End-Effector Robotic Rehabilitation After Spinal Cord Injury: A Systematic Review of Devices, Operational Characteristics Used, Outcome Measures, and Rehabilitation Effectiveness

Background: End-effector robotic devices are increasingly used in rehabilitation to retrain neural pathways through repetitive, task-specific exercise. However, the influence of movement kinematic variables remains unclear. This systematic review aimed to; (i) identify end-effector robotic systems used in upper- and lower-limb spinal cord injury rehabilitation, (ii) describe their technical specifications and operational use, and (iii) explore associations between device use characteristics and study outcomes. Methods: A systematic review of five databases was conducted from inception to June 2026. Results: Fifteen studies, ten lower-limb and five upper-limb, met the inclusion criteria. These covered five commercially available lower-limb devices and three upper-limb devices. Most lower-limb studies demonstrated moderate-to-large improvements in balance, ambulation (WISCI-II), walking endurance (6mWT), and independence (SCIM-III). End-effector training produced comparable outcomes to both conventional therapy and exoskeleton-based rehabilitation in controlled comparisons. Upper-limb studies showed substantial heterogeneity in outcome selection, reflecting diverse rehabilitation goals. Conclusions: WISCI-II and 10MWT were the most used lower-limb functional assessments, with SCIM-III used to assess independence for both upper- and lower-limb motor impairments. Reporting of kinematic settings are often limited and concentrated at study onset, limiting assessment of their contribution to outcomes. Reporting the progression of session-level metrics is needed to better understand how time-varying kinematics affect intervention effectiveness.