Artificial gait in complete spinal cord injured subjects: how to assess clinical performance

Abstract

Objective: Adapt the 6 minutes walking test (6MWT) to artificial gait in complete spinal cord injured (SCI) patients aided by neuromuscular electrical stimulation. Method: Nine male individuals with paraplegia (AIS A) participated in this study. Lesion levels varied between T4 and T12 and time post injured from 4 to 13 years. Patients performed 6MWT 1 and 6MWT 2. They used neuromuscular electrical stimulation, and were aided by a walker. The differences between two 6MWT were assessed by using a paired t test. Multiple r-squared was also calculated. Results: The 6MWT 1 and 6MWT 2 were not statistically different for heart rate, distance, mean speed and blood pressure. Multiple r-squared (r 2 = 0.96) explained 96% of the variation in the distance walked. Conclusion: The use of 6MWT in artificial gait towards assessing exercise walking capacity is reproducible and easy to apply. It can be used to assess SCI artificial gait clinical performance.Keywords: spinal cord injury, walking, rehabilitation, paraplegia. RESUMOObjetivo: Adaptar o teste de caminhada dos 6 minutos (TC6) para marcha artificial de pacientes com lesão medular completa associado a eletroestimulação neuromuscular. Método: Nove participantes do sexo masculino com paraplegia (AIS A) participaram do estudo. O nível de lesão variou entre T4 e T12 , tempo de lesão variou entre 4 e 13 anos. Os pacientes realizaram dois TC6 (TC6-1 e TC6-2). Os participantes usaram eletroestimulação neuromuscular e foram auxiliados por andador. As diferenças entre os dois TC6 foram avaliadas pelo teste t pareado e calculado o r 2 . Resultados: Não foi encontrada diferença estatística entre TC6-1 e TC6-2 para frequência cardíaca, distância, velocidade média e pressão arterial. O r 2 = 0,96 explica 96% da variação na distância caminhada. Conclusão: O uso do TC6 em marcha artificial para avaliação da capacidade de exercício de caminhada é reprodutível e fácil de aplicar. Esse teste pode ser utilizado para avaliar o desempenho clínico da marcha artificial de indivíduos com lesão medular.Palavras-chave: lesão medular, marcha, reabilitação, paraplegia.Assessing walking in patients with locomotion disorders is an important measure in rehabilitation. However, the walking ability of spinal cord injured (SCI) subjects ranges from total incapacity to near normal speed 1 , due to the large variability of lesion.Many methods were developed to allow gait of spinal cord injured subjects, including a variety of orthosis, neuromuscular electrical stimulation (NMES), hybrid orthosis 2 and exoskeleton 3 . Without walking aiding devices, complete SCI subjects are limited to the wheelchair, which is practical towards locomotion. One gait training option is the association with NMES, even quadriplegic patients are able to walk aided by body-weight support tool and NMES 4 . Since 1989, our laboratory has been developing technology to prepare subjects with spinal cord injury to walk again using NMES. Studies showed benefits of this gait training as increase in bone mass, the preservation of...