Objective
To compare the energy efficiency of gait with knee-ankle-foot orthosis (KAFO) and robot-assisted gait and to develop a usability questionnaire to evaluate the satisfaction of walking devices in paraplegic patients with spinal cord injuries.
Methods
Thirteen patients with complete paraplegia participated and 10 completed the evaluation. They were trained to walk with KAFO (KAFO-gait) or a ReWalk robot (ReWalk-gait) for 4 weeks (20 sessions). After a 2-week wash-out period, they switched walking devices and underwent 4 additional weeks of training. Two evaluations were performed (after 2 and 4 weeks) following the training periods for each walking device, using the 6-minute walking test (6MWT) and 30-minute walking test (30MWT). The spatiotemporal variables (walking distance, velocity, and cadence) and energy expenditure (heart rate, maximal heart rate, the physiologic cost index, oxygen consumption, metabolic equivalents, and energy efficiency) were evaluated duringthe 6MWT and 30MWT. A usability evaluation questionnaire for walking devices was developed based on the International Organization for Standardization/International Electrotechnical Commission guidelines through expert consultation.
Results
The ReWalk-gait presented significant advantages in energy efficiency compared to KAFO-gait in the 6MWT and 30MWT; however, there were no differences in walking distance or speed in the 30MWT between ReWalk-gait and KAFOgait. The usability test demonstrated that ReWalk-gait was not superior to KAFO-gait in terms of safety, efficacy, efficiency, or patient satisfaction.
Conclusion
The robot (ReWalk) enabled patients with paraplegia to walk with lower energy consumption compared to KAFO, but the ReWalk-gait was not superior to KAFO-gaitin terms of patient satisfaction.

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