Supported treadmill ambulation training after spinal cord injury: a pilot study

OBJECTIVES: To conduct a pilot study of weight-supported ambulation training after incomplete spinal cord injury (SCI), and to assess its safety. DESIGN: Quasiexperimental, repeated measures, single group. SETTING: Veterans Affairs medical center. PATIENTS: Three subjects with incomplete, chronic, thoracic SCIs; 2 classified as D on the American Spinal Injury Association (ASIA) impairment scale and 1 as ASIA impairment scale C. INTERVENTION: Subjects participated in 12 weeks of training assisted by 2 physical therapists. The training consisted of walking on a treadmill while supported by a harness and a pneumatic suspension device. Support started at 40% of body weight and a treadmill speed of.16kmph, and progressed by reducing support and increasing treadmill speed and continuous treadmill walking time up to 20 minutes. Training was conducted for 1 hour per day, 5 days per week for 3 months. Treadmill walking occurred for 20 minutes during the sessions. MAIN OUTCOME MEASURES: Gait function (speed, endurance, walking status, use of assistive device and orthotics); oxygen costs of walking; brain motor control assessment; self-report indices; ASIA classification; muscle function test; and safety. RESULTS: All 3 subjects increased gait speed (.118m/s initially to.318m/s after training 12wk), and gait endurance (20.3m/5min initially to 63.5m/5min). The oxygen costs decreased from 1.96 to 1.33mL x kg(-1) x m(-1) after 12 weeks of training. CONCLUSIONS: This pilot study suggests that supported treadmill ambulation training can improve gait for individuals with incomplete SCIs by using objective gait measures. The self-report indices used have promise as patient-centered outcome measures of this new form of gait training. A larger, controlled study of this technique is warranted.     

Walking after incomplete spinal cord injury using an implanted FES system: a case report

Implanted functional electrical stimulation (FES) systems for walking are experimentally available to individuals with incomplete spinal cord injury (SCI); however, data on short-term therapeutic and functional outcomes are limited. The goal of this study was to quantify therapeutic and functional effects of an implanted FES system for walking after incomplete cervical SCI. After robotic-assisted treadmill training and overground gait training maximized his voluntary function, an individual with incomplete SCI (American Spinal Injury Association grade C, cervical level 6-7) who could stand volitionally but not step was surgically implanted with an 8-channel receiver stimulator and intramuscular electrodes. Electrodes were implanted bilaterally, recruiting iliopsoas, vastus intermedius and lateralis, tensor fasciae latae, tibialis anterior, and peroneus longus muscles. Twelve weeks of training followed limited activity post-surgery. Customized stimulation patterns addressed gait deficits via an external control unit. The system was well-tolerated and reliable. After the 12-week training, maximal walking distance increased (from 14 m to 309 m), maximal walking speed was 10 times greater (from 0.02 m/s to 0.20 m/s), and physiological cost index was 5 times less (from 44.4 beats/m to 8.6 beats/m). Voluntary locomotor function was unchanged. The implanted FES system was well-tolerated, reliable, and supplemented function, allowing the participant limited community ambulation. Physiological effort decreased and maximal walking distance increased dramatically over 12 weeks.     

Optimal outcomes obtained with body-weight support combined with treadmill training in stroke subjects

OBJECTIVES: To identify stroke patients who are most likely to benefit from locomotor training with body-weight support (BWS), to determine the extent of carryover from treadmill training to overground locomotion, and to determine the variables that are most likely to influence the recovery of locomotion. DESIGN: A randomized clinical trial. SETTING: Inpatient rehabilitation hospital. PARTICIPANTS: Of 100 stroke subjects, 50 were randomized to receive locomotor training with BWS (BWS group), and 50 were randomized to receive locomotor training with full weight bearing (no-BWS group). The subjects were stratified according to their initial overground walking speed and endurance, initial treadmill speed and endurance, functional balance, motor recovery, side of the lesion, and age. INTERVENTION: Fifty subjects were trained to walk on a treadmill with up to 40% of their body weight supported by a BWS system with an overhead harness (BWS group), and 50 subjects were trained to walk while bearing their full weight (no-BWS group). MAIN OUTCOME MEASURES: Clinical outcome measures included overground walking speed and endurance, functional balance, and motor recovery. The effect of confounding variables such as age, comorbidity, and depression on locomotor outcome was also investigated. RESULTS: After 6 weeks of locomotor training, the BWS group scored significantly higher in all clinical outcomes. When the subjects were stratified according to their initial overground walking speed, endurance, balance, and motor recovery, a significant statistical difference in gait and balance dysfunction of all outcomes occurred in the more severely impaired subjects. An important transfer from treadmill speed to overground walking speed was observed in subjects in the BWS group. Finally, a significantly greater effect was observed in older subjects (65-85y) in the BWS group. CONCLUSIONS: Retraining gait in severely impaired stroke subjects with a percentage of their body weight supported resulted in better walking and postural abilities than did gait training in patients bearing their full weight. It appears that subjects with greater gait impairments benefited the most from training with BWS, as did the older patients with stroke. There is evidence of transfer from treadmill training to overground locomotion.     

Effects of a simple functional electric system and/or a hinged ankle-foot orthosis on walking in persons with incomplete spinal cord injury

OBJECTIVES: To compare the effect of functional electric stimulation (FES) with that of a hinged ankle-foot orthosis (AFO) for assisting foot clearance, gait speed, and endurance and to determine whether there is added benefit in using FES in conjunction with the hinged AFO in persons with incomplete spinal cord injury (SCI). DESIGN: Within-subject comparison of walking under 4 conditions: AFO, FES, AFO and FES, and no orthosis. A plastic hinged AFO was used for all AFO conditions. SETTING: Tertiary rehabilitation center. PARTICIPANTS: Nineteen subjects with incomplete SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The self-selected gait speed, 6-minute walk distance, and foot clearance values were compared between conditions. RESULTS: Gait speed increased with FES ( P <.05) and with the AFO ( P =.06). Six-minute walk distance also increased with the AFO ( P <.05). No difference was found between the 2 forms of orthoses in either gait speed or endurance. The greatest increase in gait speed and endurance from the no-orthosis condition occurred with the combined AFO and FES condition. Foot clearance improved with FES but not with AFO. Subjects whose gait speed increased with FES had weaker hip flexors, knee flexors, and ankle dorsiflexors than those who did not benefit from FES. CONCLUSIONS: Both FES and the hinged AFO promote walking and FES is only superior to the AFO in increasing foot-clearance values. The hinged AFO and FES together may offer advantages over either device alone.     

Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: a multicenter trial

OBJECTIVE: To determine whether automated locomotor training with a driven-gait orthosis (DGO) can increase functional mobility in people with chronic, motor incomplete spinal cord injury (SCI). DESIGN: Repeated assessment of the same patients or single-case experimental A-B design. SETTING: Research units of rehabilitation hospitals in Chicago; Heidelberg, Germany; and Basel and Zurich, Switzerland. PARTICIPANTS: Twenty patients with a chronic (>2 y postinjury), motor incomplete SCI, classified by the American Spinal Injury Association (ASIA) Impairment Scale with ASIA grades C (n=9) and D (n=11) injury. Most patients (n=16) were ambulatory before locomotor training. INTERVENTION: Locomotor training was provided using robotic-assisted, body-weight-supported treadmill training 3 to 5 times a week over 8 weeks. Single training sessions lasted up to 45 minutes of total walking time, with gait speed between .42 and .69 m/s and body-weight unloading as low as possible (mean +/- standard deviation, 37%+/-17%). MAIN OUTCOME MEASURES: Primary outcome measures included the 10-meter walk test, the 6-minute walk test, the Timed Up & Go test, and the Walking Index for Spinal Cord Injury-II tests. Secondary measures included lower-extremity motor scores and spastic motor behaviors to assess their potential contribution to changes in locomotor function. All subjects were tested before, during, and after training. RESULTS: Locomotor training using the DGO resulted in significant improvements in the subjects' gait velocity, endurance, and performance of functional tasks. There were no significant changes in the requirement of walking aids, orthoses, or external physical assistance. There was no correlation between improvements in walking speed or changes in muscle strength or spastic motor behaviors. CONCLUSIONS: Intensive locomotor training on a treadmill with the assistance of a DGO results in improved overground walking.     

Comparison of soleus H-reflex modulation after incomplete spinal cord injury in 2 walking environments: treadmill with body weight support and overground

Phadke CP, Wu SS, Thompson FJ, Behrman AL. Comparison of soleus H-reflex modulation after incomplete spinal cord injury in 2 walking environments: treadmill with body weight support and overground.

Objective

To investigate a walking environment effect on soleus H-reflex modulation during walking in persons with motor incomplete spinal cord injury (SCI) and noninjured controls.

Design

Pretest and posttest repeated-measures quasi-experimental controlled design.

Setting

Locomotor training laboratory.

Participants

Eight adults with incomplete SCI and 8 noninjured age- and speed-matched controls.

Intervention

Walking overground with a customary assistive device and brace at a self-selected, comfortable walking speed was compared with walking on treadmill with 40% body weight support (BWS) and manual trainers for leg and trunk movement guidance.

Main Outcome Measure

Mean soleus H-reflex amplitude (H/M ratio) was recorded during midstance and midswing phases of walking.

Results

The H/M ratio was 33% smaller in stance phase (P=.078) and 56% smaller in the swing phase (P=.008) of walking on the treadmill with BWS and manual assistance compared with overground in the incomplete SCI group. The H/M ratio in the incomplete SCI group was significantly greater compared with noninjured controls in the stance and swing phases of overground walking (P=.001, P=.007, respectively). Soleus H-reflex modulation in the 2 walking environments did not differ significantly in the noninjured population.

Conclusions

Training walking on a treadmill with BWS and manual assistance to approximate the kinematics and spatiotemporal pattern of walking may be a more optimal environment to aid in normalizing reflex modulation after incomplete SCI when compared with conventional gait training overground.     

Robotic resistance treadmill training improves locomotor function in human spinal cord injury: a pilot study

Wu M, Landry JM, Schmit BD, Hornby TG, Yen S-C. Robotic resistance treadmill training improves locomotor function in human spinal cord injury: a pilot study.ObjectiveTo determine whether cable-driven robotic resistance treadmill training can improve locomotor function in humans with incomplete spinal cord injury (SCI).DesignRepeated assessment of the same patients with crossover design.SettingResearch units of rehabilitation hospitals in Chicago.ParticipantsPatients with chronic incomplete SCI (N=10) were recruited to participate in this study.InterventionsSubjects were randomly assigned to 1 of 2 groups. One group received 4 weeks of assistance training followed by 4 weeks of resistance training, while the other group received 4 weeks of resistance training followed by 4 weeks of assistance training. Locomotor training was provided by using a cable-driven robotic locomotor training system, which is highly backdrivable and compliant, allowing patients the freedom to voluntarily move their legs in a natural gait pattern during body weight supported treadmill training (BWSTT), while providing controlled assistance/resistance forces to the leg during the swing phase of gait.Main Outcome MeasuresPrimary outcome measures were evaluated for each participant before training and after 4 and 8 weeks of training. Primary measures were self-selected and fast overground walking velocity and 6-minute walking distance. Secondary measures included clinical assessments of balance, muscle tone, and strength.ResultsA significant improvement in walking speed and balance in humans with SCI was observed after robotic treadmill training using the cable-driven robotic locomotor trainer. There was no significant difference in walking functional gains after resistance versus assistance training, although resistance training was more effective for higher functioning patients.ConclusionsCable-driven robotic resistance training may be used as an adjunct to BWSTT for improving overground walking function in humans with incomplete SCI, particularly for those patients with relatively high function.     

Combined use of body weight support, functional electric stimulation, and treadmill training to improve walking ability in individuals with chronic incomplete spinal cord injury

OBJECTIVE: To assess the effect of an intervention combining body weight support (BWS), functional electric stimulation (FES), and treadmill training on overground walking speed (OGWS), treadmill walking speed, speed and distance, and lower extremity motor scores (LEMS). DESIGN: Before and after comparison. SETTING: Miami Project to Cure Paralysis. PARTICIPANTS: Nineteen subjects with American Spinal Injury Association class C injury who were at least 1 year postinjury and had asymmetrical lower extremity function. INTERVENTION: Subjects trained 1.5 hours per day, 3 days per week, for 3 months. The training consisted of body weight-supported treadmill walking assisted by electric stimulation. Stimulation was applied to common peroneal nerve of the weaker lower extremity (LE) and timed to assist with the swing phase of the step cycle. MAIN OUTCOME MEASURES: OGWS in the absence of both BWS and FES; LEMS, and treadmill training parameters of speed and distance. RESULTS: Over the course of training, there was a significant increase in OGWS (from.12 +/- 0.8m/s to .21 +/- .15m/s, p = .0008), treadmill walking speed (from .23 +/- .12m/s to.49 +/- .20m/s, p = .00003), and treadmill walking distance (from 93 +/- 84m to 243 +/- 139m, p = .000001). The median LEMS increased significantly for both the stimulated and nonstimulated leg (from 8 to 11 in the FES-assisted leg, from 15 to 18 in the nonassisted leg, p < .005 for each). CONCLUSIONS: All subjects showed improvement in OGWS and overall LE strength. Further research is required to delineate the essential elements of these particular training strategies.     

Improved intralimb coordination in people with incomplete spinal cord injury following training with body weight support and electrical stimulation

BACKGROUND AND PURPOSE: Limb coordination is an element of motor control that is frequently disrupted following spinal cord injury (SCI). The authors assessed intralimb coordination in subjects with SCI following a 12-week program combining body weight support, electrical stimulation, and treadmill training. SUBJECTS: Fourteen subjects with long-standing (mean time post-SCI=70 months, range=12-171 months), incomplete SCI participated. Three subjects without SCI provided data for comparison. METHODS: A vector-based technique was used to assign values to the frame-by-frame changes in hip/knee angle, and vector analysis techniques were used to assess how closely the hip/knee angles of each step cycle resembled those of every other step cycle. Overground and treadmill walking speeds also were measured. RESULTS: Following training, 9 of the 14 subjects with SCI demonstrated greater intercycle agreement. Mean overground and treadmill walking speeds improved (84% and 158%, respectively). DISCUSSION AND CONCLUSION: The intervention used in this study is based on our current understanding of the role of afferent input in the production of walking. Although the study sample was small and there was no control group, results suggest that training may improve intralimb coordination in people with SCI.     

Locomotor training progression and outcomes after incomplete spinal cord injury

BACKGROUND AND PURPOSE: The use of locomotor training with a body-weight-support system and treadmill (BWST) and manual assistance has increased in rehabilitation. The purpose of this case report is to describe the process for retraining walking in a person with an incomplete spinal cord injury (SCI) using the BWST and transferring skills from the BWST to overground assessment and community ambulation. CASE DESCRIPTION: Following discharge from rehabilitation, a man with an incomplete SCI at C5-6 and an American Spinal Injury Association (ASIA) Impairment Scale classification of D participated in 45 sessions of locomotor training. OUTCOMES: Walking speed and independence improved from 0.19 m/s as a home ambulator using a rolling walker and a right ankle-foot orthosis to 1.01 m/s as a full-time ambulator using a cane only for community mobility. Walking activity (mean+/-SD) per 24 hours increased from 1,054+/-543 steps to 3,924+/-1,629 steps. DISCUSSION: In a person with an incomplete SCI, walking ability improved after locomotor training that used a decision-making algorithm and progression across training environments.     

基于FES控制下的踏车训练应用于脑卒中偏瘫患者的效果观察

目的 探究对脑卒中偏瘫患者进行基于多通道功能性电刺激(FES)控制下的踏车训练的效果.方法 选取2018年8月至2020年12月来中风二科就诊的103例脑卒中偏瘫患者,采用随机数字表分组.对照组51例进行常规治疗和康复训练,观察组52例增加FES控制下的踏车训练,观察两组康复效果.结果 干预后观察组双膝屈曲最大平均值(...     

Comparison of angular lumbar spine and pelvis kinematics during treadmill and overground locomotion

OBJECTIVE: To determine the differences between angular oscillation curves of the lumbar spine and pelvis during walkway and treadmill ambulation. DESIGN: An in vivo observation of walking in overground and treadmill conditions. BACKGROUND: Angular movements of the lumbar spine and pelvis have been obtained during overground and treadmill walking. No data are available to indicate whether lumbar spine treadmill findings may be compared or generalized to overground readings. METHODS: Nine male subjects walked at their natural cadence along an 8 m walkway positioned over a motorized treadmill. During each of 20 walking trials, kinematic data of one full gait cycle were collected in the middle segment of the walkway. Following the overground readings the walkway was removed and treadmill recordings were taken at the subjects' preferred walking speed and at an imposed speed of 1.25 m/s. Movement patterns and maximum oscillation angles were calculated in each plane. RESULTS: Cross-correlation values of pairwise comparisons demonstrated almost comparable movement patterns between walking conditions (r > or =0.891; p<0.001) except for the movement in the sagittal plane (r=0.642, p<0.01). ANOVA for repeated measures revealed significant (p<0.05) differences in the gait cycle duration as well as reductions in oscillation amplitudes of the upper lumbar region and the pelvis in both the frontal and transverse plane during treadmill walking compared to walkway locomotion. CONCLUSIONS: Statistically significant differences exist for some angular lumbar spine movement parameters between walkway and treadmill locomotion. RELEVANCE: The observed differences between overground and treadmill locomotion should be taken in account when treadmill-based lumbar spine and pelvis kinematics want to be extended or compared to overground recordings.     

功能性电刺激结合快速步行训练对脑卒中偏瘫患者功能的影响

目的:观察功能性电刺激结合快速步行训练对脑卒中偏瘫后遗症期患者社区性步行能力及生理耗能的影响。方法:将30例脑卒中偏瘫足下垂患者随机分为观察组和对照组各15例,均接受神经内科常规药物及康复功能训练;观察组采用功能性电刺激(FES)结合快速步行训练,FES刺激患侧腓总神经和胫前肌;对照组采用常规的减重跑台快速步行训练。分别在治疗前、治疗后评定6分钟步行距离(6MWD)及生理耗能指数(PCI)。结果:治疗4周后,2组PCI较治疗前有显著降低(P0.05),6MWD均较治疗前显著增加(P0.05);静息心率治疗前后比较差值无统计学意义。2组治疗后,观察组的PCI明显低于对照组(P0.05),而6MWD、静息心率组间差异无统计学意义。结论:功能性电刺激结合快速步行训练和传统的减重跑台快速步行训练都能够显著改善脑卒中偏瘫后遗症期患者的社区性步行能力及生理耗能;功能性电刺激结合快速步行训练降低生理耗能更明显。     

Efficacy of Partial Body Weight-Supported Treadmill Training Compared With Overground Walking Practice for Children With Cerebral Palsy: A Randomized Controlled Trial

Willoughby KL, Dodd KJ, Shields N, Foley S. Efficacy of partial body weight-supported treadmill training compared with overground walking practice for children with cerebral palsy: a randomized controlled trial.

Objective

To evaluate the efficacy of 9 weeks of twice-weekly partial body weight-supported treadmill training (PBWSTT) for children with cerebral palsy (CP) and moderate to severe walking difficulty compared with overground walking.

Design

Randomized controlled trial.

Setting

Metropolitan Specialist School for children with moderate to severe physical and/or intellectual disabilities.

Participants

Thirty-four children classified level III or IV by the Gross Motor Function Classification System were recruited and randomly allocated to experimental or control groups. Of these, 26 (15 girls, 11 boys; mean age 10y, 10mo ± 3y, 11mo [range, 5-18y]) completed training and testing.

Interventions

Both groups completed 9 weeks of twice-weekly walking training. The experimental group completed PBWSTT, and the control group completed overground walking practice.

Main Outcome Measures

Ten-meter walk test (self-selected walking speed), 10-minute walk (walking endurance), School Function Assessment.

Results

The overground walking group showed a trend for an increase in the distance walked over 10 minutes (F=3.004, P=.097). There was no statistically significant difference in self-selected walking speed over 10 meters or in walking function in the school environment as measured by the School Function Assessment.

Conclusions

PBWSTT is safe and feasible to implement in a special school setting; however, it may be no more effective than overground walking for improving walking speed and endurance for children with CP. Continued emphasis on progressive reduction of body weight support along with adding concurrent overground walking practice to a treadmill training protocol may increase the intensity of training and assist with carryover of improvements to overground walking. Treadmill training programs that include concurrent overground walking as an additional key feature of the training protocol need to be rigorously evaluated for children with CP.     

Effect of wearable exoskeleton on post-stroke gait: A systematic review and meta-analysis

BackgroundWearable exoskeletons are a recently developed technology.ObjectivesThe present systematic review aimed to investigate the effect of a wearable exoskeleton on post-stroke walking by considering its use in a gait training system and simply as an orthosis assisting walking.MethodsWe systematically searched for randomised and quasi-randomised controlled trials in PubMed, Scopus, CINAHL and Embase databases from their earliest publication record to July 2021. We chose reports of trials investigating the effects of exoskeleton-assisted training or the effects of wearing an exoskeleton to assist walking. A meta-analysis was conducted to explore the benefits of the wearable exoskeleton on mobility capacity, walking speed, motor function, balance, endurance and activities of daily living.ResultsWe included 13 studies (492 participants) comparing exoskeleton-assisted training with dose-matched conventional gait training. Studies addressing the effect of wearing a wearable exoskeleton were unavailable. As compared with conventional gait training at the end of the intervention, exoskeleton-assisted training was superior for walking speed (mean difference [MD] 0.13 m/s, 95% CI 0.05; 0.21) and balance (standardized MD [SMD] 0.3, 95% CI 0.07; 0.54). The subgroup with chronic stroke (i.e., > 6 months) presented the outcome favouring exoskeleton-assisted training regarding overall mobility capacity (SMD 0.37, 95% CI 0.04; 0.69). At the end of follow-up, exoskeleton-assisted training was superior to conventional gait training in overall mobility (SMD 0.45, 95% CI 0.07; 0.84) and endurance (MD 46.23 m, 95% CI 9.90; 82.56).ConclusionsExoskeleton-assisted training was superior to dose-matched conventional gait training in several gait-related outcomes at the end of the intervention and follow-up in this systematic review and meta-analysis, which may support the use of exoskeleton-assisted training in the rehabilitation setting. Whether wearing versus not wearing a wearable exoskeleton is beneficial during walking remains unknown.     

Body weight support treadmill and overground ambulation training for two patients with chronic disability secondary to stroke.

BACKGROUND AND PURPOSE: Body weight support (BWS) treadmill training has recently been shown to be effective for gait training following stroke, but few researchers have measured the usefulness of this intervention in enhancing function, and there are no reports in which BWS overground ambulation was studied. The purposes of this case report were (1) to report the feasibility and patient tolerance for using a BWS system for overground ambulation, (2) to measure the function of patients with chronic stroke (2 years post-stroke) prior to and following BWS treadmill and overground ambulation training, and (3) to describe a protocol used for patient treatment progression using BWS treadmill training. CASE DESCRIPTIONS: The participants were 2 women, aged 87 and 93 years, who had strokes more than 2 years before data collection. A 10-m timed walk test, the Berg Balance Scale, the gait portion of the Tinetti Gait and Balance Assessment, and a measure of step length were administered. Intervention consisted of BWS ambulation training 3 times a week for 6 to 7 weeks. Each day there was BWS treadmill and overground training. OUTCOMES: Participant A improved most in 10-m walking time and Berg Balance Scale score. Participant B exhibited improvements in step length and 10-m walking time. DISCUSSION: The outcomes suggest that very old patients with chronic functional deficits secondary to cerebrovascular accident tolerated BWS treadmill and overground ambulation training and made improvements following this intervention.     

Unexpected recovery after robotic locomotor training at physiologic stepping speed: a single-case design

Spiess MR, Jaramillo JP, Behrman AL, Teraoka JK, Patten C. Unexpected recovery after robotic locomotor training at physiologic stepping speed: a single-case design.ObjectivesTo investigate the effect of walking speed on the emergence of locomotor electromyogram (EMG) patterns in an individual with chronic incomplete spinal cord injury (SCI), and to determine whether central pattern generator activity during robotic locomotor training (RLT) transfers to volitional EMG activity during overground walking.DesignSingle-case (B-A-B; experimental treatment–withdrawal–experimental treatment) design.SettingFreestanding rehabilitation research center.ParticipantA 50-year-old man who was nonambulatory for 16 months after incomplete SCI (sub-T11).InterventionsThe participant completed two 6-week blocks of RLT, training 4 times per week for 30 minutes per session at walking speeds up to 5km/h (1.4m/s) over continuous bouts lasting up to 17 minutes.Main Outcome MeasuresSurface EMG was recorded weekly during RLT and overground walking. The Walking Index for Spinal Cord Injury (WISCI-II) was assessed daily during training blocks.ResultsDuring week 4, reciprocal, patterned EMG emerged during RLT. EMG amplitude modulation revealed a curvilinear relationship over the range of walking speeds from 1.5 to 5km/h (1.4m/s). Functionally, the participant improved from being nonambulatory (WISCI-II 1/20), to walking overground with reciprocal stepping using knee-ankle-foot orthoses and a walker (WISCI-II 9/20). EMG was also observed during overground walking. These functional gains were maintained greater than 4 years after locomotor training (LT).ConclusionsHere we report an unexpected course of locomotor recovery in an individual with chronic incomplete SCI. Through RLT at physiologic walking speeds, it was possible to activate the central pattern generator even 16 months postinjury. Further, to a certain degree, improvements from RLT transferred to overground walking. Our results suggest that LT-induced changes affect the central pattern generator and allow supraspinal inputs to engage residual spinal pathways.     

Validation of a wireless dry electrode system for electroencephalography

Powered robotic exoskeletons are an emerging technology of wearable orthoses that can be used as an assistive device to enable non-ambulatory individuals with spinal cord injury (SCI) to walk, or as a rehabilitation tool to improve walking ability in ambulatory individuals with SCI. No studies to date have systematically reviewed the literature on the efficacy of powered exoskeletons on restoring walking function. Our objective was to systematically review the literature to determine the gait speed attained by individuals with SCI when using a powered exoskeleton to walk, factors influencing this speed, and characteristics of studies involving a powered exoskeleton (e.g. inclusion criteria, screening, and training processes). A systematic search in computerized databases was conducted to identify articles that reported on walking outcomes when using a powered exoskeleton. Individual gait speed data from each study was extracted. Pearson correlations were performed between gait speed and 1) age, 2) years post-injury, 3) injury level, and 4) number of training sessions. Fifteen articles met inclusion criteria, 14 of which investigated the powered exoskeleton as an assistive device for non-ambulatory individuals and one which used it as a training intervention for ambulatory individuals with SCI. The mean gait speed attained by non-ambulatory participants (n = 84) while wearing a powered exoskeleton was 0.26 m/s, with the majority having a thoracic-level motor-complete injury. Twelve articles reported individual data for the non-ambulatory participants, from which a positive correlation was found between gait speed and 1) age (r = 0.27, 95 % CI 0.02–0.48, p = 0.03, 63 participants), 2) injury level (r = 0.27, 95 % CI 0.02–0.48, p = 0.03, 63 participants), and 3) training sessions (r = 0.41, 95 % CI 0.16–0.61, p = 0.002, 55 participants). In conclusion, powered exoskeletons can provide non-ambulatory individuals with thoracic-level motor-complete SCI the ability to walk at modest speeds. This speed is related to level of injury as well as training time.     

Functional electrical stimulation-assisted walking for persons with incomplete spinal injuries: longitudinal changes in maximal overground walking speed

This study investigated the changes in maximal overground walking speed (MOWS) that occurred during walking training with a functional electrical stimulation (FES) orthosis by chronic spinal cord injured persons with incomplete motor function loss. The average walking speed over a distance of 10 m was calculated while the participants (n = 14) used their FES orthosis with and without power as well as with the various ambulatory assistive devices available. Within the first year of use, walking with an FES orthosis facilitated use of more advanced ambulatory assistive devices (10/14), improvements in functional mobility (12/14) and increases in the combined (0.26 m/s) and therapeutic (0.25 m/s) MOWS that were correlated (combined: r = 0.57; therapeutic: r = 0.69) with their respective initial MOWS. A longitudinal analysis showed that increases in MOWS followed a pattern of changes best described by either an exponential association (8/12) or a linear (4/12) model. These changes were similar for the combined and therapeutic MOWS (7/11) as well as for the different ambulatory assistive devices (8/9). It is concluded that the increased MOWS during walking training using the FES orthosis is mostly due to a therapeutic effect, implying that mechanisms of plasticity occur during such a training paradigm.     

Immediate effects of speed-dependent treadmill training on gait parameters in early Parkinson's disease

OBJECTIVE: To compare the immediate effects of different training interventions on gait parameters in patients with early Parkinson's disease (PD). DESIGN: Randomized, multiple intervention crossover pilot study. SETTING: A rehabilitation center for adult persons with neurologic disorders. PARTICIPANTS: Seventeen patients with early PD (Hoehn and Yahr stages I through III) and gait disturbances. INTERVENTION: Patients were randomly assigned to varying sequences of the following interventions over 4 consecutive days: structured speed-dependent treadmill training (STT), limited progressive treadmill training (LTT), conventional gait training (CGT), and a control intervention. MAIN OUTCOME MEASURES: Basic gait parameters (overground walking speed and stride length at self-adapted speeds) and parameters of gait analysis based on vertical ground reaction forces. RESULTS: STT and LTT improved all basic gait parameters and the double stance duration compared with preintervention values (P<.05). No changes were found after CGT and the control intervention (P<.05). Significantly higher gains were observed in all basic gait parameters after STT and LTT when compared with CGT and the control intervention (P<.05). Additionally, a greater reduction of double stance duration was found after STT than after the control intervention (P<.001). No significant differences in gains were observed between STT and LTT, or between CGT and the control intervention, in all gait parameters. CONCLUSION: The main disturbances of gait in PD, namely, speed and stride length, can be improved through a single intervention of STT or LTT, but not through CGT and the control intervention.