A network analysis of 'thinking a lot': Connections to childhood trauma and post-traumatic stress disorder among men who have sex with men in Vietnam.

Spinal Cord Injury (SCI) is a severe condition leading to significant motor and sensory deficits, particularly affecting mobility and ambulation. Among its secondary complications, spasticity is one of the most prevalent and disabling, requiring targeted rehabilitation strategies [, ]. Recent advancements in robotic-assisted rehabilitation, particularly with wearable powered overground exoskeletons, offer a novel approach to gait training in individuals with SCI [, ]. These devices not only assist in restoring walking ability but have also shown potential in modulating muscle tone and reducing spasticity [–]. Recent studies have highlighted the feasibility and effectiveness of using exoskeletons in inpatient rehabilitation settings, demonstrating the utilization of overground exoskeleton gait training during inpatient rehabilitation and its positive outcomes in improving mobility and independence []. Furthermore, Baunsgaard et al. conducted a large cohort study that evaluated the safety and gait outcomes of gait training after SCI, further supporting the integration of these devices into clinical rehabilitation programs []. Unlike stationary robotic-assisted devices, which are classified as device-in-charge robots [], overground exoskeletons function as patient-in-charge systems, allowing individuals to walk in real-world environments and experience a more dynamic and physiologically typical gait []. This type of approach requires more active participation from the patient during walking, including a higher cognitive demand, which may further enhance neuroplasticity and motor learning []. These exoskeletons facilitate repetitive, high-intensity gait training, essential for functional recovery post-SCI []. The repetitive nature of movement promotes cortical reorganization, a key mechanism underlying neuroplasticity and functional improvement in individuals with spinal cord injury []. While the concept of anatomical spinal cord repair remains speculative and is not directly evidenced by current clinical neurophysiological data, functional gains following exoskeleton-assisted gait training are believed to arise from adaptive plasticity within the sensorimotor system. Functional MRI studies have demonstrated that, after spinal cord injury, sensorimotor activation patterns initially expand and later become more focused in cortical motor areas as recovery progresses []. Moreover, paired-pulse somatosensory evoked potential (ppSEP) protocols have shown normalization of cortical excitability in patients after exoskeleton-assisted gait training, supporting the hypothesis of cortical-level adaptation []. These neuroplastic changes may contribute to improved voluntary motor control and walking ability. Additionally, exoskeleton-assisted walking has been associated with psychological benefits, including increased motivation and improved mood, which may further enhance engagement in the rehabilitation process [, ]. Overground exoskeletons provide dynamic support, adapt to user needs in real-time, and deliver proprioceptive stimuli that simulate natural gait, promoting sensory feedback essential for neuromuscular re-education [, ]. Their design and feedback mechanisms not only facilitate muscle engagement but also improve postural demand and trunk activation by requiring the user to perform dynamic weight shifts to maintain continuous walking.This interaction with the exoskeleton device enhances the rehabilitation experience, supporting balance recovery and functional gait patterns []. By replicating near-physiological gait, these exoskeletons help optimize motor learning and neuroplasticity, which are critical for restoring mobility after SCI []. Even in chronic SCI, the spinal cord retains a latent capacity for plasticity, particularly within spinal interneuronal networks, reflex pathways, and central pattern generators (CPGs). Robotic gait training can reactivate these mechanisms through repeated, task-specific sensory and motor stimulation[, ].