Locomotor Training Research Articles

Роль быстрого бега в предотвращении негативных влияний пребывания человека в невесомости

The prospects of deep space exploration necessitate modification of the principles and methods underlying the system designed to prevent negative impact of weightlessness on the human body. This work aimed to determine how fast running, as part of locomotor training during a space flight (SF), helps maintain physical ability of a person. The study involved 10 cosmonauts; their physical performance was assessed at all stages of the SF with the help of the Individual Strategies Test (IST). The parameters registered when the participants were doing the IST included heart rate (HR), gas exchange, capillary blood lactate concentration. The cosmonauts were divided into two groups based on the differences in the mean distance covered while fast running on a treadmill (single session). Group A (n = 4) run 949 m/day on average, group B (n = 6) — 2669 m/day. After SF, HR in group A increased at speeds from 5 to 8 km/h (p < 0.05), pulmonary ventilation indicators grew at speeds from 8 to 15 km/h (p < 0.05), and the capillary blood lactate concentration measured during the post-test recovery period increased by 37% (p = 0.03). Moreover, after SF, the pulse sum recorded under load and during recovery was 14% (p = 0.02) and 15% (p = 0.03) in group A, respectively, while in group B we registered no differences. Thus, our hypothesis that fast running triggers sensory reactions simulatingEarth conditions for the body, which consequently activates physiological mechanisms counteracting the negative effects of weightlessness, has been confirmed in a space experiment.

An evidence-based approach to the recovery of bladder and bowel function after pediatric spinal cord injury

IntroductionBladder dysfunction and associated complications of the urinary system negatively impact the quality of life in children living with spinal cord injury (SCI). Pediatric lower urinary tract deficits include bladder over-activity, inefficient emptying, decreased compliance, and incontinence. Recent evidence in adults with SCI indicates significant improvements in bladder capacity and detrusor pressure following participation in an activity-based recovery locomotor training (ABR-LT) rehabilitative program. Additionally, anecdotal self-reports from parents in our Pediatric NeuroRecovery Program reference changes in bladder function, ranging from awareness of bladder fullness to gains in voluntary control while undergoing ABR-LT. Case presentationIn a within-subjects repeated measures study, we investigated the effect of ABR-LT on bladder function in three children (ages: 2.5, 3, and 6 years) who sustained upper motor neuron SCI. Each child received at least 60 sessions of ABR-LT (5x/week) for 12–14 weeks. Bladder function was assessed via urodynamics and the Common Data Elements questionnaires. Awareness of bladder filling during cystometry was present in all children and detrusor leak point pressure (LPP) was reduced post-ABR-LT relative to pre-training. A decrease in LPP after locomotor training was observed in all three participants. One out of the three participants had substantial improvements in bladder capacity post-ABR-LT and experienced less bowel incontinence following training. DiscussionLike our evidence in adults, the changes in bladder function suggest an interaction between lumbosacral networks regulating spinal reflex control of bladder filling, voiding, and afferent input (including potential descending supraspinal commands) and those activated by ABR-LT. Locomotor training may be associated with increased bladder capacity, enhanced perception of bladder filling, and decreased LPP as well as improvements in bowel control in pediatric SCI. This research suggests that children and adolescents with traumatic SCI could experience dynamic improvements in bladder and bowel function with the aid of various therapies. Studies assessing the durability of training on the recovery of bladder and bowel dysfunction in children with SCI are needed.

An analysis of the effectiveness of rehabilitation protocols for patients with spinal cord injury: A systematic review

Abstract Aim SCI may cause loss of sensory function, paralysis, and limited functional mobility. The specificity of SCI has expanded the scope of medical trials and given rise to therapeutic options that incorporate new technologies with robotics and electronic devices. We aimed to identify various therapeutic options and develop effective treatment regimens. Methods We conducted the systematic review using the following digital databases: MEDLINE/PubMed and Google Scholar. We focused on publications published between 2012 and 2023 and The following primary terms were searched: “Spinal cord injury rehabilitation,” “Spinal cord injury exercise,” and “Spinal cord injury therapy,” with the Boolean operator “AND/OR” used for additional searches. A total of 110 relevant articles were identified during the selection process. After screening and assessing eligibility, the final 17 studies were included in this systematic review Results & conclusion The current paper gave a taxonomy of electrical instrumentation and traditional rehabilitation technologies. We also discovered that FES is used as a comprehensive regimen that involves both the upper and lower extremities, and that locomotor training using robots is beneficial in improving walking ability. We discovered that diversified training programs using conventional methods concentrated on the physical independence of patients with chronic SCI.

A qualitative study of the perceived benefits of participating in a spinal cord rehabilitation intervention in a low-middle income country

Purpose Improving quality of life (QoL) is a major goal of rehabilitation following spinal cord injury (SCI). However, people with disabilities in resource constrained contexts have limited access to rehabilitation and poorer health outcomes, including QoL. There is a paucity of qualitative research on the experiences of persons with SCI involved in rehabilitation programmes in low-middle income countries. This study aimed to assess participants’ perceptions of the benefits of a 24-week SCI rehabilitation programme delivered as part of a pilot randomized controlled trial (RCT) in South Africa. Materials and methods Sixteen participants, with chronic motor-incomplete tetraplegia, were enrolled in a two-arm pilot RCT involving robotic locomotor training, a novel technology, and standard activity-based training (Pan African Clinical Trial Registry (PACTR201608001647143)). Data were collected via in-depth interviews and analysed using thematic analysis. Results Participants described several improvements in QoL, including enhanced functional independence; reduced secondary complications; and improved psychosocial and emotional well-being. Conclusions The holistic approach to rehabilitation calls for the involvement of individuals’ views about what matters to them to inform clinical practice and to highlight the role that physical activity and the perceived successes play in shaping the lived experiences after SCI. Trial registration Pan African Clinical Trial Registry (PACTR201608001647143), registration date (21st May 2016), study start date (30th Nov 2016)https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=1647

Assessing walking ability using a robotic gait trainer: opportunities and limitations of assist-as-needed control in spinal cord injury

BackgroundWalking impairments are a common consequence of neurological disorders and are assessed with clinical scores that suffer from several limitations. Robot-assisted locomotor training is becoming an established clinical practice. Besides training, these devices could be used for assessing walking ability in a controlled environment. Here, we propose an adaptive assist-as-needed (AAN) control for a treadmill-based robotic exoskeleton, the Lokomat, that reduces the support of the device (body weight support and impedance of the robotic joints) based on the ability of the patient to follow a gait pattern displayed on screen. We hypothesize that the converged values of robotic support provide valid and reliable information about individuals’ walking ability.MethodsFifteen participants with spinal cord injury and twelve controls used the AAN software in the Lokomat twice within a week and were assessed using clinical scores (10MWT, TUG). We used a regression method to identify the robotic measure that could provide the most relevant information about walking ability and determined the test–retest reliability. We also checked whether this result could be extrapolated to non-ambulatory and to unimpaired subjects.ResultsThe AAN controller could be used in patients with different injury severity levels. A linear model based on one variable (robotic knee stiffness at terminal swing) could explain 74% of the variance in the 10MWT and 61% in the TUG in ambulatory patients and showed good relative reliability but poor absolute reliability. Adding the variable ‘maximum hip flexor torque’ to the model increased the explained variance above 85%. This did not extend to non-ambulatory nor to able-bodied individuals, where variables related to stance phase and to push-off phase seem more relevant.ConclusionsThe novel AAN software for the Lokomat can be used to quantify the support required by a patient while performing robotic gait training. The adaptive software might enable more challenging training conditions tuned to the ability of the individuals. While the current implementation is not ready for assessment in clinical practice, we could demonstrate that this approach is safe, and it could be integrated as assist-as-needed training, rather than as assessment.Trial registrationClinicalTrials.gov Identifier: NCT02425332.

Moderate to Vigorous Intensity Locomotor Training After Stroke: A Systematic Review and Meta-analysis of Mean Effects and Response Variability.

This meta-analysis quantified mean effects of moderate to vigorous intensity locomotor training (LT mv ) on walking outcomes in subacute and chronic stroke, and the magnitude of variability in LT mv response. Databases were searched for randomized trials comparing LT mv with no intervention, nongait intervention, or low-intensity gait training. Comfortable gait speed (CGS), fastest gait speed (FGS), 6-minute walk test (6MWT), walking activity (steps per day), and adverse effect/event (AE) data were extracted. Pooled estimates were calculated for mean changes, AE relative risks, and the standard deviation of response (SD response ) to LT mv versus control groups, stratified by study chronicity where possible. There were 19 eligible studies (total N = 1096): 14 in chronic stroke (N = 839) and 5 in subacute stroke (N = 257). Compared with control interventions, LT mv yielded significantly greater increases in CGS (chronic, +0.06 m/s [95% confidence interval (CI), 0.01-0.10]; subacute, +0.16 [0.12-0.19]; subacute vs chronic, P = 0.03), FGS (chronic, +0.07 m/s [0.02-0.13]; subacute, +0.21 [0.01, 0.41]; P = 0.04), and 6MWT (chronic, +33 m [24-42]; subacute, +51 [26-77]; P = 0.054) but not steps/day (+260 [-1159 to 1679]). There were no treatment-related serious AEs among 398 LT mv participants in 14 AE-reporting studies. SD response estimates indicated substantial response variability: CGS, 0.11 m/s [0.00-0.15]; FGS, 0.14 m/s [-0.00 to 0.20]; and 6MWT, 41 m [27-51]. LT mv improves mean walking capacity outcomes in subacute and chronic stroke and does not appear to have high risk of serious harm. Response magnitude varies within and between chronicity subgroups, and few studies have tested effects on daily walking activity or non-serious AEs.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A452 ).

Activity based restorative therapy considerations for children: medical and therapeutic perspectives for the pediatric population.

Well-established scientific evidence demonstrates that activity is essential for the development and repair of the central nervous system, yet traditional rehabilitation approaches target muscles only above the lesion as a means of compensation. Activity-Based Rehabilitation (ABR) represents an evolving paradigm shift in neurorehabilitation targeting activation of the neuromuscular system below the lesion. Based on activity-dependent plasticity, ABR offers high intensity activation of the nervous system to optimize the capacity for recovery, while working to offset the chronic complications that occur as a result of neurologic injury. Treatment focus shifts from compensatory training to promotion of restoration of function with special emphasis on normalizing sensory cues and movement kinematics. ABR in children carries special considerations for a developing nervous system and the focus is not just restoring functions but advancing functions in line with typical development. Application of activity-based interventions includes traditional rehabilitation strategies at higher intensity and frequency than in traditional models, including locomotor training, functional electrical stimulation, massed practice, and task specific training, applied across the continuum of care from early intervention to the chronic condition.

Poster (Health Services, Economics and Policy Change) ID 1977284

Background/Objective Activity-based therapies (ABT) are task specific, repetitive and intensive active movement interventions that may improve function and independence for individuals with spinal cord injury. The cost of implementing ABT is an important consideration for rehabilitation facilities interested in providing this intervention. Thus, a scoping review was conducted to evaluate the economic evidence for ABT for the rehabilitation of upper or lower limb impairment. Design/Methods A search of various scientific literature databases (including EMBASE, MEDLINE and CINAHL) was conducted using search terms developed in collaboration with a Medical Librarian. Studies were included if they were economic analyses of an ABT conducted for individuals with upper or lower limb mobility impairment. Titles and abstracts were initially screened by two of the authors followed by a full-text review of remaining articles. Articles included in the review were evaluated for methodological quality and presented descriptively because of the heterogeneity in study design, populations and outcomes. Results Of the 6,031 unique citations originally identified, 14 articles were included after full-text screening. Two-third of the studies were for stroke and half of the studies originated from the US. Robot-assisted therapies represented half of the studies and about a quarter were locomotor training programs. In the stroke and spinal cord injured population, robot-assisted therapies and body supported treadmill therapy appear to be cost-effective respectively. Conclusions There is some evidence to support the cost-effectiveness of robot-assisted therapies and body supported treadmill therapy. However, the evidence is very limited and additional research is needed.

Robotic locomotor training in a low-resource setting: a randomized pilot and feasibility trial

Purpose Activity-based Training (ABT) represents the current standard of neurological rehabilitation. Robotic Locomotor Training (RLT), an innovative technique, aims to enhance rehabilitation outcomes. This study aimed to conduct a randomized pilot and feasibility trial of a locomotor training program within South Africa. Materials and methods Individuals with chronic traumatic motor incomplete tetraplegia (n = 16). Each intervention involved 60-minute sessions, 3x per week, for 24-weeks. Outcomes included feasibility measures and functional capacity. Results 17 out of 110 individuals initiated the program (recruitment rate = 15.4%) and 16 completed the program (drop-out rate = 5.8%) and attended sessions (attendance rate = 93.9%). Both groups showed a significant increase in upper extremity motor score (MS) and abdominal strength post intervention. Only the RLT group showed a significant change in lower extremity MS, with a mean increase of 3.00 [0.00; 16.5] points over time. Distance walked in the Functional Ambulatory Inventory (SCI-FAI) increased significantly (p = 0.02) over time only for the RLT group. Conclusions Feasibility rates of the intervention and functional outcomes justify a subsequent powered RCT comparing RLT to ABT as an effective rehabilitation tool for potentially improving functional strength and walking capacity in people with incomplete SCI.

Motor and autonomic concomitant health improvements with neuromodulation and exercise (MACHINE) training: a randomised controlled trial in individuals with spinal cord injury

IntroductionMotor and autonomic dysfunctions are widespread among people with spinal cord injury (SCI), leading to poor health and reduced quality of life. Exercise interventions, such as locomotor training (LT), can...

The use of transcranial direct current stimulation in individuals with cerebral palsy: a scoping review

BACKGROUND: Cerebral palsy (CP) is a neurodevelopmental condition that begins in early childhood and persists throughout life, causing limitations in daily activities and social participation. Neuromodulatory interventions using non-invasive brain stimulation, like transcranial direct current stimulation (tDCS), have been increasingly investigated, aiming to influence cortical excitability in neurologic conditions, including CP. OBJECTIVE: To summarize current evidence for the use of tDCS on individuals with CP. METHODS: Using scoping review methodology, the terms "cerebral palsy" and "transcranial direct current stimulation" were screened in PubMed, Cochrane, LILACS, SciELO, PEDro, and Embase databases, searching for clinical trials that applied tDCS interventions into children and adults with CP. Quality assessment of all eligible studies was performed using the PEDro Scale. RESULTS: A total of 1773 articles (including duplicates) were found, of which 14 met the predetermined criteria. Two hundred and thirty-three individuals with CP, with ages ranging from 5 to 27 years, participated in these studies. The main therapeutic effects of anodal tDCS were reported on upper limb dysfunctions, balance, and gait. The primary motor cortex was the most frequently applied target. The combined use of tDCS with other motor training techniques, such as constraint-induced movement therapy (CIMT) and treadmill locomotor training, showed better results. CONCLUSION: Emerging evidence reveals that the use of tDCS in individuals with CP is safe, feasible, easy to apply, tolerable, and effective when performed according to the recommendations available to date. The tDCS protocols in these studies were partially homogeneous, and sample sizes were generally small. More large-scale longitudinal studies are needed, particularly in individuals with ataxic and dyskinetic CP.

Automatic diseases detection and classification of EEG signal with pervasive computing using machine learning

PurposeThe natural control, feedback, stimuli and protection of these subsequent principles founded this project. Via properly conducted experiments, a multilayer computer rehabilitation system was created that integrated natural interaction assisted by electroencephalogram (EEG), which enabled the movements in the virtual environment and real wheelchair. For blind wheelchair operator patients, this paper involved of expounding the proper methodology. For educating the value of life and independence of blind wheelchair users, outcomes have proven that virtual reality (VR) with EEG signals has that potential.Design/methodology/approachIndividuals face numerous challenges with many disorders, particularly when multiple dysfunctions are diagnosed and especially for visually effected wheelchair users. This scenario, in reality, creates in a degree of incapacity on the part of the wheelchair user in terms of performing simple activities. Based on their specific medical needs, confined patients are treated in a modified method. Independent navigation is secured for individuals with vision and motor disabilities. There is a necessity for communication which justifies the use of VR in this navigation situation. For the effective integration of locomotion besides, it must be under natural guidance. EEG, which uses random brain impulses, has made significant progress in the field of health. The custom of an automated audio announcement system modified to have the help of VR and EEG for the training of locomotion and individualized interaction of wheelchair users with visual disability is demonstrated in this study through an experiment. Enabling the patients who were otherwise deemed incapacitated to participate in social activities, as the aim was to have efficient connections.FindingsTo protect their life straightaway and to report all these disputes, the military system should have high speed, more precise portable prototype device for nursing the soldier health, recognition of solider location and report about health sharing system to the concerned system. Field programmable gate array (FPGA)-based soldier’s health observing and position gratitude system is proposed in this paper. Reliant on heart rate which is centered on EEG signals, the soldier’s health is observed on systematic bases. By emerging Verilog hardware description language (HDL) programming language and executing on Artix-7 development FPGA board of part name XC7ACSG100t the whole work is approved in a Vivado Design Suite. Classification of different abnormalities and cloud storage of EEG along with the type of abnormalities, artifact elimination, abnormalities identification based on feature extraction, exist in the segment of suggested architecture. Irregularity circumstances are noticed through developed prototype system and alert the physically challenged (PHC) individual via an audio announcement. An actual method for eradicating motion artifacts from EEG signals that have anomalies in the PHC person’s brain has been established, and the established system is a portable device that can deliver differences in brain signal variation intensity. Primarily the EEG signals can be taken and the undesirable artifact can be detached, later structures can be mined by discrete wavelet transform these are the two stages through which artifact deletion can be completed. The anomalies in signal can be noticed and recognized by using machine learning algorithms known as multirate support vector machine classifiers when the features have been extracted using a combination of hidden Markov model (HMM) and Gaussian mixture model (GMM). Intended for capable declaration about action taken by a blind person, these result signals are protected in storage devices and conveyed to the controller. Pretending daily motion schedules allows the pretentious EEG signals to be caught. Aimed at the validation of planned system, the database can be used and continued with numerous recorded signals of EEG. The projected strategy executes better in terms of re-storing theta, delta, alpha and beta complexes of the original EEG with less alteration and a higher signal to noise ratio (SNR) value of the EEG signal, which illustrates in the quantitative analysis. The projected method used Verilog HDL and MATLAB software for both formation and authorization of results to yield improved results. Since from the achieved results, it is initiated that 32% enhancement in SNR, 14% in mean squared error (MSE) and 65% enhancement in recognition of anomalies, hence design is effectively certified and proved for standard EEG signals data sets on FPGA.Originality/valueThe proposed system can be used in military applications as it is high speed and excellent precise in terms of identification of abnormality, the developed system is portable and very precise. FPGA-based soldier’s health observing and position gratitude system is proposed in this paper. Reliant on heart rate which is centered on EEG signals the soldier health is observed in systematic bases. The proposed system is developed using Verilog HDL programming language and executing on Artix-7 development FPGA board of part name XC7ACSG100t and synthesised using in Vivado Design Suite software tool.

The influence of backward versus forward locomotor training on gait speed and balance control post-stroke: Recovery or compensation?

Backward walking training has been reported to improve gait speed and balance post-stroke. However, it is not known if gains are achieved through recovery of the paretic limb or compensations from the nonparetic limb. The purpose of this study was to compare the influence of backward locomotor training (BLT) versus forward locomotor training (FLT) on gait speed and dynamic balance control, and to quantify the underlying mechanisms used to achieve any gains. Eighteen participants post chronic stroke were randomly assigned to receive 18 sessions of either FLT (n = 8) or BLT (n = 10). Pre- and post-intervention outcomes included gait speed (10-meter Walk Test) and forward propulsion (time integral of anterior-posterior ground-reaction-forces during late stance for each limb). Dynamic balance control was assessed using clinical (Functional Gait Assessment) and biomechanical (peak-to-peak range of whole-body angular-momentum in the frontal plane) measures. Balance confidence was assessed using the Activities-Specific Balance Confidence scale. While gait speed and balance confidence improved significantly within the BLT group, these improvements were associated with an increased nonparetic limb propulsion generation, suggesting use of compensatory mechanisms. Although there were no improvements in gait speed within the FLT group, paretic limb propulsion generation significantly improved post-FLT, suggesting recovery of the paretic limb. Neither training group improved in dynamic balance control, implying the need of balance specific training along with locomotor training to improve balance control post-stroke. Despite the within-group differences, there were no significant differences between the FLT and BLT groups in the achieved gains in any of the outcomes.

Komplexe Patternaddition – Coordinative Locomotor Training by Britta Dietz

Das Coordinative Locomotor Training, CLT, ist eine Behandlungsform aus der Neuroreha, die auf Basis der PNF entwickelt wurde. Die darin drei-dimensional fazilitierten Bewegungen gehen von den Schlüsselpunkten Tuber ossi ischii und Angulus inferior scapulae aus. Damit lassen sich die Stabilität und Koordination im Gang verbessern.

Assessment of Dorsiflexion Ability across Tasks in Persons with Subacute SCI after Combined Locomotor Training and Transcutaneous Spinal Stimulation.

In people with spinal cord injury (SCI), transcutaneous spinal stimulation (TSS) has an immediate effect on the ability to dorsiflex the ankle, but persistent effects are not known. Furthermore, TSS has been associated with improved walking, increased volitional muscle activation, and decreased spasticity when combined with locomotor training (LT). In this study, the persistent impact of combined LT and TSS on dorsiflexion during the swing phase of walking and a volitional task in participants with SCI is determined. Ten participants with subacute motor-incomplete SCI received 2 weeks of LT alone (wash-in phase), followed by 2 weeks of either LT + TSS (TSS at 50 Hz) or LT + TSSSham (intervention phase). There was no persistent effect of TSS on dorsiflexion during walking and inconsistent effects on the volitional task. There was a strong positive correlation between the dorsiflexor ability for both tasks. There was a moderate effect of 4 weeks of LT on increased dorsiflexion during the task (d = 0.33) and walking (d = 0.34) and a small effect on spasticity (d = -0.2). Combined LT + TSS did not show persistent effects on dorsiflexion ability in people with SCI. Four weeks of locomotor training was associated with increased dorsiflexion across tasks. Improvements in walking observed with TSS may be due to factors other than improved ankle dorsiflexion.

Feasibility, safety, and functional outcomes using the neurological controlled Hybrid Assistive Limb exoskeleton (HAL®) following acute incomplete and complete spinal cord injury – Results of 50 patients

Objective Recent studies reveal that Hybrid Assistive Limb (HAL®) locomotion training in paraplegic patients suffering from chronic spinal cord injury (SCI) induces improvements in functional and ambulatory mobility. The purpose of this study was to determine the safety, feasibility, and functional effectiveness of HAL® locomotion training in the initial rehabilitation of acute SCI patients. This clinical trial represents the first systematic intervention worldwide for acute SCI patients using a neurologically controlled exoskeleton. Design Single center, prospective study. Setting BG University Hospital Bergmannsheil, Bochum, Germany. Participants Fifty acute SCI patients (14 women, 36 men). Interventions All participants received a daily (5 times/week) HAL® exoskeleton supported training for 12 weeks (mean amount of training sessions 60.4 ± 30.08). Outcome Measures Functional outcome for overground walking was monitored using the 10-m-walk test (10 MWT) combined with the WISCI II score, 6-minute-walk test (6 MWT) and the timed-up and go test (TUG test). Treadmill-related parameters (speed, distance and walking time) and the Lower Extremity Motor Score (LEMS) were recorded separately. Results Significant improvements were observed for HAL®-associated (walking time, distance and speed) and for functional outcomes (10 MWT, 6 MWT and TUG-test). WISCI-II-Score and the LEMS increased significantly compared with the status prior to training. Conclusion HAL® locomotion training is feasible and safe in the rehabilitation of acute SCI patients. The HAL® exoskeleton enables the patient to perform effective treadmill training and leads to improvements in functional and ambulatory mobility. However, spontaneous recovery vs training-related effects remain unclear and findings should not be extrapolated beyond the acute in-patient rehabilitation setting. Trial registration: German Clinical Trials Register identifier: DRKS00010250..

A systematic review of the determinants of implementation of a locomotor training program using a powered exoskeleton for individuals with a spinal cord injury

Background Wearable powered exoskeletons represent a promising rehabilitation tool for locomotor training in various populations, including in individuals with a spinal cord injury. The lack of clear evidence on how to implement a locomotor powered exoskeleton training program raises many challenges for patients, clinicians and organizations. Objective To report determinants of implementation in clinical practice of an overground powered exoskeleton locomotor training program for persons with a spinal cord injury. Data sources Medline, CINAHL, Web of Science. Study selection Studies were included if they documented determinants of implementation of an overground powered exoskeleton locomotor training program for individuals with spinal cord injury. Data extraction Eligible studies were identified by two independent reviewers. Data were extracted by one reviewer, based on constructs of the Consolidated Framework for Implementation Research, and validated by a second reviewer. Results Sixty-three articles were included. 49.4% of all determinants identified were related to the intervention characteristics, 29.6% to the individuals’ characteristic and 13.5% to the inner setting. Recurrent barriers identified were the high prevalence of adverse events (e.g., skin issues, falls) and device malfunctions. Adequate training for clinicians, time and resource available, as well as discussion about patients’ expectations were identified as facilitators. Conclusions Powered exoskeleton training is a complex intervention. The limited information on the context and the implementation process domains may represent a barrier to a successful transition from knowledge to action.

Neuromodulation Through Spinal Cord Stimulation Restores Ability to Voluntarily Cycle After Motor Complete Paraplegia.

Abstract Epidural spinal cord stimulation (eSCS) of the lower thoracic spinal cord has been shown to partially restore volitional movement in patients with complete chronic spinal cord injury (cSCI). Combining eSCS with intensive locomotor training improves motor function, including standing and stepping, but many patients with cSCI suffer from long-standing muscle atrophy and loss of bone mineral density, which may prohibit safe implementation. Safe, accessible, and effective avenues for pairing neuromodulation with activity-based therapy remain unexplored. Cycling is one such option that can be utilized as an eSCS therapy given its low-risk and low-weight-bearing requirement. We investigated the feasibility and kinematics of motor-assisted and passive cycle-based therapy for cSCI patients with epidural spinal cord stimulation. Seven participants who underwent spinal cord stimulation surgery in the Epidural Stimulation After Neurologic Damage (E-STAND) trial (NCT03026816) participated in a cycling task using the motor assist MOTOmed Muvi 300. A factorial design was used such that participants were asked to cycle with and without conscious effort with and without stimulation. We used mixed effects models assessing maximum power output and time pedaling unassisted to evaluate the interaction between stimulation and conscious effort. Cycling was well-tolerated and we observed no adverse events, including in participants up to 17 years post-initial injury and up to 58 years old. All participants were found to be able to pedal without motor assist, which primarily occurred when stimulation and effort were applied together (p = 0.001). Additionally, the combination of stimulation and intention was significantly associated with higher maximum power production (p < 0.0001) and distance pedaled (p = 0.0001). No association was found between volitional movement and participant factors: age, time since injury, and spinal cord atrophy. With stimulation and conscious effort, all participants were able to achieve active cycling without motor assistance. Thus, our stationary cycling factorial study design demonstrated volitional movement restoration with eSCS in a diverse study population of cSCI participants. Further, motor-assist cycling was well-tolerated without any adverse events. Cycling has the potential to be a safe research assessment and physical therapy modality for cSCI patients utilizing eSCS who have a high risk of injury with weight bearing exercise. The cycling modality in this study was demonstrated to be a straightforward assessment of motor function and safe for all participants regardless of age or time since initial injury.

Change of Foot Pressure Distributions on Stance Leg during Coordinative Locomotor Training in Healthy Adults

Change of Foot Pressure Distributions on Stance Leg during Coordinative Locomotor Training in Healthy Adults

Priming locomotor training with transspinal stimulation in people with spinal cord injury: study protocol of a randomized clinical trial

BackgroundThe seemingly simple tasks of standing and walking require continuous integration of complex spinal reflex circuits between descending motor commands and ascending sensory inputs. Spinal cord injury greatly impairs standing and walking ability, but both improve with locomotor training. However, even after multiple locomotor training sessions, abnormal muscle activity and coordination persist. Thus, locomotor training alone cannot fully optimize the neuronal plasticity required to strengthen the synapses connecting the brain, spinal cord, and local circuits and potentiate neuronal activity based on need. Transcutaneous spinal cord (transspinal) stimulation alters motoneuron excitability over multiple segments by bringing motoneurons closer to threshold, a prerequisite for effectively promoting spinal locomotor network neuromodulation and strengthening neural connectivity of the injured human spinal cord. Importantly, whether concurrent treatment with transspinal stimulation and locomotor training maximizes motor recovery after spinal cord injury is unknown.MethodsForty-five individuals with chronic spinal cord injury are receiving 40 sessions of robotic gait training primed with 30 Hz transspinal stimulation at the Thoracic 10 vertebral level. Participants are randomized to receive 30 min of active or sham transspinal stimulation during standing or active transspinal stimulation while supine followed by 30 min of robotic gait training. Over the course of locomotor training, the body weight support, treadmill speed, and leg guidance force are adjusted as needed for each participant based on absence of knee buckling during the stance phase and toe dragging during the swing phase. At baseline and after completion of all therapeutic sessions, neurophysiological recordings registering corticospinal and spinal neural excitability changes along with clinical assessment measures of standing and walking, and autonomic function via questionnaires regarding bowel, bladder, and sexual function are taken.DiscussionThe results of this mechanistic randomized clinical trial will demonstrate that tonic transspinal stimulation strengthens corticomotoneuronal connectivity and dynamic neuromodulation through posture-dependent corticospinal and spinal neuroplasticity. We anticipate that this mechanistic clinical trial will greatly impact clinical practice because, in real-world clinical settings, noninvasive transspinal stimulation can be more easily and widely implemented than invasive epidural stimulation. Additionally, by applying multiple interventions to accelerate motor recovery, we are employing a treatment regimen that reflects a true clinical approach.Trial registrationClinicalTrials.gov NCT04807764. Registered on March 19, 2021.