Use of zero-gravity robotic-assisted locomotion simulator in rehabilitation of patients with spinal trauma sequelae

Abstract

In 2013, the WHO reported that 250,000 to 500,000 people worldwide are affected by traumatic spinal cord injury every year (WHO, 2013). In Russia, it is estimated that over 250,000 people suffer from disabilities as a result of spinal cord injury. This number continues to increase due to an increase in injury rate, as well as improvement in survival rate of patients affected by acute and long-term periods of traumatic spinal cord injury (TSCI). This study aimed to justify the safe and effective use of a zero-gravity robotic-assisted trainer for locomotor therapy in complex rehabilitation of patients with TSCI, as well as to compare this therapeutic approach with conventional motor rehabilitation programs that use other robotic mechanotherapy techniques. Neurological and functional disorders were assessed in 30 TSCI patients based on clinical examination and electromyography (EMG) results. All patients were classified into an intervention group and a control group by sequential randomisation. Rehabilitation programs for the intervention and control groups were alike, except for robotic mechanotherapy. Significant positive dynamic changes in motor functions, measured according to the ASIA Impairment Scale (American Spinal Cord Injury Association; Marino et al., 2003) were noted in the intervention group, in which two patients moved up to a higher level. EMG data showed a significant difference between the groups in favour of the intervention group. In addition, there was a significant difference between the two groups in postural function improvement in a seated position. Rehabilitation of patients in the intervention group involved engaging the axial muscles, facilitating an increase in strength, and improving trunk muscle control. Both groups of patients showed a significant decline in spasticity, as well as changes in their functional status. The ability of patients to perform normal daily activities also showed improvement. Our findings show that zero-gravity robotic-assisted locomotor training is a safe and effective procedure in the complex rehabilitation of patients with TSCI. This technique improves motor skills, self-care, and postural function in TSCI patients. Furthermore, we found a significant correlation between neurological and functional changes, which is indicative that this new therapeutic modality focuses on a restorative concept. Further research with a power increment is warranted.