Overground vs. treadmill-based robotic gait training to improve seated balance in people with motor-complete spinal cord injury: a case report

Chisholm, Amanda E.; Alamro, Raed A.; Williams, Alison M. M.; Lam, Tania

doi:10.1186/s12984-017-0236-z

Cited by 40 publications

(55 citation statements)

References 28 publications

(38 reference statements)

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“…However, these neurological examinations rely only on sensory testing to infer the level of motor function in the trunk, and so any motor sparing of the trunk muscles may be missed. Indeed, recent evidence has shown that many individuals who have been classified with a high‐thoracic or cervical mcSCI retain sparing of trunk muscles, thus presenting the opportunity to develop new interventions to recruit and strengthen the trunk muscles to improve functional seated balance in this population . Our results suggest that our ACE “spin” training program may be an effective way to actively target and train trunk muscles, even for those with high‐thoracic/cervical injuries who may have difficulty performing traditional trunk exercises.…”

Section: Discussionmentioning

confidence: 81%

Arm crank ergometer “spin” training improves seated balance and aerobic capacity in people with spinal cord injury

Williams

Chisholm

Lynn

et al. 2019

Scandinavian Med Sci Sports

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Background: There is some evidence that upper-body training modalities can improve not only aerobic capacity but also seated balance in people with spinal cord injury (SCI), even in those classified with motor-complete paralysis above T6. Here, we evaluated the effect of arm crank ergometry (ACE) "spin" training on trunk muscle recruitment and its effects on seated balance and aerobic capacity. Methods: Eight individuals with high-level complete and 6 with either a low-level complete or a motor-incomplete SCI participated in this study. Participants completed 5 weeks of a group ACE "spin" training protocol which featured modulations in cadence and resistance as well as back-supported and unsupported bouts. Surface electromyography was used to confirm trunk muscle recruitment during unsupported ACE. Changes in aerobic capacity (peak oxygen consumption) and seated balance control (center of pressure parameters) were assessed at pre-and post-intervention. Results: Unsupported ACE was effective for eliciting trunk muscle activity (P < .05).Following training, peak oxygen consumption significantly improved by an average of 16% (P = .005). Static sitting balance significantly improved from pre-to postintervention, but only when tested with eyes closed as measured by a reduction in area (P = .047) and velocity of center of pressure (P = .013). No significant changes were observed in static sitting balance with eyes open or in dynamic sitting balance. Conclusion: Group ACE "spin" classes may benefit not only aerobic fitness but also static seated balance control in people with SCI.

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Section: Discussionmentioning

confidence: 81%

Arm crank ergometer “spin” training improves seated balance and aerobic capacity in people with spinal cord injury

Williams

Chisholm

Lynn

et al. 2019

Scandinavian Med Sci Sports

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“…We identified 1,081 unique records through database searching and one addition through reference searching ( Figure 1 ). Of those, 139 records remained after title and abstract screening, of which 50 met the inclusion criteria and were analyzed (Husemann et al, 2007 ; Mayr et al, 2007 ; Freivogel et al, 2008 , 2009 ; Lo and Triche, 2008 ; Ng et al, 2008 ; Hesse and Werner, 2009 ; Borggraefe et al, 2010 ; Chin et al, 2010 ; Lo et al, 2010 ; Geroin et al, 2011 ; Morone et al, 2011 ; Turiel et al, 2011 ; Benito-Penalva et al, 2012 ; Carda et al, 2012 ; Gizzi et al, 2012 ; Picelli et al, 2012 , 2015 ; Vaney et al, 2012 ; Geigle et al, 2013 ; Kelley et al, 2013a , b ; Aach et al, 2014 ; Labruyère and van Hedel, 2014 ; Nilsson et al, 2014 ; Stoller et al, 2014 , 2015 ; Asbeck et al, 2015 ; Filippo et al, 2015 ; Ochi et al, 2015 ; Schoenrath et al, 2015a , b ; Sczesny-Kaiser et al, 2015 , 2017 ; Wu et al, 2015 ; Chua et al, 2016 ; Forrester et al, 2016 ; Ikumi et al, 2016 ; Kumru et al, 2016a , b ; Aurich-Schuler et al, 2017 ; Bae et al, 2017 ; Chisholm et al, 2017 ; Esquenazi et al, 2017 ; Grasmücke et al, 2017 ; Jansen et al, 2017 , 2018 ; Kim et al, 2019 ; Straudi et al, 2019 ; Tanaka et al, 2019 ). We identified some studies with overlap in patients (Kelley et al, 2013a , b ; Aach et al, 2014 ; Stoller et al,…”

Section: Resultsmentioning

confidence: 99%

Occurrence and Type of Adverse Events During the Use of Stationary Gait Robots—A Systematic Literature Review

et al. 2020

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Robot-assisted gait training (RAGT) devices are used in rehabilitation to improve patients' walking function. While there are some reports on the adverse events (AEs) and associated risks in overground exoskeletons, the risks of stationary gait trainers cannot be accurately assessed. We therefore aimed to collect information on AEs occurring during the use of stationary gait robots and identify associated risks, as well as gaps and needs, for safe use of these devices. We searched both bibliographic and full-text literature databases for peer-reviewed articles describing the outcomes of stationary RAGT and specifically mentioning AEs. We then compiled information on the occurrence and types of AEs and on the quality of AE reporting. Based on this, we analyzed the risks of RAGT in stationary gait robots. We included 50 studies involving 985 subjects and found reports of AEs in 18 of those studies. Many of the AE reports were incomplete or did not include sufficient detail on different aspects, such as severity or patient characteristics, which hinders the precise counts of AE-related information. Over 169 device-related AEs experienced by between 79 and 124 patients were reported. Soft tissue-related AEs occurred most frequently and were mostly reported in end-effector-type devices. Musculoskeletal AEs had the second highest prevalence and occurred mainly in exoskeleton-type devices. We further identified physiological AEs including blood pressure changes that occurred in both exoskeleton-type and end-effector-type devices. Training in stationary gait robots can cause injuries or discomfort to the skin, underlying tissue, and musculoskeletal system, as well as unwanted blood pressure changes. The underlying risks for the most prevalent injury types include excessive pressure and shear at the interface between robot and human (cuffs/harness), as well as increased moments and forces applied to the musculoskeletal system likely caused by misalignments (between joint axes of robot and human). There is a need for more structured and complete recording and dissemination of AEs related to robotic gait training to increase knowledge on risks. With this information, appropriate mitigation strategies can and should be developed and implemented in RAGT devices to increase their safety.

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“…The intense training of the impaired limb and the acquisition of new motor skills mediate functional recovery through the sprouting of new synapses [ 5 ]. Enhancement of trunk muscle activity during robot training may lead to improvement in balance control [ 21 ]. Improved balance control from standing to sitting shows an improved gait function.…”

Section: Discussionmentioning

confidence: 99%

Effects of Robot-Assisted Gait Training in Patients with Burn Injury on Lower Extremity: A Single-Blind, Randomized Controlled Trial

Joo

Lee

Cho

et al. 2020

JCM

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This study investigated the effects of robot-assisted gait training (RAGT) on gait function in burn patients. Briefly, 40 burn patients were randomly divided into an RAGT group or a conventional training (CON) group. SUBAR® (Cretem, Korea) is a wearable robot with a footplate that simulates normal gait cycles. The RAGT group underwent 30 min of robot-assisted training using SUBAR® with 30 min of conventional physiotherapy once a day, 5 days a week for 12 weeks. Patients in the CON group received 30 min of overground gait training and range-of-motion (ROM) exercises twice a day for 5 days a week for 12 weeks. The RAGT group and the CON group underwent 60 min of training per day. The intervention frequency and duration did not differ between the RAGT group and the CON group. The main outcomes were functional ambulatory category (FAC); 6-min walking test (6MWT); visual analogue scale (VAS) during gait movement; ROM; and isometric forces of bilateral hip, knee, and ankle muscles before and after 12 weeks of training. The results of the VAS, FAC, and 6MWT (8.06 ± 0.66, 1.76 ± 0.56, and 204.41 ± 85.60) before training in the RAGT group improved significantly (4.41 ± 1.18, 4.18 ± 0.39, and 298.53 ± 47.75) after training (p < 0.001, p < 0.001, and p < 0.001). The results of the VAS, FAC, and 6MWT (8.00 ± 1.21, 1.75 ± 0.58, and 220.94 ± 116.88) before training in the CON group improved significantly (5.00 ± 1.03, 3.81 ± 1.05, and 272.19 ± 110.14) after training (p < 0.001, p < 0.001, and p = 0.05). There were differences in the improvement of results of the VAS, FAC, and 6MWT between groups after training, but they were not statistically significant (p = 0.23, p = 0.14, and p = 0.05). The isometric strengths of the right hip extensor (p = 0.02), bilateral knee flexor (p = 0.04 in the right, and p = 0.001 in the left), bilateral knee extensor (p = 0.003 in the right, and p = 0.002 in the left), bilateral ankle dorsiflexor (p = 0.04 in the right, and p = 0.02 in the left), and bilateral ankle plantarflexor (p = 0.001 in the right, and p = 0.008 in the left) after training were significantly improved compared with those before training in the RAGT group. The ROMs of the right knee extension (p = 0.03) and bilateral ankle plantarflexion (p = 0.008 in the right, and p = 0.03 in the left) were significantly improved compared with measurements before training in the RAGT. There were no significant differences of the isometric strengths and ROMs of the bilateral hip, knee, and ankle muscles after training in the CON group. There were significant improvements in the isometric strengths of the left knee flexor (p = 0.01), left ankle dorsiflexor (p = 0.01), and left ankle plantarflexor (p = 0.003) between the two groups. The results suggested that RAGT is effective to facilitate early recovery of muscles strength after a burn injury. This is the first study to evaluate the effectiveness of RAGT in patients with burns compared with those receiving conventional training. The absence of complications in burn patients provides an opportunity to enlarge the application area of RAGT.

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Overground vs. treadmill-based robotic gait training to improve seated balance in people with motor-complete spinal cord injury: a case report

Cited by 40 publications

References 28 publications

Arm crank ergometer “spin” training improves seated balance and aerobic capacity in people with spinal cord injury

Arm crank ergometer “spin” training improves seated balance and aerobic capacity in people with spinal cord injury

Occurrence and Type of Adverse Events During the Use of Stationary Gait Robots—A Systematic Literature Review

Effects of Robot-Assisted Gait Training in Patients with Burn Injury on Lower Extremity: A Single-Blind, Randomized Controlled Trial

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