function in rehabilitation institutions under the supervision of a trained healthcare professional for individuals with stroke who have gait deficits and exhibit gait speeds of at least 0.4 m/s and are able to walk at least 10 meters with assistance from a maximum of 1 person.

In 2022, EksoNR™ (Ekso Bionics Inc) was cleared for marketing by the FDA through the 510(k) process (K220988). EksoNR is intended to perform ambulatory functions in rehabilitation institutions under the supervision of a trained physical therapist for the following populations: individuals with multiple sclerosis (upper extremity motor function of at least 4/5 in at least 1 arm); individuals with acquired brain injury, including traumatic brain injury and stroke (upper extremity motor function of at least 4/5 in at least 1 arm); individuals with spinal cord injuries at levels T4 to L5 (upper extremity motor function of at least 4/5 in both arms), and individuals with spinal cord injuries at levels of C7 to T3 (ASIA D with upper extremity motor function of at least 4/5 in both arms).

In 2022, Atalante® (Wandercraft SAS) was cleared for marketing by the FDA through the 510(k) process (K221859). The Indego was the predicate device. Atalante is intended to enable individuals (>18 years of age, able to tolerate a stand-up position) with hemiplegia due to cerebrovascular accident to perform ambulatory functions and mobility exercises, handsfree, in rehabilitation institutions under the supervision of a trained operator. The Atalante X® was cleared for marketing by the FDA through the 510(k) process (K232077) and is intended to perform ambulatory functions and mobility exercises, hands-free, in rehabilitation institutions for individuals with hemiplegia due to cerebrovascular accident and individuals with spinal cord injuries at levels T5 to L5.

For individuals who have lower-limb disabilities who receive a powered exoskeleton, the evidence includes 1 systematic review,1 randomized controlled trial (RCT), 1 randomized cross-over study, and 1 case series describing community use. Relevant outcomes are functional outcomes, quality of life, and treatment-related morbidity. At the present, evaluation of exoskeletons is limited to small studies primarily performed in institutional settings with patients who have spinal cord injury. These studies have assessed the user’s ability to perform, under close supervision, standard tasks such as the Timed Up & Go test, 6-minute walk test, and 10- meter walk test. A recent systematic review included these studies and qualitatively described the effects of powered exoskeletons on walking and on secondary health conditions. However, lack of high-quality studies and heterogeneity of outcome measures precluded the ability to make general conclusions. Evidence on the use of powered exoskeletons in the community or home setting is even more limited. A recent RCT compared quality of life measures in patients with spinal cord injury using in-home powered exoskeleton plus wheelchair versus wheelchair alone, and reported similar results between both groups. In addition, 1 randomized, open- label cross-over study and a case series in patients with multiple sclerosis and spinal cord injury, respectively, assessed use of powered exoskeletons in the outpatient setting. Although these small studies indicate powered exoskeletons may be used safely in the outpatient setting, these devices require significant training, and their efficacy has been minimally evaluated. Further evaluation of users’ safety with these devices under regular conditions, including the potential to trip and fall, is necessary. Additional studies, particularly high-quality

500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 4 (401) 274-4848 WWW.BCBSRI.COM

RCTs, are needed to determine the benefits of these devices both inside and outside of the institutional setting. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

CODING Medicare Advantage Plans and Commercial Products The following code(s) are not covered for Medicare Advantage Plans and not medically necessary for Commercial Products:
K1007 Bilateral hip, knee, ankle, foot (HKAFO) device, powered, includes pelvic component, single or double upright(s), knee joints any type, with or without ankle joints any type, includes all components and accessories, motors, microprocessors, sensors E0739 Rehabilitation system with interactive interface providing active assistance in rehabilitation therapy, includes all components and accessories, motors, microprocessors, sensors (Text revised effective 10/1/2024)

RELATED POLICIES None

PUBLISHED Provider Update, July 2025 Provider Update, September 2024 Provider Update, May 2023 Provider Update, July 2022 Provider Update, July 2021

REFERENCES

1. Zeilig G, Weingarden H, Zwecker M, et al. Safety and tolerance of the ReWalk™ exoskeleton suit for ambulation by people with complete spinal cord injury: a pilot study. J Spinal Cord Med. Mar 2012; 35(2): 96-101. PMID 22333043
2. Asselin P, Knezevic S, Kornfeld S, et al. Heart rate and oxygen demand of powered exoskeleton-assisted walking in persons with paraplegia. J Rehabil Res Dev. 2015; 52(2): 147-58. PMID 26230182
3. Lajeunesse V, Vincent C, Routhier F, et al. Exoskeletons' design and usefulness evidence according to a systematic review of lower limb exoskeletons used for functional mobility by people with spinal cord injury. Disabil Rehabil Assist Technol. Oct 2016; 11(7): 535-47. PMID 26340538
4. Tamburella F, Lorusso M, Tramontano M, et al. Overground robotic training effects on walking and secondary health conditions in individuals with spinal cord injury: systematic review. J Neuroeng Rehabil. Mar 15 2022; 19(1): 27. PMID35292044
5. Chun A, Asselin PK, Knezevic S, et al. Changes in bowel function following exoskeletal-assisted walking in persons with spinal cord injury: an observational pilot study. Spinal Cord. Apr 2020; 58(4): 459-466. PMID 31822808
6. McIntosh K, Charbonneau R, Bensaada Y, et al. The Safety and Feasibility of Exoskeletal-Assisted Walking in Acute Rehabilitation After Spinal Cord Injury. Arch Phys Med Rehabil. Jan 2020; 101(1): 113-
7. PMID 31568761
8. Tsai CY, Delgado AD, Weinrauch WJ, et al. Exoskeletal-Assisted Walking During Acute Inpatient Rehabilitation Leads to Motor and Functional Improvement in Persons With Spinal Cord Injury: A Pilot Study. Arch Phys Med Rehabil. Apr 2020;101(4): 607-612. PMID 31891715
9. Gagnon DH, Vermette M, Duclos C, et al. Satisfaction and perceptions of long-term manual wheelchair users with a spinal cord injury upon completion of a locomotor training program with an overground robotic exoskeleton. Disabil Rehabil Assist Technol. Feb 2019; 14(2): 138-145. PMID 29256640
10. Guanziroli E, Cazzaniga M, Colombo L, et al. Assistive powered exoskeleton for complete spinal cord injury: correlations between walking ability and exoskeleton control. Eur J Phys Rehabil Med. Apr 2019; 55(2): 209-216. PMID 30156088

500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 5 (401) 274-4848 WWW.BCBSRI.COM

10. Khan AS, Livingstone DC, Hurd CL, et al. Retraining walking over ground in a powered exoskeleton after spinal cord injury: a prospective cohort study to examine functional gains and neuroplasticity. J Neuroeng Rehabil. Nov 21 2019;16(1): 145. PMID 31752911
11. Kressler J, Domingo A. Cardiometabolic Challenges Provided by Variable Assisted Exoskeletal Versus Overground Walking in Chronic Motor-incomplete Paraplegia: A Case Series. J Neurol Phys Ther. Apr 2019; 43(2): 128-135. PMID30883500
12. Kubota S, Abe T, Kadone H, et al. Hybrid assistive limb (HAL) treatment for patients with severe thoracic myelopathy due to ossification of the posterior longitudinal ligament (OPLL) in the postoperative acute/subacute phase: A clinical trial. JSpinal Cord Med. Jul 2019; 42(4): 517-525. PMID 30335588
13. Manns PJ, Hurd C, Yang JF. Perspectives of people with spinal cord injury learning to walk using a powered exoskeleton.J Neuroeng Rehabil. Jul 19 2019; 16(1): 94. PMID 31324256
14. van Dijsseldonk RB, Rijken H, van Nes IJW, et al. Predictors of exoskeleton motor learning in spinal cord injured patients. Disabil Rehabil. Jul 2021; 43(14): 1982-1988. PMID 31724882
15. Alamro RA, Chisholm AE, Williams AMM, et al. Overground walking with a robotic exoskeleton elicits trunk muscle activity in people with high-thoracic motor-complete spinal cord injury. J Neuroeng Rehabil. Nov 20 2018; 15(1): 109. PMID30458839
16. Bach Baunsgaard C, Vig Nissen U, Katrin Brust A, et al. Gait training after spinal cord injury: safety, feasibility and gait function following 8 weeks of training with the exoskeletons from Ekso Bionics. Spinal Cord. Feb 2018; 56(2): 106-116.PMID 2910565717.
17. Baunsgaard CB, Nissen UV, Brust AK, et al. Exoskeleton gait training after spinal cord injury: An exploratory study on secondary health conditions. J Rehabil Med. Sep 28 2018; 50(9): 806-813. PMID 30183055
18. Cahill A, Ginley OM, Bertrand C, et al. Gym-based exoskeleton walking: A preliminary exploration of non-ambulatory end-user perspectives. Disabil Health J. Jul 2018; 11(3): 478-485. PMID 29500092
19. Chang SH, Afzal T, Berliner J, et al. Exoskeleton-assisted gait training to improve gait in individuals with spinal cord injury: a pilot randomized study. Pilot Feasibility Stud. 2018; 4: 62. PMID 29556414
20. Escalona MJ, Brosseau R, Vermette M, et al. Cardiorespiratory demand and rate of perceived exertion during overground walking with a robotic exoskeleton in long-term manual wheelchair users with chronic spinal cord injury: A cross-sectional study. Ann Phys Rehabil Med. Jul 2018; 61(4): 215-223. PMID 29371106
21. Gagnon DH, Escalona MJ, Vermette M, et al. Locomotor training using an overground robotic exoskeleton in long-term manual wheelchair users with a chronic spinal cord injury living in the community: Lessons learned from a feasibility study in terms of recruitment, attendance, learnability, performance and safety. J Neuroeng Rehabil. Mar 01 2018; 15(1): 12.PMID 29490678
22. Juszczak M, Gallo E, Bushnik T. Examining the Effects of a Powered Exoskeleton on Quality of Life and Secondary Impairments in People Living With Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2018; 24(4): 336-342. PMID 30459496
23. Ramanujam A, Cirnigliaro CM, Garbarini E, et al. Neuromechanical adaptations during a robotic powered exoskeleton assisted walking session. J Spinal Cord Med. Sep 2018; 41(5): 518-528. PMID 28427305
24. Ramanujam A, Momeni K, Husain SR, et al. Mechanisms for improving walking speed after longitudinal powered robotic exoskeleton training for individuals with spinal cord injury. Annu Int Conf IEEE Eng Med Biol Soc. Jul 2018; 2018: 2805-2808. PMID 30440984
25. Sale P, Russo EF, Scarton A, et al. Training for mobility with exoskeleton robot in spinal cord injury patients: a pilot study. Eur J Phys Rehabil Med. Oct 2018; 54(5): 745-751. PMID 29517187
26. Tefertiller C, Hays K, Jones J, et al. Initial Outcomes from a Multicenter Study Utilizing the Indego Powered Exoskeleton in Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2018; 24(1): 78-85. PMID 29434463
27. Yatsugi A, Morishita T, Fukuda H, et al. Feasibility of Neurorehabilitation Using a Hybrid Assistive Limb for Patients Who Underwent Spine Surgery. Appl Bionics Biomech. 2018; 2018: 7435746. PMID 30116296

500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 6 (401) 274-4848 WWW.BCBSRI.COM

28. Birch N, Graham J, Priestley T, et al. Results of the first interim analysis of the RAPPER II trial in patients with spinal cord injury: ambulation and functional exercise programs in the REX powered walking aid. J Neuroeng Rehabil. Jun 19 2017; 14(1): 60. PMID 28629390
29. Karelis AD, Carvalho LP, Castillo MJ, et al. Effect on body composition and bone mineral density of walking with a robotic exoskeleton in adults with chronic spinal cord injury. J Rehabil Med. Jan 19 2017; 49(1): 84-87. PMID 27973679
30. Benson I, Hart K, Tussler D, et al. Lower-limb exoskeletons for individuals with chronic spinal cord injury: findings from a feasibility study. Clin Rehabil. Jan 2016; 30(1): 73-84. PMID 25761635
31. Lonini L, Shawen N, Scanlan K, et al. Accelerometry-enabled measurement of walking performance with a robotic exoskeleton: a pilot study. J Neuroeng Rehabil. Mar 31 2016; 13: 35. PMID 27037035
32. Platz T, Gillner A, Borgwaldt N, et al. Device-Training for Individuals with Thoracic and Lumbar Spinal Cord Injury Using a Powered Exoskeleton for Technically Assisted Mobility: Achievements and User Satisfaction. Biomed Res Int. 2016; 2016: 8459018. PMID 27610382
33. Sale P, Russo EF, Russo M, et al. Effects on mobility training and de-adaptations in subjects with Spinal Cord Injury due to a Wearable Robot: a preliminary report. BMC Neurol. Jan 28 2016; 16: 12. PMID 26818847
34. Stampacchia G, Rustici A, Bigazzi S, et al. Walking with a powered robotic exoskeleton: Subjective experience, spasticity and pain in spinal cord injured persons. NeuroRehabilitation. Jun 27 2016; 39(2): 277-83. PMID 27372363
35. Kozlowski AJ, Bryce TN, Dijkers MP. Time and Effort Required by Persons with Spinal Cord Injury to Learn to Use a Powered Exoskeleton for Assisted Walking. Top Spinal Cord Inj Rehabil. 2015; 21(2): 110-21. PMID 26364280
36. Evans N, Hartigan C, Kandilakis C, et al. Acute Cardiorespiratory and Metabolic Responses During Exoskeleton-Assisted Walking Overground Among Persons with Chronic Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2015; 21(2): 122-32. PMID 26364281
37. Hartigan C, Kandilakis C, Dalley S, et al. Mobility Outcomes Following Five Training Sessions with a Powered Exoskeleton. Top Spinal Cord Inj Rehabil. 2015; 21(2): 93-9. PMID 26364278
38. Yang A, Asselin P, Knezevic S, et al. Assessment of In-Hospital Walking Velocity and Level of Assistance in a Powered Exoskeleton in Persons with Spinal Cord Injury. Top Spinal Cord Inj Rehabil. 2015; 21(2): 100-9. PMID 26364279
39. Kressler J, Thomas CK, Field-Fote EC, et al. Understanding therapeutic benefits of overground bionic ambulation: exploratory case series in persons with chronic, complete spinal cord injury. Arch Phys Med Rehabil. Oct 2014; 95(10): 1878-1887.e4. PMID 24845221
40. Fineberg DB, Asselin P, Harel NY, et al. Vertical ground reaction force-based analysis of powered exoskeleton-assisted walking in persons with motor-complete paraplegia. J Spinal Cord Med. Jul 2013; 36(4): 313-21. PMID 23820147
41. Kolakowsky Hayner SCJ. A. Safety and Feasibility of using the EksoTM Bionic Exoskeleton to Aid Ambulation after Spinal Cord Injury. J Spine. 2013; 4:456.
42. Talaty M, Esquenazi A, Briceno JE. Differentiating ability in users of the ReWalk(TM) powered exoskeleton: an analysis of walking kinematics. IEEE Int Conf Rehabil Robot. Jun 2013; 2013: 6650469. PMID 24187286
43. Esquenazi A, Talaty M, Packel A, et al. The ReWalk powered exoskeleton to restore ambulatory function to individuals with thoracic-level motor-complete spinal cord injury. Am J Phys Med Rehabil. Nov 2012; 91(11): 911-21. PMID 23085703
44. Spungen AM, Bauman WA, Biswas K, et al. The design of a randomized control trial of exoskeletal- assisted walking in the home and community on quality of life in persons with chronic spinal cord injury. Contemp Clin Trials. Sep 2020; 96: 106102. PMID 32800962
45. Spungen AM, Dematt EJ, Biswas K, et al. Exoskeletal-Assisted Walking in Veterans With Paralysis: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(9):e2431501. Published 2024 Sep 3. doi:10.1001/jamanetworkopen.2024.31501
46. McGibbon CA, Sexton A, Jayaraman A, et al. Evaluation of the Keeogo exoskeleton for assisting ambulatory activities in people with multiple sclerosis: an open-label, randomized, cross-over trial. J Neuroeng Rehabil. Dec 12 2018; 15(1): 117. PMID 30541585

500 EXCHANGE STREET, PROVIDENCE, RI 02903-2699 MEDICAL COVERAGE POLICY | 7 (401) 274-4848 WWW.BCBSRI.COM

47. van Dijsseldonk RB, van Nes IJW, Geurts ACH, et al. Exoskeleton home and community use in people with complete spinal cord injury. Sci Rep. Sep 24 2020; 10(1): 15600. PMID 32973244
48. Hornby TG, Reisman DS, Ward IG, et al. Clinical Practice Guideline to Improve Locomotor Function Following Chronic Stroke, Incomplete Spinal Cord Injury, and Brain Injury. J Neurol Phys Ther. Jan 2020; 44(1): 49-100. PMID 31834165

49. Hohl K, Giffhorn M., Jackson S, et al. A framework for clinical utilization of robotic exoskeletons in rehabilitation. J NeuroEngineering Rehabil. 2022:19(1). Article number 115.

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