Effects of robotic-locomotor training on stretch reflex function and muscular properties in individuals with spinal cord injury

Mirbagheri, M.M.; Kindig, Matthew W.; Niu, Xianjun

doi:10.1016/j.clinph.2014.09.010

Cited by 24 publications

(23 citation statements)

References 67 publications

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“…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].…”

Section: Study Locationmentioning

confidence: 99%

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

Fang

Tsai

et al. 2020

BioMed Research International

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Background. To investigate the effects of robot-assisted gait training (RAGT) on spasticity and pain in people with spinal cord injury (SCI). Material and methods. Four electronic databases (PubMed, Scopus, Medline, and Cochrane Central Register of Controlled Trials) were searched for studies published up to November 2019. Only human trials and of English language were included. The searched studies were reviewed and extracted independently by two authors. Randomized controlled trials (RCTs) and non-RCTs were pooled separately for analyses. Primary outcome measures included spasticity assessed by Ashworth scale (AS) or modified Ashworth scale (MAS) and pain assessed by VAS. Secondary outcome measures included lower extremity motor score (LEMS) and walking ability (i.e., 6-minute walk test, 10-meter walk test). Results. A total of 225 studies were identified. Eighteen studies (7 RCTs and 11 non-RCTs) including 301 subjects met inclusion criteria. The outcome measure of spasticity significantly improved in favor of RAGT group in non-RCTs (AS: 95%CI=−0.202 to -0.068, p≤0.001; MAS: 95%CI=−2.886 to -1.412, p≤0.001). The results on pain did not show significant change after RAGT in either RCTs or non-RCTs. LEMS and walking ability significantly increased in favor of RAGT. Conclusions. RAGT can improve spasticity and walking ability in people with SCI. The probable reason for no significant change in pain after RAGT is floor effect. RAGT is beneficial for normalizing muscle tone and for improving lower extremity function in people with SCI without causing extra pain.

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Section: Study Locationmentioning

confidence: 99%

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

Fang

Tsai

et al. 2020

BioMed Research International

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“…The mean distance walked was 2,271 m (SD 465 m), and the mean body-weight support was 40% (SD 21%), with a guidance force of 82% (SD 8%) per training session. chronic SCI without baseline gait function are able to regain functional walking (5,10,11). However, even among non-walkers, there appear to be some benefits of gait training, such as improved VO 2 and neuromuscular control (9,10).…”

Section: Resultsmentioning

confidence: 99%

“…It was decided to include subjects with poor baseline walking function since data on their training effects are more limited. Mirbagheri et al (10) found that subjects with more baseline neuromuscular disturbances were more likely to have reduced spasticity after RALT. Based on studies so far, including meta-analyses (8), the effects of RALT on walking function remain inconclusive, and it is still unclear whether subjects with Table II.…”

Section: Baseline Function May Be Importantmentioning

confidence: 99%

“…A number of randomized controlled trials (RCTs) using robotic walking therapy have been conducted with varying types of control groups, degree of injury, time since injury, site of the lesion, and varying number and length of the training sessions (3)(4)(5)(6)(7)(9)(10)(11). These and other factors, such as use of anti-spastic medication, all seem to influence the outcome.…”

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confidence: 99%

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Robot-assisted locomotor training did not improve walking function in patients with chronic incomplete spinal cord injury: A randomized clinical trial

Piira¹,

Lannem²,

Sørensen³

et al. 2019

J Rehabil Med

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This randomized clinical trial assesses the effects of robot-assisted treadmill training in persons with chronic incomplete spinal cord injury acquired > 2 years earlier. Due to recruitment challenges, it was possible to recruit only 63% of the planned number of participants. The intervention group received gait training 3 days per week for a period of 6 months and the control group received usual care with their local physical therapist. The intervention group showed improvements in lower extremity strength and balance, but no change in walking function. Significant between-group difference was found only in postural control, favouring the control group. Because the target number of study participants was not reached, the study was underpowered and nonsignificant, and thus the findings are inconclusive. This training method may have benefits, but the robotic device is expensive and training effects are limited when the person's baseline function is poor and the training starts late in incomplete spinal cord injury. Objective: To assess the effects of robot-assisted locomotor training in patients with chronic incomplete spinal cord injury. Design: Randomized single-blind controlled clinical trial. Setting: The intervention site was an outpatient clinic, and pre-and post-evaluations were performed in a rehabilitation hospital. Patients: A total of 24 subjects with American Spinal Injury Association Impairment Scale grades C or D, > 2 years post-injury. Interventions: Subjects were randomized to 60 days of robot-assisted locomotor training, or to usual care. Methods: Walking function, lower extremity muscle strength and balance were assessed single-blinded pre-and post-intervention. Results: After a 9-year recruitment period, only 24 of the planned 30 subjects had been enrolled (mean time since injury 17 (standard deviation (SD) 20) years for all subjects). Walking function, lower extremity muscle strength and balance improved modestly in both groups, with no statistically significant group difference in walking function or muscle strength, whereas postural control declined significantly in the intervention group, compared with controls (p = 0.03). Conclusion: Late-onset robot-assisted locomotor training did not re-establish independent walking function. A modest, but non-significant, effect was seen on muscle strength and balance. However, significant between-group differences were found only in postural control in the control group.

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“…In the gait training interventions, there is a predominance of studies with incomplete SCI patients, given the greater potential for functional gait recovery for these individuals. In addition, 2 studies 33,36 indicate that ambulating individuals-who present the highest initial gait deficits, as indicated by a lower speed and resistance of the initial gait-present greater potential for Physical Exercise in SCI: Systematic Review improvement from the interventions. Interventions that focused on balance training included individuals with tetraplegia and paraplegia with incomplete SCI (classified ASIA Impairment Scale C-D).…”

Section: Characteristics Of Subjectsmentioning

confidence: 99%

Physical Exercise for Individuals With Spinal Cord Injury: Systematic Review Based on the International Classification of Functioning, Disability, and Health

Gaspar¹,

Padula²,

Freitas³

et al. 2019

Journal of Sport Rehabilitation

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Introduction: Considering the reduction of physical activity performed daily in people with spinal cord injury, it is necessary to analyze the interventions based on physical exercises in order to provide recommendations based on evidence. Objectives: To review and evaluate the literature on physical exercise interventions for individuals with SCI, based on the International Classification of Functioning, Disability and Health, as well as physiological parameters for exercise prescription. Method: A systematic review of the literature produced from August 2016 to February 2017 within the PubMed, Embase, Cochrane Library, and MEDLINE databases. Results: Two independent examiners conducted a search in which 223 articles were initially found. A third evaluator verified possible divergences and generated a final list of 25 articles that strictly met the inclusion criteria, 5 of which investigated the effects of aerobic exercise, 2 of resistance training, 2 of balance training, 12 of gait training, and 4 evaluating the combined effect of 2 or more forms of training. Conclusion: Considering studies classified as of high and moderate quality of evidence, positive effects were observed in the domains of structures and functions, in aerobic, resistance training and combined exercises, and in some studies with gait training. In the domain of activities and participation, positive effects were observed in the studies with gait training, balance training, and combined interventions.

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Effects of robotic-locomotor training on stretch reflex function and muscular properties in individuals with spinal cord injury

Cited by 24 publications

References 67 publications

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

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

Robot-assisted locomotor training did not improve walking function in patients with chronic incomplete spinal cord injury: A randomized clinical trial

Physical Exercise for Individuals With Spinal Cord Injury: Systematic Review Based on the International Classification of Functioning, Disability, and Health

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