Zero-Gravity Robotic-Assisted Locomotion Simulator in Rehabilitation: a Prospective Randomized Clinical Study of 30 Spinal Trauma Sequelae Patients

Abstract

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.