Abstract
BackgroundIn incomplete spinal cord injury (iSCI), sensorimotor impairments result in severe limitations to ambulation. To improve walking capacity, physical therapies using robotic-assisted locomotor devices, such as the Lokomat, have been developed. Following locomotor training, an improvement in gait capabilities—characterized by increases in the over-ground walking speed and endurance—is generally observed in patients. To better understand the mechanisms underlying these improvements, we studied the effects of Lokomat training on impaired ankle voluntary movement, known to be an important limiting factor in gait for iSCI patients.MethodsFifteen chronic iSCI subjects performed twelve 1-hour sessions of Lokomat training over the course of a month. The voluntary movement was qualified by measuring active range of motion, maximal velocity peak and trajectory smoothness for the spastic ankle during a movement from full plantar-flexion (PF) to full dorsi-flexion (DF) at the patient’s maximum speed. Dorsi- and plantar-flexor muscle strength was quantified by isometric maximal voluntary contraction (MVC). Clinical assessments were also performed using the Timed Up and Go (TUG), the 10-meter walk (10MWT) and the 6-minute walk (6MWT) tests. All evaluations were performed both before and after the training and were compared to a control group of fifteen iSCI patients.ResultsAfter the Lokomat training, the active range of motion, the maximal velocity, and the movement smoothness were significantly improved in the voluntary movement. Patients also exhibited an improvement in the MVC for their ankle dorsi- and plantar-flexor muscles. In terms of functional activity, we observed an enhancement in the mobility (TUG) and the over-ground gait velocity (10MWT) with training. Correlation tests indicated a significant relationship between ankle voluntary movement performance and the walking clinical assessments.ConclusionsThe improvements of the kinematic and kinetic parameters of the ankle voluntary movement, and their correlation with the functional assessments, support the therapeutic effect of robotic-assisted locomotor training on motor impairment in chronic iSCI.
Highlights
In incomplete spinal cord injury, sensorimotor impairments result in severe limitations to ambulation
Relationship between walking assessments and ankle ability measures We investigated the relationship between ankle voluntary movement capabilities and walking capacities using correlation analysis on baseline measurements
Both the mobility assessed with the Timed Up and Go (TUG) and the over-ground walking speed measured with the 10-meter walk test (10MWT) showed significant correlations with active range of motion (AROM), AROM1stMU, MVCPF and MVCDF (All Ps < 0.05)
Summary
In incomplete spinal cord injury (iSCI), sensorimotor impairments result in severe limitations to ambulation. Physical therapies using robotic-assisted locomotor devices, such as the Lokomat, have been developed. To better understand the mechanisms underlying these improvements, we studied the effects of Lokomat training on impaired ankle voluntary movement, known to be an important limiting factor in gait for iSCI patients. A majority of patients with incomplete motor SCI (iSCI) recovers a certain level of walking capacity but presents severe limitations [7]. Robotic-assisted locomotor present several advantages, including the ability to increase the intensity and the total duration of training while maintaining a physiological gait pattern. Locomotor robotic devices can reduce personnel costs involved in manual assistance training (which can require up to three physical therapists) and can prevent excessive fatigue induced by electrical stimulation
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.