Effect of EMG-biofeedback robotic-assisted body weight supported treadmill training on walking ability and cardiopulmonary function on people with subacute spinal cord injuries – a randomized controlled trial

Abstract

Background Body weight supported treadmill training (BWSTT) is a frequently used approach for restoring the ability to walk after spinal cord injury (SCI). However, the duration of BWSTT is usually limited by fatigue of the therapists and patients. Robotic-assisted body weight supported treadmill training (RABWSTT) was developed to tackle the aforesaid limitation. Currently, limited randomized controlled trials are available to investigate its effectiveness, especially on cardiopulmonary function. The aim of this two-arm, parallel-group randomized controlled trial is to examine the feasibility of adapting an EMG-biofeedback system for assist-as-needed RABWSTT and its effects on walking and cardiopulmonary function in people with SCI. Methods Sixteen incomplete SCI subjects were recruited and randomly allocated into an intervention group or control group. The intervention group received 30 min of RABWSTT with EMG biofeedback system over the vastus lateralis muscle to enhance active participation. Dose equivalent passive lower limbs mobilization exercise was provided to subjects in the control group. Results Significant time-group interaction was found in the Walking Index for Spinal Cord Injury version II (WISCI II) ( p = 0.020), Spinal Cord Independence Measure version III (SCIM III) mobility sub-score ( p < 0.001), bilateral symmetry ( p = 0.048), maximal oxygen consumption ( p = 0.014) and peak expiratory flow rate ( p = 0.048). Wilcoxon signed-rank test showed that the intervention group had significant improvement in the above-mentioned outcomes after the intervention except WISCI II, which also yielded marginal significance level. Conclusion The present study demonstrated that the use of EMG-biofeedback RABWSTT enhanced the walking performance for SCI subjects and improve cardiopulmonary function. Positive outcomes reflect that RABSTT training may be able to enhance their physical fitness. Trial registration The study protocol was approved by the Research Ethics Committee (Kowloon Central/ Kowloon East), Hospital Authority on 6 December 2013, and the Human Subjects Ethics Sub-committee of The Hong Kong Polytechnic University on 15 May 2013, with reference numbers KC/KC-13-0181/ER-2 and HSEARS20130510002 respectively. The study was registered in ClinicalTrials.gov on 20 November 2013, with reference number NCT01989806 .)

Body weight-supported gait training for patients with spinal cord injury: a network meta-analysis of randomised controlled trials

“…In the 15 selected RCTs,three body weight-supported gait training protocols were used, namely RAGT 7 , 28 , 30 , 31 , 33 , 34 , 36 – 41 , BWSTT 29 , 32 , 35 , 37 , and BWSOGT 29 , 35 . Conventional gait training was prespecified as a control intervention.…”

“…Of the 15 selected RCTs, six reported on adverse events 29 , 30 , 33 , 35 , 39 , 41 . No adverse events were observed in four studies 30 , 33 , 35 , 41 , and two reported that some participants had experienced pain 29 , 39 . The investigated interventions were relatively safe and well tolerated by participants.…”

“…Our results supported its use by these patients. Robotic training has become readily accessible in rehabilitation centres, and robot-assisted gait rehabilitation has received much attention owing to its benefits for people with neurological conditions 30 , 43 . Robotic training may be an attractive option for patients and their families because of its sophistication and use of computer interface that offers a virtual reality experience both biofeedback 43 .…”

“…Two reviewers assessed the quality of the selected RCTs by using the RoB 2 tool 24 . All studies had a low risk of bias in terms of the randomisation process 7,[28][29][30][31][32][33][34][35][36][37][38][39][40][41] . Some concerns were noted for all studies in terms of deviation from the intended intervention 7,[28][29][30][31][32][33][34][35][36][37][38][39][40][41] .…”

Feasibility of Augmenting Ankle Exoskeleton Walking Performance With Step Length Biofeedback in Individuals With Cerebral Palsy

“…This work is licensed under a Creative Commons Attribution 4.0 License. For more information, see https://creativecommons.org/licenses/by/4.0/ Incorporating biofeedback with body-weight-supported or tethered robot-assisted (i.e., Lokomat) gait training has been found to facilitate anticipated favorable rehabilitation benefits in people with stroke [19], [20], spinal cord injury [21], and in children with CP [22]. However, we are not aware of any study that has integrated biofeedback with wearable (i.e., untethered) powered assistive devices to promote training outcomes.…”