The overground robot-assisted walking is well accepted by SCI persons and has positive effects in terms of spasticity and pain reduction.

Background: In the last years there has been an intense technological development of robotic devices for gait rehabilitation in spinal cord injury (SCI) patients. The aim of the present study was to evaluate energy cost and psychological impact during a rehabilitation programme with two different types of robotic rehabilitation systems (stationary system on treadmill, Lokomat and overground walking system, Ekso GT). Methods: Fifteen SCI patients with different injury levels underwent robot-assisted gait training sessions, divided into 2 phases: in the first phase all subjects completed 3 sessions both Lokomat and Ekso GT. Afterwards, participants were randomly assigned to Lokomat or the Ekso for 17 sessions. A questionnaire, investigating the Subjective Psychological Impact (SPI) during gait training, was administrated. The functional outcome measures were oxygen consumption (VO2), carbon dioxide production (VCO2), Metabolic Equivalent of Task (MET), walking economy, and heart rate (HR). Results: The metabolic responses (7.73 ± 1.02 mL/kg/min) and MET values (3.20 ± 1.01) during robotic overground walking resulted higher than those during robotic treadmill walking (3.91 ± 0.93 mL/kg/min and 1.58 ± 0.44; p < 0.01). Both devices showed high scores in emotion and satisfaction. Overground walking resulted in higher scores of fatigue, mental effort and discomfort while walking with Lokomat showed a higher score in muscle relaxation. All patients showed improvements in walking economy due to a decrease of energy cost with increased speed and workload. Conclusions: Overground robotic assisted gait training in rehabilitation programmePowered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation needs higher cognitive and cardiovascular efforts than robot-assisted gait training on treadmill. Response to Reviewers:Authors' answers to Reviewers Neurological SciencesWe warmly thank Reviewers for helpful comments and criticisms. Note for reviewing purposes -Our comments/answers in bold italic Revisions and corrections in the text all in red bold Reviewer #1: The revision is satisfying. We thank the Reviewer for her/his positive comment.Reviewer #2: Dear authors, the paper addresses a current topic that has been well developed.However, I suggest some changes to be made. We thank the Reviewer for his positive comment.

Study design: This is a cross-sectional study. Objectives: The objective of this study was to examine the associations among the quality of couple relationship, perceived social support and health-related quality of life (HRQoL) in persons with spinal cord injury (SCI). Setting: The study was conducted in Italy. Methods: Forty-three persons with SCI were administered questionnaires for the evaluation of relationship quality (Dyadic Adjustment Scale), perceived social support (Multidimensional Scale of Perceived Social Support) and HRQoL (Short Form 36). Results: Many significant correlations between the scores of relationship quality and social support were detected. Relationship quality also correlated with relevant measures of HRQoL, such as Mental Health and Vitality. No correlation between spousal support and HRQoL was found, whereas friends' support correlated with Physical Role Functioning. Conclusions: Data suggest that the perception of social support is strictly related to relationship quality and that marital satisfaction might be related to relevant aspects of HRQoL more likely than social support itself.

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Among the objectives of spinal cord injury (SCI) rehabilitation, (i) prevention of bony, muscular and joint trophism and (ii) limitation of spastic hypertone represent important goals to be achieved. The aim of this study is to use functional electrical stimulation (FES) to activate pedaling on cycle-ergometer and analyse effects of this technique for a rehabilitation training in SCI persons. Five spinal cord injured subjects were recruited and underwent a two months FES-cycling training. Our results show an increase of thigh muscular area and endurance after the FES-cycling training, without any increase of spasticity. This approach, which is being validated on a larger pool of patients, represents a potential tool for improving the rehabilitation outcome of complete and incomplete SCI persons.

A reduced spasticity and pain was observed after the intrathecal Baclofen infusion for at least 76 months. To obtain these results a dosage adjustment was needed only in the first year after the implantation.

Study design: Cross sectional. Objectives: To examine associations among functional status, health-related and individualised quality of life (QoL) and coping style in subjects with spinal cord injury (SCI). Setting: Italy. Methods: Forty subjects attending our hospital-based rehabilitation centre for SCI were administered the Spinal Cord Independence Measure-version III (SCIM-III), the Short Form-36 (SF-36), the Schedule for the Evaluation of Individual QoL-Direct Weighting (SEIQoL-DW) and the Coping Inventory for Stressful Situation (CISS) to assess functional status, health-related QoL, individualised QoL and coping strategies, respectively. Results: The SCIM-III scores were positively correlated (Po0.01) with the physical functioning subscale of the SF-36. The only scale that correlated (Po0.01) with the SEIQoL-DW scores was the SF-36 mental health subscale. Positive correlations among taskoriented or avoidance-oriented coping and specific measures of health-related QoL emerged. Conclusions: Data from the present study showed only a few associations among different measures of QoL and suggest that patientcentered evaluations of QoL are not necessarily or strictly related to functional status or health-related QoL. Coping strategies seem to be significantly related to the subjects perceptions of QoL, but mostly in the health-related domains.

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