Robot-assisted and exoskeleton gait and arm training

Domain IX · Biomedical, neuro & digital

What it is

Robot-assisted and exoskeleton training is not a psychotherapy. It is a group of rehabilitation technologies used by the treating rehabilitation team, chiefly physiotherapists (physical therapists) and occupational therapists, for people with weakness or paralysis after stroke, spinal cord injury,…

Format

• Format: individual sessions, in person or remote; family or companion sessions where a companion is required or involved. Contact with the team only with the client's consent.

Who practises it, and how they are trained or regulated

• The rehabilitation team sets the course (assessment, eligibility screening, device fitting, supervised training, progression, review, and for personal devices, home-use training with a companion). Session numbers and schedules are clinical decisions of the treating team and are not given here. The psychotherapist's work runs in parallel phases:
• Version followed: robot-assisted and exoskeleton training as delivered by physiotherapy and occupational therapy teams, described from FDA classification actions (2014–2015), manufacturer intended-use statements, the Cochrane reviews on gait (2025 update) and arm training (2018), the RATULS trial (Lancet 2019) and the NICE stroke rehabilitation evidence review on robot-assisted arm training; status as of October…
• Robot-assisted and exoskeleton training is not a psychotherapy. It is a group of rehabilitation technologies used by the treating rehabilitation team, chiefly physiotherapists (physical therapists) and occupational therapists, for people with weakness or paralysis after stroke, spinal cord injury, acquired brain injury and other neurological conditions. Three broad device families appear in the sources:

Evidence status, as the guide reports it

• The core idea of change, as rehabilitation sources describe it, is that devices allow many repetitions of task-like movement or walking that a person could not yet perform alone, with the aim of improving strength, function or walking independence; the devices supplement rather than replace…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• sudden calm after a major setback; withdrawal. Working: the client has and uses a plan.
• hopelessness, suicidal thoughts, marked change in cognition. Working: referral happens and is followed up.
• shame, social withdrawal, or relational strain. Working: the client can express what they want others to understand.
• split messages between team and therapist; confidentiality breaches. Working: team and therapist work from a shared picture.
• misunderstandings the client holds about what the device does; details that point to a safety issue (skin, falls, pain) to pass on.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.