Unexpected Recovery After Robotic Locomotor Training at Physiologic Stepping Speed: A Single-Case Design

Spiess, Martina R.; Jaramillo, Jeffrey; Behrman, Andrea L.; Teraoka, Jeffrey K.; Patten, Carolynn

doi:10.1016/j.apmr.2012.02.030

Cited by 15 publications

(6 citation statements)

References 49 publications

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“…With the help of an electromechanical gait trainer, the GT‐1 (Reha‐Stim, Berlin, Germany), patients with chronic hemiparesis, who were nonambulatory, conducted 800‐1000 steps per 20‐minute training session [25]. An individual with SCI, initially unable to walk 10 m between parallel bars even with the assistance of 2 persons, walked between 606 and 2424 m per 30‐minute training session with the assistance of the Lokomat (Hocoma, Volketswil, Switzerland) [26]. Advanced gait trainers hence allowed a 2‐ to almost 10‐fold increase in the number of conducted steps or gait distance during a training session.…”

Section: Intensity and Guidancementioning

confidence: 99%

“…Optimal sensory cues also include walking speed. Increased speeds are associated with increases in locomotor EMG activity, especially at speeds greater than 2.5 km/h [26,46]. Advanced gait trainers are able to provide training with high speeds over longer periods of time, and high speeds are preferred to increase activity of the leg muscles [26,47].…”

Section: Locomotor Training (Lt) Principlesmentioning

confidence: 99%

“…Increased speeds are associated with increases in locomotor EMG activity, especially at speeds greater than 2.5 km/h [26,46]. Advanced gait trainers are able to provide training with high speeds over longer periods of time, and high speeds are preferred to increase activity of the leg muscles [26,47]. Conversely, one study also found that slower training speeds may lead to greater benefits than fast training in severely affected patients early after a stroke [48].…”

Section: Locomotor Training (Lt) Principlesmentioning

confidence: 99%

See 2 more Smart Citations

Getting the Best Out of Advanced Rehabilitation Technology for the Lower Limbs: Minding Motor Learning Principles

Spiess

Steenbrink²,

Esquenazi

2018

PM&R

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Advanced technology, including gait‐training devices, is increasingly being integrated into neurorehabilitation. However, to use gait‐training devices to their optimal potential, it is important that they are applied in accordance with motor learning and locomotor training principles. In this article, we outline the most important principles and explain how advanced gait‐training devices are best used to improve therapy outcome.

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Section: Intensity and Guidancementioning

confidence: 99%

Section: Locomotor Training (Lt) Principlesmentioning

confidence: 99%

Section: Locomotor Training (Lt) Principlesmentioning

confidence: 99%

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Getting the Best Out of Advanced Rehabilitation Technology for the Lower Limbs: Minding Motor Learning Principles

Spiess

Steenbrink²,

Esquenazi

2018

PM&R

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“…The case studies that make up the exceptions all relate to individuals with low paraplegia who likely retained some volitional control of proximal lower extremity muscles and who had involuntary muscle activity (spasticity) that contributed to weight bearing. 9,91,92 There were increases in the strength of the paralyzed quadriceps, tibialis anterior, and soleus muscles at E3 in most participants (50%, 88%, and 75%, respectively), assessed from >10% increases in the amplitude of the respective maximal muscle compound action potentials over the average baseline (Fig. 1A).…”

Section: Lower Extremity Neurological Activity Does Not Changementioning

confidence: 94%

Body System Effects of a Multi-Modal Training Program Targeting Chronic, Motor Complete Thoracic Spinal Cord Injury

Gant

Nagle

Cowan

et al. 2018

Journal of Neurotrauma

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The safety and efficacy of pharmacological and cellular transplantation strategies are currently being evaluated in people with spinal cord injury (SCI). In studies of people with chronic SCIs, it is thought that functional recovery will be best achieved when drug or cell therapies are combined with rehabilitation protocols. However, any functional recovery attributed to the therapy may be confounded by the conditioned state of the body and by training-induced effects on neuroplasticity. For this reason, we sought to investigate the effects of a multi-modal training program on several body systems. The training program included body-weight-supported treadmill training for locomotion, circuit resistance training for upper body conditioning, functional electrical stimulation for activation of sublesional muscles, and wheelchair skills training for overall mobility. Eight participants with chronic, thoracic-level, motor-complete SCI completed the 12-week training program. After 12 weeks, upper extremity muscular strength improved significantly for all participants, and some participants experienced improvements in function, which may be explained by increased strength. Neurological function did not change. Changes in pain and spasticity were highly variable between participants. This is the first demonstration of the effect of this combination of four training modalities. However, balancing participant and study-site burden with capturing meaningful outcome measures is also an important consideration.

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“…Many investigators have reported beneficial effects of automated (222,270), electromechanical (22), robotic (185,234,275), cable-driven (274), conventional treadmill training (61), daily passive cycling (45), exoskeletal robotic orthoses (110,175), and other activity-based training (157) on locomotor function and balance (67), spasticity (28,163), gait impairment (113), and respiratory function (247). Less intensive locomotor training (twice a week) also appears to be beneficial (187).…”

Section: Importance Of Locomotor Trainingmentioning

confidence: 99%

Electrical Stimulation and Motor Recovery

Young

2015

Cell Transplant

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In recent years, several investigators have successfully regenerated axons in animal spinal cords without locomotor recovery. One explanation is that the animals were not trained to use the regenerated connections. Intensive locomotor training improves walking recovery after spinal cord injury (SCI) in people, and >90% of people with incomplete SCI recover walking with training. Although the optimal timing, duration, intensity, and type of locomotor training are still controversial, many investigators have reported beneficial effects of training on locomotor function. The mechanisms by which training improves recovery are not clear, but an attractive theory is available. In 1949, Donald Hebb proposed a famous rule that has been paraphrased as "neurons that fire together, wire together." This rule provided a theoretical basis for a widely accepted theory that homosynaptic and heterosynaptic activity facilitate synaptic formation and consolidation. In addition, the lumbar spinal cord has a locomotor center, called the central pattern generator (CPG), which can be activated nonspecifically with electrical stimulation or neurotransmitters to produce walking. The CPG is an obvious target to reconnect after SCI. Stimulating motor cortex, spinal cord, or peripheral nerves can modulate lumbar spinal cord excitability. Motor cortex stimulation causes long-term changes in spinal reflexes and synapses, increases sprouting of the corticospinal tract, and restores skilled forelimb function in rats. Long used to treat chronic pain, motor cortex stimuli modify lumbar spinal network excitability and improve lower extremity motor scores in humans. Similarly, epidural spinal cord stimulation has long been used to treat pain and spasticity. Subthreshold epidural stimulation reduces the threshold for locomotor activity. In 2011, Harkema et al. reported lumbosacral epidural stimulation restores motor control in chronic motor complete patients. Peripheral nerve or functional electrical stimulation (FES) has long been used to activate sacral nerves to treat bladder and pelvic dysfunction and to augment motor function. In theory, FES should facilitate synaptic formation and motor recovery after regenerative therapies. Upcoming clinical trials provide unique opportunities to test the theory. INTRODUCTIONIn the past decade, several prominent laboratories have shown axonal regeneration in animal spinal cord injury (SCI) models, but locomotor recovery did not follow regeneration (277). For example Lu et al. (159,160) and He's group (156,282) regenerated many axons that synapsed with neurons in the lower spinal cord, but the animals did not recover walking. To explain the lack of locomotor recovery, the investigators assume that insufficient numbers of regenerated axons have formed synapses with appropriate neurons in the lower spinal cord to support locomotion. Another explanation for the lack of locomotor recovery after complete SCI and regeneration is that the animals did not learn to use their newly regrown connections.Regenerated fibe...

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Unexpected Recovery After Robotic Locomotor Training at Physiologic Stepping Speed: A Single-Case Design

Cited by 15 publications

References 49 publications

Getting the Best Out of Advanced Rehabilitation Technology for the Lower Limbs: Minding Motor Learning Principles

Getting the Best Out of Advanced Rehabilitation Technology for the Lower Limbs: Minding Motor Learning Principles

Body System Effects of a Multi-Modal Training Program Targeting Chronic, Motor Complete Thoracic Spinal Cord Injury

Electrical Stimulation and Motor Recovery

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