Prediction of gait recovery in spinal cord injured individuals trained with robotic gait orthosis

Journal of NeuroEngineering and Rehabilitation, 2014 · DOI: 10.1186/1743-0003-11-42 · Published: March 24, 2014

Spinal Cord Injury Assistive Technology Rehabilitation

Simple Explanation

This study investigates how people with spinal cord injuries (SCI) recover their ability to walk when using a robotic device called Lokomat. The researchers wanted to see if they could predict who would benefit most from this type of training. The study found that people with better initial walking ability showed significant improvements in speed and balance with Lokomat training. However, those with poorer initial walking ability did not show significant improvement. Importantly, the strength of the ankle muscles before training could predict who would benefit most from Lokomat training. This could help doctors personalize treatment plans for SCI patients.

Study Duration

4 weeks

Participants

40 SCI subjects with spastic hypertonia

Evidence Level

Not specified

Key Findings

1
Two distinct recovery classes (low and high walking capacity) were identified for each clinical evaluation from both the control and intervention groups.
2
Subjects with initial high walking capacity displayed significant improvements in speed and functional mobility (0.033 m/s/week and–0.41 s/week respectively).
3
The subject’s ankle torque can predict whether he/she would benefit most from Lokomat training prior to the therapy.

Research Summary

The longitudinal growth pattern of gait impairment for two groups of SCI subjects—control and intervention—over four weeks of ongoing Lokomat training, was investigated and analyzed with the GMM. Two classes of growth trajectory in each clinical evaluation were identified for both the control and intervention groups, representing subgroups with low and high walking capacity. Overall, our study indicates that Lokomat training can be an effective physical intervention for SCI subjects with high walking capacity, but not for those with low walking capacity.

Practical Implications

Personalized Therapy

Ankle torque measurements can help individualize therapeutic programs that maximize patient recovery while minimizing unnecessary efforts and costs.

Predictive Tool

Ankle MVC can be a fast and reliable clinical assessment to identify subjects most likely to progress during Lokomat training.

Treatment Planning

Clinicians can use ankle torque to prescribe a therapeutic and rehabilitation plan that optimizes an individual’s recovery outcomes.

Study Limitations

1
It was not feasible to blind the researchers who performed the tests to the group allocation
2
All tests and trainings for each individual subject were performed by the same researcher; however, since this longitudinal study occurred over a span of multiple years, it was not feasible for one researcher to test all subjects.
3
The effects of these limitations on the results are unclear.

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