Strength training versus robot-assisted gait training after incomplete spinal cord injury: a randomized pilot study in patients depending on walking assistance

Abstract

BackgroundTask-specific locomotor training has been promoted to improve walking-related outcome after incomplete spinal cord injury (iSCI). However, there is also evidence that lower extremity strength training might lead to such improvements. The aim of this randomized cross-over pilot study was to compare changes in a broad spectrum of walking-related outcome measures and pain between robot-assisted gait training (RAGT) and strength training in patients with chronic iSCI, who depended on walking assistance. We hypothesized that task-specific locomotor training would result in better improvements compared to strength training.MethodsNine participants with a chronic iSCI were randomized to group 1 or 2. Group 1 received 16 sessions of RAGT (45 min each) within 4 weeks followed by 16 sessions of strength training (45 min each) within 4 weeks. Group 2 received the same interventions in reversed order. Main outcome measures were the 10 m Walk Test (10MWT) at preferred and maximal speed. Furthermore, we assessed several measures such as walking speed under different conditions, balance, strength, and 2 questionnaires that evaluate risk of falling and pain. Data were collected at baseline, between interventions after 4 weeks, directly after the interventions and at follow-up 6 months after the interventions. Pain was assessed repeatedly throughout the study.ResultsThere were no significant differences in changes in scores between the 2 interventions, except for maximal walking speed (10MWT), which improved significantly more after strength training than after RAGT. Pain reduced after both interventions.ConclusionIn patients with chronic iSCI dependent on walking assistance, RAGT was not more effective in improving walking-related outcome compared to lower extremity strength training. However, the low sample size limits generalizability and precision of data interpretation.Trial registrationThis study was registered at Clinicaltrials.gov (NCT01087918).

Robot-assisted gait training (Lokomat) improves walking function and activity in people with spinal cord injury: a systematic review

“…Five trials were conducted in the U.S. [16–20], 2 in Spain [21, 22], 1 in Switzerland [23], 1 in China [24], and 1 in Korea. [25] All trials compared parallel intervention groups, and one study [23] used a crossover design. All studies were published in English.…”

“…The number of participants in each study ranged from 9 [8, 23] to 88 [22] and the age of the participants ranged from 16 [22] to 70 years [22, 23]; more males than females participated. All included studies provided information on the level of spinal cord injury (C2 to L3) and baseline severity (AIS grades B to D); i.e., incomplete SCI.…”

“…Most studies involved upper motor neuron lesions only, but two [22, 24] also included participants with lower motor neuron lesions. Most studies were AIS grade C/D [16, 17, 20–23] or D [24, 25], motor incomplete SCI only, but two studies [18, 19] included AIS grade B/C/D, motor or sensory incomplete SCI. Of the participants, 263 in four studies [18, 21, 22, 25] were assessed at < 6 months post-injury and 209 in five studies [16, 17, 19, 20, 23] were assessed at > 12 months post-injury.…”

“…Among 10 comparisons, 3 investigated RAGT versus conventional OGT [21, 22, 25] and 2 investigated RAGT versus BWS gait training [17, 18]. Two investigated RAGT versus non-gait-specific training (strength [23] or bike [24]). Finally, three trials compared RAGT with no intervention [16, 19, 20].…”

“…The frequency of treatment ranged from three [16, 18–20, 25] to four [23] or five [17, 21, 22] times per week. The duration of treatment was 4 weeks [16, 19, 20, 23, 25], 8 weeks [18, 21, 22] or 12 weeks [17].…”