Background: Spinal cord injury (SCI) remains a significant global health challenge, with an estimated incidence of 0.9 million cases annually and contributing to 6.2 million years lived with disability. In Asia, incidence rates range from 12 to 61.6 per million population, predominantly affecting young males due to falls and traumatic events, as seen in Malaysian cohorts where over 57% of cases are traumatic. Rehabilitation faces barriers such as impaired mobility, chronic pain, spasticity, and diminished psychological well-being, all of which adversely impact quality of life (QoL). Orthotic devices, including ankle-foot orthoses (AFOs), knee-ankle-foot orthoses (KAFOs), and spinal braces, serve as pivotal tools in SCI management by providing mechanical support, facilitating gait, and promoting functional independence. Emerging evidence links orthoses to neuroplasticity, enabling neural rewiring through repetitive task-specific training, thus aligning with neuroscience principles to enhance recovery and mental health outcomes.

Objectives: This study aimed to systematically review the efficacy of orthoses in SCI rehabilitation, their effects on mobility, pain management, spasticity reduction, psychological well-being, and overall QoL, while exploring their role in fostering neuroplasticity and implications for multidisciplinary care in neuroscience and mental health contexts.

Methods: A systematic review was conducted using databases such as PubMed, Scopus, and Web of Science, searching for studies published between 2010 and 2025. Inclusion criteria encompassed randomized controlled trials, cohort studies, and case series focusing on orthoses (e.g., AFOs, KAFOs, exoskeletons) in adult SCI patients. Outcomes were assessed using standardized metrics like the SF-36 for QoL, WHOQOL-BREF for global well-being, and functional independence measures. Data synthesis involved qualitative analysis and meta-analytic approaches where feasible, with risk of bias evaluated via the Cochrane tool.

Results: Thirty-two studies demonstrated orthotic efficacy, with 70% reporting improvements in walking and standing stability. KAFOs and reciprocating gait orthoses enhanced QoL scores by 15-20% on SF-36 scales, particularly in physical functioning and mental health domains, compared to non-orthotic interventions. Powered exoskeletons reduced spasticity and pain while promoting neuroplasticity through massed repetition, leading to better neural recovery in incomplete SCI cases. Innovative smart orthoses, such as AI-integrated devices, showed superior outcomes in functional independence and psychological resilience.

Discussion/Conclusion: Orthoses significantly advance SCI rehabilitation by supporting neuroplasticity, reducing secondary complications, and improving QoL, with strong ties to neuroscience through enhanced cortical reorganization and mental health benefits. Multidisciplinary collaboration is essential, particularly in Asian contexts where resource-limited settings amplify the need for accessible innovations. Limitations include study heterogeneity and small sample sizes. Future research should prioritize longitudinal trials on AI-enhanced orthoses to optimize global mental health integration in neuroscience.

Akshay Kumar is a renowned Prosthetist and Orthotist with over 15 years of expertise in orthotic and prosthetic rehabilitation, focusing on health and disability management. As a senior professional at the Composite Regional Centre for Skill Development, Rehabilitation, and Empowerment of Persons with Disabilities in Kozhikode, Kerala, India, he has led transformative initiatives in assistive technology, enhancing mobility and quality of life for individuals with neurological and orthopedic conditions. His extensive contributions span clinical practice, research, and education, with a strong presence in national and international journals, where his work has advanced rehabilitation science and policy. His research emphasizes innovative, user-centered orthotic solutions and equitable healthcare access, particularly in resource-limited settings. As an advocate for inclusive rehabilitation, he collaborates with multidisciplinary teams to address diverse patient needs, earning global recognition for his impactful work. A sought-after speaker at international conferences, he continues to shape the field through his dedication to improving functional outcomes and mental well-being for individuals with disabilities. His leadership and vision have made significant strides in fostering accessible, evidence-based rehabilitation practices worldwide.