减重平板步行训练对完全性脊髓损伤患者下肢骨骼肌萎缩与步行能力的影响

目的研究减重平板步行训练对完全性脊髓损伤患者下肢骨骼肌萎缩与步行能力的影响。方法20例胸段完全性脊髓损伤患者分为对照组与减重组各10例。所有患者均采用综合康复治疗方法,减重组在身体条件许可的情况下及早接受减重平板步行训练3个月。在训练前后对患者进行大腿周经测量、功能独立性评定(FIM)步行能力评定、10m步行速度、日常生活活动能力(ADL)评定。减重组患者还在减重平板步行训练前后进行下肢大腿中部肌肉MRI检查。结果减重组患者训练后,MRI示下肢肌肉均较训练前相对肥大。减重组步行能力、10m步行速度的恢复优于对照组(P<0.05)。治疗前后减重组与对照组大腿周经、ADL评分无显著性差异(P>0.05)。结论减重平板步行训练不仅能够改善脊髓损伤引起的下肢骨骼肌萎缩,而且能够提高脊髓损伤患者的步行能力。     

减重平板训练改善T1损伤伴脊髓空洞症患者步行能力

脊髓损伤所致的瘫痪是一种严重的残疾 ,直接影响患者的生活质量。我们通过对 1例Ｔ1 损伤合并脊髓空洞症致截瘫的患者采用综合康复治疗 (包括Ｘ .Ｏ .Ｓ训练仪、截瘫支具、减重平板步行等训练 )后 ,目前患者在助行器帮助下可行走 10 0ｍ ,达到日常生活完全自理。康复治疗效果显著 ,报道如下。一、病例介绍患者为男性 ,5 1岁 ,因双下肢麻木、乏力 2年 ,进行性加重致双下肢瘫痪 1个月 ,诊断为Ｔ1 5脊髓肿瘤合并脊髓空洞症 ,于1999年 4月在外院接受脊髓肿瘤切除手术 ,术后 40ｄ来我院接受康复治疗。当时患者脊髓损伤平面在Ｔ1 ,脊髓损伤分级为…     

减重步行训练对不完全脊髓损伤患者步行能力的影响

目的探讨减重步行训练对不完全脊髓损伤（ISCI）患者步行能力的影响。方法将42例ISCI患者随机分为减重步行训练（BWSTT）组（n=22）和对照组（n=20）。两组患者均接受常规截瘫康复治疗。BWSTT组在常规康复治疗基础上,每日行减重步行训练1次,共计治疗1个月。分别于治疗前及治疗1个月后,采用步长、步速、功能性步行分级对患者的步行能力进行评定。结果治疗前,BWSTT组和对照组患者的步长、步速和功能性步行分级差异无显著性（P〉0．05）。治疗1个月后,两组患者的步长、步速和功能性步行分级与治疗前相比较,差异具有显著性（P〈0．05）;且BWSTT组患者的步长、步速和功能性步行分级与对照组相比较,差异具有显著性（P〈0.05）。结论在常规康复治疗基础上应用减重步行训练,能更大程度提高不完全脊髓损伤患者的步行能力。     

电针配合减重步行训练对脊髓损伤患者步行功能的影响

目的 观察电针配合减重步行对脊髓损伤患者步行功能的影响。方法选择1998-01／2004-12辽东学院医学院脊髓损伤住院及门诊患者30例。于椎体减压及内固定术拆线后转入，随机分成实验组和对照组，每组15例。实验组采用电针配合减重步行治疗，对照组仅采用减重步行训练。6个月后，下肢运动功能采用Fugl-Meyel指数评定，步行功能采用Lindmark指数进行评定。结果按意向处理分析，30例患者均进入结果分析。实验组和对照组治疗前Fugl-Meyer指数评分接近(8．5&;#177;6．3．8．8&;#177;7．2，t=0．12，P&;gt;0．05)；Lindmark指数评定无差异。6个月后实验组Fugl-Meyler指数评分明显高于对照组(23．8&;#177;4．1．17．2&;#177;5．0，t=3．95，P&;lt;0．01)。Lindmark指数评定实验组明显高于对照组(140．0&;#177;3．8，112．0&;#177;2．6，t=19．8,P&;lt;0．01)。结论电针配合减重步行可以提高脊髓损伤患者下肢运动能力，明显改善步行功能。     

早期减重平板步行训练对脑卒中患者步行能力的影响

目的研究早期减重平板步行训练对脑卒中偏瘫患者步行能力的影响。 方法将76例脑卒中偏瘫患者随机分为治疗组及对照组,2组患者均给予常规康复治疗,治疗组同时给予减重平板步行训练,共治疗8周。于治疗前、治疗8周后对2组患者功能性步行分级（FAC）及步行速度进行评定。 结果2组患者经8周治疗后,发现其FAC分级及步行速度均较治疗前明显改善（均P<0.01）,且以治疗组的改善幅度较显著,与对照组比较,组间差异具有统计学意义（P<0.01）。 结论在常规康复治疗基础上辅以减重平板步行训练,对进一步改善脑卒中偏瘫患者步行功能具有显著促进作用。     

重量支撑平板步行训练对不完全脊髓损伤患者步行能力的影响

目的:研究重量支撑平板步行训练对不完全脊髓损伤(SCI)患者步行能力的影响.方法:20例胸段不完全SCI患者(分类为ASIA C或D)随机分为对照组与减重组各10例,均采用综合康复治疗,包括神经营养等药物,运动疗法,作业疗法及针刺等;减重组患者在身体条件许可的情况下及早接受重量支撑平板步行训练.治疗前后对2组患者进行ASIA下肢运动评分,FIM步行能力、10 m步行速度及ADL评定.结果:治疗3个月后,ASIA下肢运动功能评分与治疗前比较减重组明显提高(P<0.05),对照组无明显变化;而FIM步行能力、10 m步行速度及ADL能力2组均有提高(P<0.05),其中FIM步行能力及10 m步行速度减重组明显优于对照组(P<0.05).结论:重量支撑平板步行训练能显著提高不完全SCI患者的步行能力和步行速度.     

减重平板训练对瘫痪后步行障碍患者的影响

目的：观察减重平板训练对脊髓损伤和脑损伤造成的长期下肢瘫痪步行功能的作用。方法：10名男性患者，年龄25－64岁，其中4例脊髓损伤，6例脑血管意外，病程平均1．4年，减重平板训练前均接受不同程度的传统康复训练，功能步行评定为0－1分，接受减重平板训练每天1次，开始减重重量在50％－70％之间，平板速度为0．27m/s，平均20次，所有虱训练前后接受功能步行和一般平衡功能测定，其中7例患者在Kistler压电晶体式三维测力台上进行步态分析。结果：患者经过阶段性减重平板训练，功能性步行评定及站立平衡功能比传统康复治疗前后有十分明显的改善（P＜0．0001，P＝0．0003），其中7例患者的平均步速达0．36m/s，左右足对台压力峰值和支撑时间无明显差异（P＞0．05），结论：减重平板训练对长期瘫痪患者改善步行能力有帮助。     

步行训练对不完全性脊髓损伤大鼠损伤部位周围组织可塑性的影响

目的探讨步行训练对不完全性脊髓损伤大鼠损伤部位周围组织可塑性的影响。 方法将雌性SD大鼠24只分为步行训练组和对照组,每组12只,制作第10胸椎段脊髓损伤模型。步行训练组在制作脊髓损伤模型后1周开始进行步行训练,共训练9周;对照组不接受干预。制作模型后每周利用BBB评分评定后肢运动功能,8周后取材进行免疫荧光染色、Western blotting和轴突示踪分析。 结果后肢运动功能：步行训练组在伤后4周（步行训练3周）时,BBB评分较对照组出现明显改善（P<0.05）,一直持续到实验结束（伤后第10周,P<0.01）。损伤部位神经丝(NF)免疫荧光染色分析：对照组胶质瘢痕中可见许多排列比较规则、与脊髓纵轴方向一致的NF阳性纤维穿行,步行训练组除了可见少量NF阳性纤维在胶质瘢痕中穿越,还可见较多的NF阳性纤维围绕空洞边缘延伸,其NF阳性纤维数量明显高于对照组（P<0.05）。损伤部位生长相关蛋白-43（GAP-43）表达：2组损伤部位周围均可见呈红色的排列凌乱的GAP-43表达,步行训练组GAP-43+组织免疫荧光灰度值较对照组高 (P<0.05)。皮质脊髓束再生:2组损伤部位尾侧均未见生物素化葡聚糖胺（BDA）标记的纤维。 结论步行训练能明显增强脊髓损伤大鼠后肢损伤部位组织的可塑性,促进大鼠后肢运动功能恢复,但未能促进皮质脊髓束的再生。     

电针配合减重步行训练对脊髓损伤患者步行功能的影响

目的观察电针配合减重步行对脊髓损伤患者步行功能的影响。方法选择1998-01/2004-12辽东学院医学院脊髓损伤住院及门诊患者30例。于椎体减压及内固定术拆线后转入,随机分成实验组和对照组,每组15例。实验组采用电针配合减重步行治疗,对照组仅采用减重步行训练。6个月后,下肢运动功能采用Fugl-Meyer指数评定,步行功能采用Lindmark指数进行评定。结果按意向处理分析,30例患者均进入结果分析。实验组和对照组治疗前Fugl-Meyer指数评分接近(8.5±6.3,8.8±7.2,t=0.12,P>0.05);Lindmark指数评定无差异。6个月后实验组Fugl-Meyer指数评分明显高于对照组(23.8±4.1,17.2±5.0,t=3.95,P<0.01)。Lindmark指数评定实验组明显高于对照组(140.0±3.8,112.0±2.6,t=19.8P<0.01)。结论电针配合减重步行可以提高脊髓损伤患者下肢运动能力,明显改善步行功能。     

水中平板步行训练对脊髓损伤患者康复疗效的初步观察

目的观察水中平板步行训练对脊髓损伤患者的康复疗效。方法对11例外伤性不完全性脊髓损伤患者进行水中平板步行训练等康复治疗，记录水中平板步行训练前后的ASIA运动评分、ASIA感觉评分。以及训练时的行走距离、最大步速和训练前后的日常生活活动能力（ADL）评分变化。结果经水中平板步行训练后，患者的ASIA感觉评分提高（P〈0．05），ASIA运动评分、行走距离、最大步速及ADL评分明显提高（P〈0．01）。结论在常规康复治疗基础上进行水中平板步行训练可改善不完全性脊髓损伤患者的运动、感觉功能及生活自理能力。     

Effects of Performance-Based Training on Gait and Balance in Individuals With Incomplete Spinal Cord Injury

ObjectiveTo determine changes in balance and gait following a task-specific, performance-based training protocol for overground locomotor training (OLT) in individuals with motor-incomplete spinal cord injury (iSCI).DesignConvenience sample, prepilot and postpilot study.SettingHuman performance research laboratory.ParticipantsAdults (N=15; 12 men and 3 women; mean age [y] ± SD, 41.5±16.9), American Spinal Injury Association Impairment Scale C or D, >6 months post-spinal cord injury.InterventionsTwo 90-minute OLT sessions per week over 12 to 15 weeks. OLT sessions were built on 3 principles of motor learning: practice variability, task specificity, and progressive overload (movement complexity, resistance, velocity, volume). Training used only voluntary movements without body-weight support, robotics, electrical stimulation, or bracing. Subjects used ambulatory assistive devices as necessary.Main Outcome MeasuresBerg Balance Scale (BBS), Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI) gait parameters, spatiotemporal measures of gait (step length, step width, percent stance, stance:swing ratio) from 7 participants who walked across a pressure-sensitive walkway.ResultsFourteen participants completed the OLT protocol and 1 participant completed 15 sessions due to scheduled surgery. The BBS scores showed a mean improvement of 4.53±4.09 (P<.001). SCI-FAI scores showed a mean increase of 2.47±3.44 (P=.01). Spatiotemporal measures of gait showed no significant changes.ConclusionThis pilot demonstrated improvements in balance and selected gait characteristics using a task-specific, performance-based OLT for chronic iSCI.     

大鼠脊髓损伤后早期应用孕酮联合减重步行训练的干预作用

目的：观察早期应用孕酮和减重步行训练对大鼠脊髓损伤（SCI）后的运动功能、脊髓形态学及脑源性神经营养因子（BDNF）mRNA表达的影响。方法：120只雄性SD大鼠随机分成假手术组、模型组、孕酮组、训练组、联合组（孕酮＋训练）,前三组各30只大鼠（每组分为第1、3、7、14、21、28天6个亚组各5只）,后两组各15只大鼠（每组分为第14、21、28天3个亚组各5只）;采用改良的Allen’s撞击法制成SCI模型;孕酮在术后30 min、6 h、24 h、48 h、72 h时以4 mg/kg的剂量腹腔注射;减重步行训练在术后1周开始,训练14 d;术后不同时间点采用BBB法进行后肢运动功能评分,HE染色观察脊髓形态学的变化,RT-PCR法检测BDNF mRNA的表达水平。结果：孕酮和训练均可促进大鼠后肢功能恢复和受损脊髓的出血吸收、神经再生,并且具有协同效应。RT-PCR结果显示假手术组BDNF mRNA低表达;模型组在3 d内升高;孕酮组在1周内高表达,高峰在第3天;训练组从第14天开始表达明显增高,训练停止1周后仍维持在高水平;联合组BDNF mRNA的表达水平较孕酮组或训练组更高（P0.01）。结论：早期应用孕酮和减重步行训练均能促进SCI大鼠的运动功能恢复,其机制之一可能是上调局部BDNF mRNA的表达,促进神经再生;两者联合应用的效果比单一应用更好。     

水中平板步行训练在脊髓损伤患者康复中的应用

水中平板步行训练是一项较新的水疗技术,兼有浸浴、水中步行及减重平板步行训练的特点。水中平板步行训练对脊髓损伤患者可能具有减轻下肢负荷、缓解痉挛、改善步态、延缓肌肉萎缩、增强残存肌力、减少心血管疾病的危险因素、改善体位性低血压等作用。目前水中平板步行训练对脊髓损伤患者各方面疗效的研究尚不充分,还有待于进一步探讨。     

Effects of Locomotor Training After Incomplete Spinal Cord Injury: A Systematic Review

Objective

To provide an overview of, and evaluate the current evidence on, locomotor training approaches for gait rehabilitation in individuals with incomplete spinal cord injury to identify the most effective therapies.

Data Sources

The following electronic databases were searched systematically from first date of publication until May 2013: Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, MEDLINE, Physiotherapy Evidence Database, and PubMed. References of relevant clinical trials and systematic reviews were also hand searched.

Study Selection

Only randomized controlled trials evaluating locomotor therapies after incomplete spinal cord injury in an adult population were included. Full-text versions of all relevant articles were selected and evaluated by both authors.

Data Extraction

Eligible studies were identified, and methodologic quality was assessed with the Physiotherapy Evidence Database scale. Articles scoring <4 points on the scale were excluded. Sample population, interventions, outcome measures, and findings were evaluated with regard to walking capacity, velocity, duration, and quality of gait.

Data Synthesis

Data were analyzed by systematic comparison of findings. Eight articles were included in this review. Five compared body-weight–supported treadmill training (BWSTT) or robotic-assisted BWSTT with conventional gait training in acute/subacute subjects (≤1y postinjury). The remaining studies each compared 3 or 4 different locomotor interventions in chronic participants (>1y postinjury). Sample sizes were small, and study designs differed considerably impeding comparison. Only minor differences in outcomes measures were found between groups. Gait parameters improved slightly more after BWSTT and robotic gait training for acute participants. For chronic participants, improvements were greater after BWSTT with functional electrical stimulation and overground training with functional electrical stimulation/body-weight support compared with BWSTT with manual assistance, robotic gait training, or conventional physiotherapy.

Conclusions

Evidence on the effectiveness of locomotor therapy is limited. All approaches show some potential for improvement of ambulatory function without superiority of 1 approach over another. More research on this topic is required.     

Effects of Epidural Spinal Cord Stimulation and Treadmill Training on Locomotion Function and Ultrastructure of Spinal Cord Anterior Horn after Moderate Spinal Cord Injury in Rats

Objective:To investigate the effects of epidural spinal cord stimulation (ESCS) and treadmill training on the locomotion function and ultrastructure of spinal cord anterior horn after moderate spinal cord injury in rats.Method:Nine adult female Sprague-Dawley rats were randomly distributed into three groups: ①spinal cord injury group (SI, n=3). ②spinal cord injury plus ESCS group (SE, n=3). ③spinal cord injury plus treadmill training group (TT, n=3). All rats received a moderate spinal cord injury surgery. Four weeks after surgery, rats in SE group received an electrode implantation procedure, with the electrode field covering spinal cord segments L2—S1. Four weeks after electrode implantation, rats received subthreshold ESCS for 30 min/d. Rats in TT group received 4cm/s treadmill training for 30min/d. Rats in SI group received no intervention, as a control group. All procedures in these three groups lasted four weeks.The open field Basso,Beattie and Bresnahan(BBB) scale was used before and after intervention to evaluate rats′ hindlimb motor function. Result:After four weeks intervention, rats in TT group improved their open field locomotion scores to 20. In contrast, no significant improvement was observed in groups SI and SE. The morphology of synapses and neurons were similar regardless of whether rats had undergone ESCS, treadmill training or not. Conclusion:ESCS alone was not sufficient to improve the walking ability of spinal cord injured rats. ESCS or treadmill training alone might not contribute to the changes of ultrastructure in anterior horn of spinal cord that underlie the recovery of walking ability. Further research is needed to understand the contributions of combination of ESCS and treadmill training to the rehabilitation of spinal cord injured rats.