Rehabilitation of walking for paraplegic patients by means of a treadmill

Felici, Francesco; Bernardi, Marco; Rodio, Angelo; Marchettoni, P; Castellano, V.; Macaluso, Andrea

doi:10.1038/sj.sc.3100403

Cited by 34 publications

(10 citation statements)

References 11 publications

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“…As compared to the other reports 4,5,[13][14][15][16] where the energy expenditure of orthotic gait was measured in reciprocating gait orthosis (RGO and ARGO), our data shows a faster gait speed with similar energy expenditures (Tables 4 and 5). The gait speed reported by Massucci et al 15 and Ijzerman et al 8 both of which used ARGO, was remarkably slower than that shown in our data.…”

Section: Comparison With Previous Resultssupporting

confidence: 68%

Effect of lesion level on the orthotic gait performance in individuals with complete paraplegia

et al. 2006

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Study design: Cross-sectional, experimental research. Objectives: To clarify the effect of lesion level on cardio-respiratory responses and biomechanical characteristics of walking with a reciprocating gait orthosis in complete paraplegia with spinal cord injury (SCI). Setting: National Rehabilitation Center for Persons with Disabilities, Japan. Methods: Ten SCI individuals (age: 20-34 years, injured level: Th5-12) who experienced orthotic gait training at least for 10 weeks participated in two experiments: (1) measurement of the cardiorespiratory responses during 20 min of orthotic gait exercise; and (2) threedimensional motion analysis and ground reaction force measurement using the VICON system. We calculated the following parameters: pulmonary ventilation, oxygen consumption (VO 2 ), heart rate (HR), gait speed, cadence, stride length, crutch force (CF), hip range of motion (ROM), and hip angular velocity (VEL). Further, energy consumption and energy cost were calculated using the steady-state value of VO 2 and gait speed. Results: The steady-state value of the VO 2 (18.273.80 ml/kg) and HR (133.0721.63 b/min) tended to be larger in higher thoracic SCI subjects. There were strong positive correlations between the lesion level and walking speed (r ¼ 0.74), energy cost (r ¼ 0.85), and hip ROM (r ¼ 0.78). On the other hand, negative correlation between the lesion level and peak CF (r ¼ À0.78) was clarified. Conclusions: The physiological intensity of the orthotic gait strongly depended on the level of lesion. It seems likely that a limited hip range of motion and excess upper limb load result in the low energy cost of orthotic gait for the higher thoracic level of paraplegic patients.

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Section: Comparison With Previous Resultssupporting

confidence: 68%

Effect of lesion level on the orthotic gait performance in individuals with complete paraplegia

et al. 2006

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“…[2][3][4][5][6][7] Although paraplegic patients with high thoracic level lesions found it difficult to achieve orthotic gait in the early stages of researches, 13 later improvement enabled them to walk independently and reciprocally. 4,5,14 However, the high energy cost is still the major reason for the limitation of the orthotic use. 4,5 As Waters et al 15 pointed out, there was a high correlation between the lower extremity muscle scores and the energy cost of the orthotic walking.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12] Figure 1 shows the relation between the energy consumption and energy cost in each previous investigation. [3][4][5]7,14,[16][17][18] Since the walking speed was delivered to divide the energy consumption by the energy cost, the slope of line from zero to each plot reflects the walking speed of each orthosis. This figure clearly shows that the WBC enables paraplegic patients to walk at relatively higher speed than other reports under almost relatively lower energy cost.…”

Section: Discussionmentioning

confidence: 99%

Energy expenditure during walking with weight-bearing control (WBC) orthosis in thoracic level of paraplegic patients

Kawashima

Sone²,

Nakazawa

et al. 2003

Spinal Cord

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Study design: Comparative study of the effectiveness of walking exercise with a newly developed gait orthosis, the weight-bearing control (WBC) orthosis, for thoracic level of paraplegic patients. Objectives: To test its feasibility as a rehabilitation alternative for paraplegic patients, the energy consumption and cost during walking with WBC were calculated and compared with the values of conventional orthoses given in previous reports. Setting: National Rehabilitation Center for the Disabled, Japan. Methods: Four paraplegic patients with traumatic spinal cord injuries ranging from T8 to T12 participated. Experiments were conducted after 3 months of the orthotic gait training with WBC. The cardiorespiratory parameters were continuously measured at rest and during walking with a telemetric device. The steady-state value of the oxygen uptake (V O 2 ), heart rate (HR), the energy consumption (J/kg/s) and energy cost (J/kg/m) were calculated. Results: The average walking speed was 19.072.58 m/min. The steady-state value of the V O 2 and HR were 16.0871.93 ml/kg and 147.3710.94 b/min, respectively. The energy cost during orthotic walking tended to be better than the values of conventional orthoses, whereas the energy consumption was almost similar. Conclusion: WBC enables thoracic level of paraplegic patients to walk at relatively higher speed than conventional orthoses under similar energy expenditure. The special devices equipped with WBC are therefore considered to lead to improvement of the energy cost of walking. The physical intensity presumed by cardiorespiratory responses during walking with WBC is suited to promote their aerobic capacity. Therefore, it is concluded that the WBC orthosis could be an effective alternative in rehabilitation for thoracic level of paraplegic patients.

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“…From the literature it is known that energy cost of locomotion in people with disabilities can be improved by training (Felici et al 1997;Protas et al 2001), so future research should also look at the effects of training to reduce the energy cost during locomotion in ambulatory children with SB.…”

Section: Peak Oxygen Uptakementioning

confidence: 99%

Limiting factors in peak oxygen uptake and the relationship with functional ambulation in ambulating children with Spina Bifida

et al. 2008

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The objective of this study is to interpret the outcomes of peak oxygen uptake (VO 2peak ) in children with SB and explore the relationship between VO 2peak and functional ambulation using retrospective cross-sectional study. Twenty-three ambulating children with SB participated at Wilhelmina's Children's Hospital Utrecht, the Netherlands. VO 2peak was measured during a graded treadmill-test. Eschenbacher's and Maninna's algorithm was used to determine limiting factors in reaching low VO 2peak values. Energy expenditure during locomotion (both O 2 rate and O 2 cost) and percentage of VO 2peak and HR peak were determined during a 6-min walking test (6MWT). Differences between community and normal ambulators were analyzed. VO 2peak , VO 2peak /kg, HR peak , RER peak and VE peak were significantly lower compared to reference values, with significant differences between normal and community ambulators. Limiting factors according to the algorithm were mostly ''muscular and/or deconditioning'' (47%) and ventilatory ''gasexchange'' (35%). Distance walked during 6MWT was 48.5% of predicted distance. Both O 2 rate and O 2 cost were high with significant differences between normal and community ambulators [17.6 vs. 21.9 ml/(kg min) and 0.27 vs 0.43 ml/ (kg m)]. Also %HR peak and %VO 2peak were significantly higher in community ambulators when compared to normal ambulators (resp. 97.6 vs. 75% and 90.2 vs. 55.9%). VO 2peak seems to be mostly limited by deconditioning and/ or muscular components and possible ventilatory factors. For both peak values and functional ambulation, community ambulators were significantly more impaired than normal ambulators. High energy expenditure, %VO 2peak and %HR peak reflect high level of strain during ambulation in the community ambulators. Future exercise testing in children with SB should include assessment of ventilatory reserve. Exercise training in ambulatory children should focus on increasing both VO 2peak and muscular endurance, as well as decreasing energy cost of locomotion.

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Rehabilitation of walking for paraplegic patients by means of a treadmill

Cited by 34 publications

References 11 publications

Effect of lesion level on the orthotic gait performance in individuals with complete paraplegia

Effect of lesion level on the orthotic gait performance in individuals with complete paraplegia

Energy expenditure during walking with weight-bearing control (WBC) orthosis in thoracic level of paraplegic patients

Limiting factors in peak oxygen uptake and the relationship with functional ambulation in ambulating children with Spina Bifida

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