AUTHOR=Hu Xiaomin , Feng Jing , Lu Jiachun , Pang Rizhao , Zhang Anren , Liu Jiancheng , Gou Xiang , Bai Xingang , Wang Junyu , Chang Cong , Yin Jie , Wang Yunyun , Xiao Hua , Wang Qian , Cheng Hong , Chang Youjun , Wang Wenchun 

TITLE=Effects of exoskeleton-assisted walking on bowel function in motor-complete spinal cord injury patients: involvement of the brain–gut axis, a pilot study

JOURNAL=Frontiers in Neuroscience

VOLUME=18

YEAR=2024

URL=https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2024.1395671

DOI=10.3389/fnins.2024.1395671

ISSN=1662-453X

ABSTRACT=<p>Evidence has demonstrated that exoskeleton robots can improve intestinal function in patients with spinal cord injury (SCI). However, the underlying mechanisms remain unelucidated. This study investigated the effects of exoskeleton-assisted walking (EAW) on intestinal function and intestinal flora structure in T2-L1 motor complete paraplegia patients. The results showed that five participants in the EAW group and three in the conventional group reported improvements in at least one bowel management index, including an increased frequency of bowel evacuations, less time spent on bowel management per day, and less external assistance (manual digital stimulation, medication, and enema usage). After 8 weeks of training, the amount of glycerol used in the EAW group decreased significantly (<italic>p &lt;</italic>0.05). The EAW group showed an increasing trend in the neurogenic bowel dysfunction (NBD) score after 8 weeks of training, while the conventional group showed a worsening trend. Patients who received the EAW intervention exhibited a decreased abundance of <italic>Bacteroidetes</italic> and <italic>Verrucomicrobia</italic>, while <italic>Firmicutes</italic>, <italic>Proteobacteria</italic>, and <italic>Actinobacteria</italic> were upregulated. In addition, there were decreases in the abundances of <italic>Bacteroides</italic>, <italic>Prevotella</italic>, <italic>Parabacteroides</italic>, <italic>Akkermansia</italic>, <italic>Blautia</italic>, <italic>Ruminococcus 2</italic>, and <italic>Megamonas</italic>. In contrast, <italic>Ruminococcus 1</italic>, <italic>Ruminococcaceae UCG002</italic>, <italic>Faecalibacterium</italic>, <italic>Dialister</italic>, <italic>Ralstonia</italic>, <italic>Escherichia-Shigella</italic>, and <italic>Bifidobacterium</italic> showed upregulation among the top 15 genera. The abundance of <italic>Ralstonia</italic> was significantly higher in the EAW group than in the conventional group, and <italic>Dialister</italic> increased significantly in EAW individuals at 8 weeks. This study suggests that EAW can improve intestinal function of SCI patients in a limited way, and may be associated with changes in the abundance of intestinal flora, especially an increase in beneficial bacteria. In the future, we need to further understand the changes in microbial groups caused by EAW training and all related impact mechanisms, especially intestinal flora metabolites.</p><p><bold>Clinical trial registration</bold>: <ext-link xlink:href="https://www.chictr.org.cn/" ext-link-type="uri" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.chictr.org.cn/</ext-link>.</p>