Effectiveness of Automated Locomotor Training in Patients with Acute Incomplete Spinal Cord Injury: A Randomized, Controlled, Multicenter Trial

Abstract

The aim of this study was to evaluate whether the effect of longer training times (50 instead of 25 min per day) using a robotic device results in a better outcome of walking ability of subjects with a subacute motor complete (American Spinal Injury Association Impairment Scale [AIS]-B) and incomplete (AIS-C) spinal cord injury. Twenty-one patients were enrolled in the study, whereof 18 completed, on average, 34 trainings in 8 weeks. Longer training times resulted in better locomotor function. The second important result of the study is that a beneficial effect can be achieved by the application of a robotic device for prolonged training sessions without requiring more personal resources. It has to remain open whether even longer training times (more than 50 min) would result in a still better outcome. In any case, the extent of possible recovery in an individual patient is determined by the level and severity of spinal cord damage.

A randomized, blinded, prospective clinical trial of postoperative rehabilitation in dogs after surgical decompression of acute thoracolumbar intervertebral disc herniation

“…Large analyses conclude that patient and injury driven factors (eg, injury severity and patient resilience) are overwhelmingly important in determining outcome . However, once patient groups with more homogeneous injury severity are evaluated, generating groups more analogous to the homogenous population of dogs examined in our trial, the effects of type and duration of locomotor training during physical treatment become apparent with longer duration and overground walking both highlighted as important for locomotor function . Here, we evaluated dogs with incomplete injuries and hypothesized that early initiation of a staged physical rehabilitation program focused on strength and coordination would improve the rate and level of their recovery.…”

Effects of Robot-Assisted Gait Training in Individuals with Spinal Cord Injury: A Meta-analysis

“…From the 18 studies, 7 trials were done in the United States [36][37][38][39][40][41][42], 2 in Spain [43,44], 2 in Switzerland [45,46], 2 in Canada [47,48], 2 in Italy [49,50], 2 in Japan [51,52], and one in Germany [53].…”

“…Seventy-nine participants from 11 non-RCTs were included. Although age was not reported in all included studies, the participants' age of RCTs and non-RCTs ranged from 34 [46] to 59 [45] and 19 [51] to 62 [52] years, respectively. One RCT [36] and one non-RCT [39] did not report the proportion of gender.…”

“…In all included RCTs, only one study [36] had high risk of bias level. Five studies [37,38,[44][45][46] reported randomization. Two studies did not mention randomization [36] or were unclear [47].…”

“…Allocation concealment was fulfilled by two studies [44,45]. Three of the included studies [44,45,47] had blinding and the other three studies [37,38,46] did not report the methodology of allocation concealment. Two studies [45,47] did intention to treat analysis and the other three studies [37,38,44] were unclear on the information about attrition bias.…”