Locomotor training using a robotic device in patients with subacute spinal cord injury

Abstract

Study design: Quasi experiment; single experimental group with matched historical control. Objectives: To evaluate the effect of an additive robotic-assisted gait training (RAGT) using the Lokomat system on the neurological and functional outcomes of patients with subacute spinal cord injury (SCI). Setting: Department of Physical Medicine and Rehabilitation. Methods: A total of 28 subacute SCI patients were treated by RAGT, 2-3 times a week, 30-45 min every treatment, concomitantly with regular physiotherapy. As control, for each patient, we matched a comparable patient treated in the same department in previous years, according to age, severity of injury, level of injury and cause. The main outcomes were: the AIS (American Spinal Injury Association impairment scale) the spinal cord independence measurement (SCIM) score, the walking index for SCI II (WISCI II) and functional ambulation category scale (FAC). Results: At the end of rehabilitation, both groups showed a significant improvement in both the FAC score and the WISCI score (Po0.01) without differences between the groups. Functional abilities, according to the SCIM score, were also improved, with a significant interaction effect; the RAGT patients improve by 30 ± 20 points, which was significantly greater gain as compared with the controls, 21 ± 14 points (P ¼ 0.05). This improvement was mainly due to the change in the SCIM motor subscales. Conclusion: RAGT is an important additional treatment to improve the functional outcome of subacute SCI patients. Larger, controlled studies are still required to determine the optimal timing and protocol design for the maximal efficacy of RAGT in SCI patients.

Functional outcome of patients 12 and 48 weeks after acute traumatic tetraplegia and paraplegia: data analysis from 2004–2009

“…11 Regarding the SCIM score it is known that locomotor training leads to an increase in SCIM points, especially in the mobility section. 12 This was also shown in the present study.…”

Effects of robotic-locomotor training on stretch reflex function and muscular properties in individuals with spinal cord injury

“…One such device is the LOKOMAT (Hocoma, Switzerland), a powered device that provides robotic-assisted step training (RAST) similar to BWSTT, but through a motorized exoskeleton that attaches to the patient’s legs, rather than manual positioning by a therapist (Colombo et al, 2000). Recent results have shown that RAST can improve walking capacity by improving gait speed, endurance, or temporal patterns of electromyographic (EMG) activity (Field-Fote et al, 2005, Hornby et al, 2005, Mazzoleni et al, 2011, Schwartz et al, 2011, Wirz et al, 2005). It has also been shown that RAST can improve spasticity as measured by the Pendulum Test (Manella et al, 2010) and reflex excitability (Manella and Field-Fote, 2013), but had no significant impact on hypertonia as measured by the Modified Ashworth Scale (MAS) (Manella and Field-Fote, 2013, Manella et al, 2010).…”

Rehabilitation of spinal cord injuries

“…After training, manual muscle test scores of wrist extensor, finger flexor and finger abductor are significantly increased [47] . Another study demonstrated that the robotic-assisted gait training using the locomat system improved the functional outcome of subacute SCI patients [48] .…”