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

Neville, Brian; Murray, D. Duncan; Rosen, Kerry B.; Bryson, Caitlin A.; Collins, John P.; Guccione, Andrew A.

doi:10.1016/j.apmr.2019.03.019

Cited by 10 publications

(10 citation statements)

References 21 publications

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“…However, the paralysis of lower limb and osteoporosis after SCI would make individuals difficult to walk or run. Instead, upper limb aerobic exercise [14], strength training [15], and balance training [16][17][18] are common exercises to maintain exercise capacity for these individuals. Nonetheless, previous study reported that these were hard to improve the resting lung function or exercise performance [19].…”

Section: Introductionmentioning

confidence: 99%

Exoskeleton-assisted walking improves pulmonary function and walking parameters among individuals with spinal cord injury: a randomized controlled pilot study

Xiang

Zong

et al. 2021

J NeuroEngineering Rehabil

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Background Exoskeleton-assisted walking (EAW) is expected to improve the gait of spinal cord injury (SCI) individuals. However, few studies reported the changes of pulmonary function (PF) parameters after EAW trainings. Hence, we aimed to explore the effect of EAW on PF parameters, 6-min walk test (6MWT) and lower extremity motor score (LEMS) in individuals with SCI and to compare those with conventional trainings. Methods In this prospective, single-center, single-blinded randomized controlled pilot study, 18 SCI participants were randomized into the EAW group (n = 9) and conventional group (n = 9) and received 16 sessions of 50–60 min training (4 days/week, 4 weeks). Pulmonary function parameters consisting of the forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), forced expiratory flow (FEF), peak expiratory flow, and maximal voluntary ventilation, 6MWT with assisted devices and LEMS were reported pre- and post-training. Results Values of FVC (p = 0.041), predicted FVC% (p = 0.012) and FEV1 (p = 0.013) were significantly greater in EAW group (FVC: 3.8 ± 1.1 L; FVC% pred = 94.1 ± 24.5%; FEV1: 3.5 ± 1.0 L) compared with conventional group (FVC: 2.8 ± 0.8 L; FVC% pred = 65.4 ± 17.6%; FEV1: 2.4 ± 0.6 L) after training. Participants in EAW group completed 6MWT with median 17.3 m while wearing the exoskeleton. There was no difference in LEMS and no adverse event. Conclusions The current results suggest that EAW has potential benefits to facilitate PF parameters among individuals with lower thoracic neurological level of SCI compared with conventional trainings. Additionally, robotic exoskeleton helped walking. Trial registration: Registered on 22 May 2020 at Chinese Clinical Trial Registry (ChiCTR2000033166). http://www.chictr.org.cn/edit.aspx?pid=53920&htm=4.

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Section: Introductionmentioning

confidence: 99%

Exoskeleton-assisted walking improves pulmonary function and walking parameters among individuals with spinal cord injury: a randomized controlled pilot study

Xiang

Zong

et al. 2021

J NeuroEngineering Rehabil

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“…21 Therefore, these are indicative important for, since the goal of treatment is to enable them to safely and easily walk with a good functional speed as far as possible. 22 Thus, the association of conventional physiotherapy with robotic therapy GS, proved to be effective in improving these aspects in the sample, because the robotic device generates a precise, repetitive and intense cycle of gait phases, also helps in motor relearning through neuroplastic promotion of the pathways involved in this process, and functional improvement of this skill. 20 Along with gait training, the main differential of the GS is the step up and down training, which can in turn increase the muscle strength, coordination, balance and cardiorespiratory conditioning of individuals practicing this mode.…”

Section: Discussionmentioning

confidence: 99%

“…20 Along with gait training, the main differential of the GS is the step up and down training, which can in turn increase the muscle strength, coordination, balance and cardiorespiratory conditioning of individuals practicing this mode. 19 Concomitantly therefore, ground gait training performed through conventional physiotherapy has been suggested as a positive reinforcer of the tasks performed during robotic therapy, bringing benefits to gait balance and functionality in individuals with incomplete chronic SCI, 22 based on In principle, they will not be coupled to a body weight adjuster during their daily gait and associated tasks, where independent weight bearing assists in obtaining physiological adaptations through progressive overload, improving the maintenance of postural orientation and balance during functional walking. 22 Finally, this was the first study conducted and found in the literature using the GS as an adjuvant therapy in the rehabilitation process of the population with chronic incomplete spinal cord injury.…”

Section: Discussionmentioning

confidence: 99%

Combined effects of physiotherapy and robotic therapy on gait balance and speed in patients with incomplete spinal cord injury

et al. 2019

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Restoring the ability to walk, especially independently, is one of the goals in the rehabilitation of patients with incomplete spinal cord injury (ISCI). The G-EO System (GS) robotic gait training acts as a reinforcer of the repetitive and specific practice of the gait phases. Objective: Investigate the combined effects of physiotherapy and robotic therapy on gait functionality in relation to balance and gait speed in patients with ISCI. Methods: Retrospective cohort study with 14 patients in the chronic phase of the disease, using the GS as a robotic intervention for gait and stairs, consisting of a 20-session protocol associated with conventional physical therapy. We used the 10-meter Walk Test (10WT) and the Berg Balance Scale (BBS). P values <0.05 were considered statistically significant using the Wilcoxon test at the beginning of conventional physical therapy and before and after intervention. Results: At the 10WT, the mean initial velocity ranged from 2.60 m/s ± 1.72 at the beginning of conventional physical therapy to 1.57 m/s ± 0.80 at the end of the 20 GS sessions with p = 0.0424. For BBS at the beginning of conventional physical therapy, the average was 31.85 points ± 12.50, and 42.35 ± 14.25 at the end of the 20 GS sessions, with p = 0.0096. Conclusions: Robotic gait therapy associated with conventional physiotherapy has been shown to be effective in promoting balance and gait speed improvement in individuals in the chronic phase after involvement of incomplete spinal cord injury.

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“…This is despite the fact that time spent on balance training during inpatient rehabilitation increases the odds of being ambulatory at discharge in people with motor incomplete SCI/D (iSCI/D) (5). Research on balance training after a motor iSCI/D is also limited (6); the majority of published studies assessing changes in balance do so after locomotor training, rather than a balance intervention (7)(8)(9)(10)(11)(12). Previously studied balance interventions have focused on anticipatory balance control, which is used to stabilize the body before a volitional movement (13).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Perturbation-Based Balance Training and Conventional Intensive Balance Training on Reactive Stepping Ability in Individuals With Incomplete Spinal Cord Injury or Disease: A Randomized Clinical Trial

et al. 2021

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Introduction: Impaired balance leads to falls in individuals with motor incomplete spinal cord injury or disease (iSCI/D). Reactive stepping is a strategy used to prevent falls and Perturbation-based Balance Training (PBT) can improve this ability.Objective: The objective of this study was to determine if PBT results in greater improvements in reactive stepping ability than frequency-matched Conventional Intensive Balance Training (CIBT) in adults with iSCI/D.Design: Randomized clinical trial.Setting: Tertiary SCI/D rehabilitation center.Participants: Twenty-one adults with chronic (>1 year) iSCI/D were randomized. Due to one drop out 20 participants completed the study.Methods: Participants were randomly allocated to complete either PBT or CIBT three times per week for 8 weeks. Both programs included challenging static and dynamic balance tasks, but the PBT group also experienced manual external balance perturbations.Main Outcome Measures: Assessments of reactive stepping ability using the Lean-and-Release test were completed at baseline, and after 4 and 8 weeks of training, and 3 and 6 months after training completion. A blinded assessor evaluated secondary outcomes.Results: Twenty-five participants were screened and 21 consented; one withdrew. Ten PBT and 10 CIBT participants were included in analyses. Across all participants there were improvements in reactive stepping ability (p = 0.049), with retention of improvements at follow up assessments. There were no differences in reactive stepping ability between groups [median (interquartile range): PBT 0.08 (0.68); CIBT 0.00 (0.22)]. One participant in the PBT group experienced a non-injurious fall during training.Conclusions: Balance training is beneficial for individuals with iSCI/D, but the addition of manual perturbations (i.e., PBT) did not prove advantageous for performance on a measure of reactive stepping ability.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT02960178.

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

Cited by 10 publications

References 21 publications

Exoskeleton-assisted walking improves pulmonary function and walking parameters among individuals with spinal cord injury: a randomized controlled pilot study

Exoskeleton-assisted walking improves pulmonary function and walking parameters among individuals with spinal cord injury: a randomized controlled pilot study

Combined effects of physiotherapy and robotic therapy on gait balance and speed in patients with incomplete spinal cord injury

The Effect of Perturbation-Based Balance Training and Conventional Intensive Balance Training on Reactive Stepping Ability in Individuals With Incomplete Spinal Cord Injury or Disease: A Randomized Clinical Trial

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