Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: A multicenter trial

Wirz, Markus; Zemon, David H.; Rupp, R.; Scheel, Anke; Colombo, G.; Dietz, Volker; Hornby, T. George

doi:10.1016/j.apmr.2004.08.004

Cited by 427 publications

(323 citation statements)

References 53 publications

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“…This study included no control condition, 19 and Wernig 20 proposed that Lokomat training may be inferior to treadmill training. However, we did not find any indication of inferiority.…”

Section: Discussionmentioning

confidence: 99%

Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke

Husemann

Müller

Krewer

et al. 2007

Stroke

359

267

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Background and Purpose-The success of gait rehabilitation after stroke depends on active walking exercises. However, the disabling after-effects of stroke often make such exercises impossible at the onset of therapy. To facilitate treadmill training of paraparetic patients, a robot-driven gait orthosis (Lokomat) was developed. We investigated the effects of the Lokomat when used with hemiparetic patients. Methods-The authors conducted a randomized, controlled pilot study of 30 acute stroke survivors. The treatment group received 30 minutes of robotic training daily and the control group 30 minutes of conventional physiotherapy daily in addition to 30 minutes of conventional physiotherapy for each group. Outcome measures were independence of gait, gait speed, gait parameters, and body tissue composition. Results-After 4 weeks of therapy, the walking ability of the Lokomat group and the control group expressed as the functional ambulation classification was significantly improved. The functional ambulation category (medianϮ interquartile range) was at baseline 0Ϯ0 in control and 0Ϯ1 in the therapy group and increased after therapy to 1Ϯ3 in both groups significantly (Pϭ0.01). There was no significant difference in gain of these parameters between the groups. The Lokomat group had a significantly longer single stance phase (sec; meanϮSEM) on the paretic leg when walking on the floor. At baseline, it was 0.19Ϯ0.17 and after therapy 0.49Ϯ0.07 (Pϭ0.014). The control group had increased their body weight approximately 1.33Ϯ1.40 kg (meanϮSEM; Pϭ0.046), mostly as fat mass, whereas the Lokomat group had lost fat mass approximately Ϫ2.9Ϯ1.0 kg (meanϮSEM; Pϭ0.016) and increased their muscle mass approximately 3.36Ϯ1.4 kg (meanϮ SEM; Pϭ0.031). Conclusions-This pilot study indicates that Lokomat therapy is a promising intervention for gait rehabilitation. Although there was no difference between groups in gain of functional scores, the Lokomat group showed an advantage of robotic training over conventional physiotherapy in improvement of gait abnormality and body tissue composition. (Stroke.

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“…This study included no control condition, 19 and Wernig 20 proposed that Lokomat training may be inferior to treadmill training. However, we did not find any indication of inferiority.…”

Section: Discussionmentioning

confidence: 99%

Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke

Husemann

Müller

Krewer

et al. 2007

Stroke

359

267

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“…In fact, an improvement of ambulatory function through intensive locomotor training can be achieved in chronic incomplete SCI subjects. 51 By such a functional training therapy inhibitory signals might become blocked as demonstrated in the cat. 48 Actually, several questions have to be answered.…”

Section: Potential Countermeasuresmentioning

confidence: 99%

Neuronal dysfunction in chronic spinal cord injury

2010

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This review describes the changes of spinal neuronal function that occur after a motor complete spinal cord injury (cSCI) in humans. In healthy subjects, polysynaptic spinal reflex (SR) evoked by non-noxious tibial nerve stimulation consists of an early SR component and rarely a late SR component. Soon after a cSCI, SR and locomotor activity are absent. After spinal shock; however, an early SR component re-appears associated with the recovery of locomotor activity in response to appropriate peripheral afferent input. Clinical signs of spasticity take place in the following months, largely as a result of nonneuronal changes. After around 1 year, the locomotor and SR activity undergo fundamental changes, that is, the electromyographic amplitude in the leg muscles during assisted locomotion exhaust rapidly, accompanied by a shift from early to dominant late SR components. The exhaustion of locomotor activity is also observed in non-ambulatory patients with an incomplete spinal cord injury (SCI). At about 1 year after injury, in most cSCI subjects the neuronal dysfunction is fully established and remains more or less stable in the following years. It is assumed that in chronic SCI, the patient's immobility resulting in a reduced input from supraspinal and peripheral sources leads to a predominance of inhibitory drive within spinal neuronal circuitries underlying locomotor pattern and SR generation. Training of spinal interneuronal circuits including the enhancement of an appropriate afferent input might serve as an intervention to prevent neuronal dysfunction after an SCI.

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“…5,10 Recent evidence indicates that individuals with incomplete SCI observe an improvement in ambulatory ability, gain functional independence and demonstrate increased muscle size following 9-12 weeks of body weight-supported treadmill training. [11][12][13][14] However, the implementation of this intervention in the clinic may be particularly challenging due to the cost of the equipment/infrastructure and intensive personnel requirements. On the other hand, a motor-driven stationary bicycle is spatially compact, and cycle locomotor training may be performed with fewer facilitators.…”

Section: Introductionmentioning

confidence: 99%

A longitudinal study of skeletal muscle following spinal cord injury and locomotor training

et al. 2008

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Study design: Experimental rat model of spinal cord contusion injury (contusion SCI).Objective: The objectives of this study were (1) to characterize the longitudinal changes in rat lower hindlimb muscle morphology following contusion SCI by using magnetic resonance imaging and (2) to determine the therapeutic potential of two types of locomotor training, treadmill and cycling. Setting: University research setting. Methods: After moderate midthoracic contusion SCI, Sprague-Dawley rats were assigned to either treadmill training, cycle training or an untrained group. Lower hindlimb muscle size was examined prior to SCI and at 1-, 2-, 4-, 8-, and 12-week post injury. Results: Following contusion SCI, we observed significant atrophy in all rat hindlimb muscles with the posterior muscles (triceps surae and flexor digitorum) showing greater atrophy than the anterior muscles (tibialis anterior and extensor digitorum). The greatest amount of atrophy was measured at 2-week post injury (range from 11 to 26%), and spontaneous recovery in muscle size was observed by 4 weeks post-SCI. Both cycling and treadmill training halted the atrophic process and accelerated the rate of recovery. The therapeutic influence of both training interventions was observed within 1 week of training and no significant difference was noted between the two interventions, except in the tibialis anterior muscle. Finally, a positive correlation was found between locomotor functional scores and hindlimb muscle size following SCI. Conclusions: Both treadmill and cycle training diminish the extent of atrophy and facilitate muscle plasticity after contusion SCI.

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Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: A multicenter trial

Cited by 427 publications

References 53 publications

Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke

Effects of Locomotion Training With Assistance of a Robot-Driven Gait Orthosis in Hemiparetic Patients After Stroke

Neuronal dysfunction in chronic spinal cord injury

A longitudinal study of skeletal muscle following spinal cord injury and locomotor training

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