Summarizing the results of the world scientific data on this topic, the possibility to evoke step-like movements in the lower limbs of patients with spinal cord injury (SCI) below the level of damage was noted. That was verified during electrical stimulation in combination with mechanotherapy, the electrodes application to the definite areas of spinal cord. In addition, we stated that these measures led to reduction of muscle hypertonus in the lower limbs, improvement of neuromuscular junction and tolerance towards increasing stimulation that were instrumentally confirmed. We stated that it is impossible to achieve the same effect using only one of these methods isolated. The first studies were carried out by implantation of epidural electrodes in the spinal cord, and later by a combination of electrical stimulation and step-like movements with the same frequency setting manually. During further technology development, stimulation became percutaneous, and the movements were carried out using robotic mechanotherapy. The advantage of this method is obvious: the specialist needs to set the initial parameters which are selected individually for the patient,to monitor the progress of the procedure and to fix changes. These devices include robotic systems which perform movements in the lower extremities with full and partial axial load. Currently a study of the device for robotic therapy in horizontal unsupported state is ongoing in rehabilitation clinic of FSBI NMCC n. a. N.I. Pirogov. Its excellence is support absense, the training is held in conditions of complete body weight unloading. Multimodal electrical stimulation is performed simultaneously with robotic therapy: percutaneous electrical stimulation of the spinal cord and functional electrical stimulation (FES) of the legs, back and abdomen muscles. It was stated that parameters of neurological status were improved significantly. This article presents the results of unsupported robotic mechanotherapy`s clinical testing in the SCI patients rehabilitation.

INTRODUCTION. According to the WHO, between 250,000 and 500,000 people are affected every year with spinal cord injury (SCI) around the world. The number of disabled people as a result of spinal cord injury in Russia is estimated to be over 250,000 and is increasing due to injury rate growth and survival rate improvement of patients in the acute and long-term periods of traumatic spinal cord injury (TSCI). AIM. To justify the efficacious and safe use of a zero-gravity robotic simulator for a locomotor therapy in the complex rehabilitation of patients with SCI and compare this therapeutic approach with conventional motor rehabilitation programs using other robotic mechanotherapy techniques. MATERIAL AND METHODS. Neurological and functional disorders were analyzed in 30 patients with SCI on the basis of clinical examination and electromyography (EMG) findings. All the patients were classified into an intervention group and a control group by a sequential randomization. The rehabilitation programs for the intervention and control groups were alike, except for robotic mechanotherapy. RESULTS. A significant positive dynamic change in motor functions according to the ASIA Impairment scale was noted in the intervention group, in which 2 patients moved up to a higher level. The EMG data showed a significant difference between the groups in favor of the intervention one. A significant difference in postural function improvement was found between the intervention and control groups in a seated position. The rehabilitation of patients from the intervention group engaged the axial muscles, promoting an increase in strength and better control of the trunk muscles. A significant spasticity decrease and changes in the functional status of the patients were observed in both groups. The patients’ ability to perform normal daily activities was registered to improve. CONCLUSION. The study demonstrated that robotic musculoskeletal training in zero-gravity conditions is safe and effective in complex rehabilitation of patients with SCI and improves motor skills, self-care and postural function. A significant correlation was found between neurological and functional changes, indicative of a restorative concept of the new therapeutic modality. Further studies with increased capacity are reasonable.

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