Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Journal of NeuroEngineering and Rehabilitation
Erschienen in: Journal of NeuroEngineering and Rehabilitation 1/2014

Open Access 01.12.2014 | Research

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

verfasst von: Rob Labruyère, Hubertus J A van Hedel

Erschienen in: Journal of NeuroEngineering and Rehabilitation | Ausgabe 1/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

Task-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.

Methods

Nine 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.

Results

There 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.

Conclusion

In 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 registration

This study was registered at Clinicaltrials.gov (NCT01087918).
Literatur
1.
Dobkin BH, Duncan PW: Should body weight-supported treadmill training and robotic-assistive steppers for locomotor training trot back to the starting gate? Neurorehabil Neural Repair 2012, 26: 308-317. 10.1177/1545968312439687CrossRefPubMedPubMedCentral
2.
Barbeau H: Locomotor training in neurorehabilitation: emerging rehabilitation concepts. Neurorehabil Neural Repair 2003, 17: 3-11. 10.1177/0888439002250442CrossRefPubMed
3.
Dobkin BH: An overview of treadmill locomotor training with partial body weight support: a neurophysiologically sound approach whose time has come for randomized clinical trials. Neurorehabil Neural Repair 1999, 13: 157-165. 10.1177/154596839901300301CrossRef
4.
Colombo G, Wirz M, Dietz V: Driven gait orthosis for improvement of locomotor training in paraplegic patients. Spinal Cord 2001, 39: 252-255. 10.1038/sj.sc.3101154CrossRefPubMed
5.
Riener R, Lunenburger L, Maier IC, Colombo G, Dietz V: Locomotor training in subjects with sensori-motor deficits: an overview of the robotic gait orthosis lokomat. J Healthcare Eng 2010, 1: 197-216. 10.1260/2040-2295.1.2.197CrossRef
6.
Hesse S, Schmidt H, Werner C, Bardeleben A: Upper and lower extremity robotic devices for rehabilitation and for studying motor control. Curr Opin Neurol 2003, 16: 705-710. 10.1097/00019052-200312000-00010CrossRefPubMed
7.
Harvey L, Wyndaele JJ: Are we jumping too early with locomotor training programs? Spinal Cord 2011, 49: 947. 10.1038/sc.2011.96CrossRefPubMed
8.
Vaney C, Gattlen B, Lugon-Moulin V, Meichtry A, Hausammann R, Foinant D, Anchisi-Bellwald AM, Palaci C, Hilfiker R: Robotic-assisted step training (lokomat) not superior to equal intensity of over-ground rehabilitation in patients with multiple sclerosis. Neurorehabil Neural Repair 2012, 26: 212-221. 10.1177/1545968311425923CrossRefPubMed
9.
Hidler J, Nichols D, Pelliccio M, Brady K, Campbell DD, Kahn JH, Hornby TG: Multicenter randomized clinical trial evaluating the effectiveness of the Lokomat in subacute stroke. Neurorehabil Neural Repair 2009, 23: 5-13.CrossRefPubMed
10.
Bouyer LJ: Animal models for studying potential training strategies in persons with spinal cord injury. J Neurol Phys Ther 2005, 29: 117-125. 10.1097/01.NPT.0000282244.31158.40CrossRefPubMed
11.
Richards CL, Olney SJ: Hemiparetic gait following stroke. Part II: recovery and physical therapy. Gait Posture 1996, 4: 149-162. 10.1016/0966-6362(96)01064-8CrossRef
12.
Kim CM, Eng JJ, Whittaker MW: Level walking and ambulatory capacity in persons with incomplete spinal cord injury: relationship with muscle strength. Spinal Cord 2004, 42: 156-162. 10.1038/sj.sc.3101569CrossRefPubMedPubMedCentral
13.
Gregory CM, Bowden MG, Jayaraman A, Shah P, Behrman A, Kautz SA, Vandenborne K: Resistance training and locomotor recovery after incomplete spinal cord injury: a case series. Spinal Cord 2007, 45: 522-530. 10.1038/sj.sc.3102002CrossRefPubMed
14.
Hesse S, Bertelt C, Jahnke MT, Schaffrin A, Baake P, Malezic M, Mauritz KH: Treadmill training with partial body weight support compared with physiotherapy in nonambulatory hemiparetic patients. Stroke 1995, 26: 976-981. 10.1161/01.STR.26.6.976CrossRefPubMed
15.
Sullivan KJ, Brown DA, Klassen T, Mulroy S, Ge T, Azen SP, Winstein CJ: Effects of task-specific locomotor and strength training in adults who were ambulatory after stroke: results of the STEPS randomized clinical trial. Phys Ther 2007, 87: 1580-1602. 10.2522/ptj.20060310CrossRefPubMed
16.
Duncan PW, Sullivan KJ, Behrman AL, Azen SP, Wu SS, Nadeau SE, Dobkin BH, Rose DK, Tilson JK, Cen S, Hayden SK: Body-weight-supported treadmill rehabilitation after stroke. N Engl J Med 2011, 364: 2026-2036. 10.1056/NEJMoa1010790CrossRefPubMedPubMedCentral
17.
Wirth B, van Hedel HJ, Curt A: Ankle dexterity remains intact in patients with incomplete spinal cord injury in contrast to stroke patients. Exp Brain Res 2008, 191: 353-361. 10.1007/s00221-008-1528-0CrossRefPubMed
18.
van Hedel HJ, Wirth B, Curt A: Ankle motor skill is intact in spinal cord injury, unlike stroke: implications for rehabilitation. Neurology 2010, 74: 1271-1278. 10.1212/WNL.0b013e3181d9ed7cCrossRefPubMed
19.
Mehrholz J, Kugler J, Pohl M: Locomotor training for walking after spinal cord injury. Cochrane Database Syst Rev 2008. CD006676
20.
Field-Fote EC, Lindley SD, Sherman AL: Locomotor training approaches for individuals with spinal cord injury: a preliminary report of walking-related outcomes. J Neurol Phys Ther 2005, 29: 127-137. 10.1097/01.NPT.0000282245.31158.09CrossRefPubMed
21.
Nooijen CF, Ter Hoeve N, Field-Fote EC: Gait quality is improved by locomotor training in individuals with SCI regardless of training approach. J Neuroeng Rehabil 2009, 6: 36. 10.1186/1743-0003-6-36CrossRefPubMedPubMedCentral
22.
Siddall PJ, McClelland JM, Rutkowski SB, Cousins MJ: A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury. Pain 2003, 103: 249-257. 10.1016/S0304-3959(02)00452-9CrossRefPubMed
23.
Martin Ginis KA, Latimer AE: The effects of single bouts of body-weight supported treadmill training on the feeling states of people with spinal cord injury. Spinal Cord 2007, 45: 112-115. 10.1038/sj.sc.3101911CrossRefPubMed
24.
Marino RJ, Barros T, Biering-Sorensen F, Burns SP, Donovan WH, Graves DE, Haak M, Hudson LM, Priebe MM: International standards for neurological classification of spinal cord injury. J Spinal Cord Med 2003,26(Suppl 1):S50-S56.PubMed
25.
Itzkovich M, Gelernter I, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, Tonack M, Hitzig SL, Glaser E, Zeilig G, et al.: The Spinal Cord Independence Measure (SCIM) version III: reliability and validity in a multi-center international study. Disabil Rehabil 2007, 29: 1926-1933. 10.1080/09638280601046302CrossRefPubMed
26.
Folstein MF, Folstein SE, McHugh PR: “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975, 12: 189-198. 10.1016/0022-3956(75)90026-6CrossRefPubMed
27.
Vallery H, Duschau-Wicke A, Riener R: Generalized elasticities improve patient-cooperative control of rehabilitation robots. IEEE Int Conf on Rehabilitation Robotics (ICORR) 2009, 535-541.
28.
Vallery H, Duschau-Wicke A, Riener R: Optimized passive dynamics improve transparency of haptic devices. IEEE Int Conf Robot Aut (ICRA) 2009, 301-306.
29.
Field-Fote EC, Roach KE: Influence of a locomotor training approach on walking speed and distance in people with chronic spinal cord injury: a randomized clinical trial. Phys Ther 2011, 91: 48-60. 10.2522/ptj.20090359CrossRefPubMedPubMedCentral
30.
van Hedel HJ, Dietz V: Walking during daily life can be validly and responsively assessed in subjects with a spinal cord injury. Neurorehabil Neural Repair 2009, 23: 117-124.CrossRefPubMed
31.
van Hedel HJ, Wirz M, Dietz V: Standardized assessment of walking capacity after spinal cord injury: the European network approach. Neurol Res 2008, 30: 61-73. 10.1179/016164107X230775CrossRefPubMed
32.
DeVivo M, Biering-Sorensen F, Charlifue S, Noonan V, Post M, Stripling T, Wing P: International spinal cord injury core data set. Spinal Cord 2006, 44: 535-540. 10.1038/sj.sc.3101958CrossRefPubMed
33.
Dittuno PL, Ditunno JF Jr: Walking index for spinal cord injury (WISCI II): scale revision. Spinal Cord 2001, 39: 654-656. 10.1038/sj.sc.3101223CrossRefPubMed
34.
Labruyère R, van Hedel H: Curve-walking is not better than straight-walking in estimating ambulation-related domains after incomplete spinal cord injury. Arch Phys Med Rehabil 2012, 93: 796-801. 10.1016/j.apmr.2011.11.009CrossRefPubMed
35.
IJzerman MJ, Baardman G, Hof MA V ‘t, Boom HB, Hermens HJ, Veltink PH: Validity and reproducibility of crutch force and heart rate measurements to assess energy expenditure of paraplegic gait. Arch Phys Med Rehabil 1999, 80: 1017-1023. 10.1016/S0003-9993(99)90054-0CrossRefPubMed
36.
Benedetti MG, Piperno R, Simoncini L, Bonato P, Tonini A, Giannini S: Gait abnormalities in minimally impaired multiple sclerosis patients. Mult Scler 1999, 5: 363-368.CrossRefPubMed
37.
Teixeira-Salmela LF, Nadeau S, McBride I, Olney SJ: Effects of muscle strengthening and physical conditioning training on temporal, kinematic and kinetic variables during gait in chronic stroke survivors. J Rehabil Med 2001, 33: 53-60. 10.1080/165019701750098867CrossRefPubMed
38.
Brotherton SS, Krause JS, Nietert PJ: Falls in individuals with incomplete spinal cord injury. Spinal Cord 2007, 45: 37-40. 10.1038/sj.sc.3101909CrossRefPubMed
39.
Wirz M, Muller R, Bastiaenen C: Falls in persons with spinal cord injury: validity and reliability of the Berg Balance Scale. Neurorehabil Neural Repair 2009, 24: 70-77.CrossRefPubMed
40.
Scivoletto G, Romanelli A, Mariotti A, Marinucci D, Tamburella F, Mammone A, Cosentino E, Sterzi S, Molinari M: Clinical factors that affect walking level and performance in chronic spinal cord lesion patients. Spine 2008, 33: 259-264. 10.1097/BRS.0b013e3181626ab0CrossRefPubMed
41.
Barbeau H, Visintin M: Optimal outcomes obtained with body-weight support combined with treadmill training in stroke subjects. Arch Phys Med Rehabil 2003, 84: 1458-1465. 10.1016/S0003-9993(03)00361-7CrossRefPubMed
42.
Mayr A, Kofler M, Quirbach E, Matzak H, Frohlich K, Saltuari L: Prospective, blinded, randomized crossover study of gait rehabilitation in stroke patients using the Lokomat gait orthosis. Neurorehabil Neural Repair 2007, 21: 307-314. 10.1177/1545968307300697CrossRefPubMed
43.
Berg KO, Wood-Dauphinee SL, Williams JI, Maki B: Measuring balance in the elderly: validation of an instrument. Can J Public Health 1992,83(Suppl 2):S7-S11.PubMed
44.
Yardley L, Beyer N, Hauer K, Kempen G, Piot-Ziegler C, Todd C: Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age Ageing 2005, 34: 614-619. 10.1093/ageing/afi196CrossRefPubMed
45.
Senn S: Cross-over trials in clinical research. 2nd edition. J. Wiley & Sons: Chichester, UK; 2002.CrossRef
46.
World Health Organization: International Classification of Functioning, Disability and Health. Geneva, Switzerland: World Health Organization; 2001. Available at: . Accessibility verified November 6, 2013 http://​www3.​who.​int/​icf Available at: . Accessibility verified November 6, 2013
47.
Wirz M, Zemon DH, Rupp R, Scheel A, Colombo G, Dietz V, Hornby TG: Effectiveness of automated locomotor training in patients with chronic incomplete spinal cord injury: a multicenter trial. Arch Phys Med Rehabil 2005, 86: 672-680. 10.1016/j.apmr.2004.08.004CrossRefPubMed
48.
Hornby TG, Campbell DD, Kahn JH, Demott T, Moore JL, Roth HR: Enhanced gait-related improvements after therapist- versus robotic-assisted locomotor training in subjects with chronic stroke: a randomized controlled study. Stroke 2008, 39: 1786-1792. 10.1161/STROKEAHA.107.504779CrossRefPubMed
49.
van Hedel HJ: Gait speed in relation to categories of functional ambulation after spinal cord injury. Neurorehabil Neural Repair 2009, 23: 343-350.CrossRefPubMed
50.
Weiss A, Suzuki T, Bean J, Fielding RA: High intensity strength training improves strength and functional performance after stroke. Am J Phys Med Rehabil 2000, 79: 369-376. quiz 391-364 10.1097/00002060-200007000-00009CrossRefPubMed
51.
Hess JA, Woollacott M: Effect of high-intensity strength-training on functional measures of balance ability in balance-impaired older adults. J Manipulative Physiol Ther 2005, 28: 582-590. 10.1016/j.jmpt.2005.08.013CrossRefPubMed
52.
Behrman AL, Lawless-Dixon AR, Davis SB, Bowden MG, Nair P, Phadke C, Hannold EM, Plummer P, Harkema SJ: Locomotor training progression and outcomes after incomplete spinal cord injury. Phys Ther 2005, 85: 1356-1371.PubMed
53.
Perera S, Mody SH, Woodman RC, Studenski SA: Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc 2006, 54: 743-749. 10.1111/j.1532-5415.2006.00701.xCrossRefPubMed
54.
Steffen T, Seney M: Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism. Phys Ther 2008, 88: 733-746. 10.2522/ptj.20070214CrossRefPubMed
55.
Burns AS, Delparte JJ, Patrick M, Marino RJ, Ditunno JF: The reproducibility and convergent validity of the walking index for spinal cord injury (WISCI) in chronic spinal cord injury. Neurorehabil Neural Repair 2011, 25: 149-157. 10.1177/1545968310376756CrossRefPubMed
56.
Hayes KW, Johnson ME: Measures of adult general performance tests: the Berg balance scale, Dynamic Gait Index (DGI), Gait Velocity, Physical Performance Test (PPT), Timed Chair Stand Test, Timed Up and Go, and Tinetti Performance-Oriented Mobility Assessment (POMA). Arthritis Care Res 2003, 49: S28-S42. 10.1002/art.11411CrossRef
57.
Scivoletto G, Tamburella F, Laurenza L, Molinari M: The spinal cord independence measure: how much change is clinically significant for spinal cord injury subjects. Disabil Rehabil 2013, 35: 1808-1813. 10.3109/09638288.2012.756942CrossRefPubMed
58.
Ditor DS, Latimer AE, Ginis KA, Arbour KP, McCartney N, Hicks AL: Maintenance of exercise participation in individuals with spinal cord injury: effects on quality of life, stress and pain. Spinal Cord 2003, 41: 446-450. 10.1038/sj.sc.3101487CrossRefPubMed
59.
Edgerton VR, de Leon RD, Tillakaratne N, Recktenwald MR, Hodgson JA, Roy RR: Use-dependent plasticity in spinal stepping and standing. Adv Neurol 1997, 72: 233-247.PubMed
60.
Harkema SJ, Hurley SL, Patel UK, Requejo PS, Dobkin BH, Edgerton VR: Human lumbosacral spinal cord interprets loading during stepping. J Neurophysiol 1997, 77: 797-811.PubMed
61.
Trimble MH, Kukulka CG, Behrman AL: The effect of treadmill gait training on low-frequency depression of the soleus H-reflex: comparison of a spinal cord injured man to normal subjects. Neurosci Lett 1998, 246: 186-188. 10.1016/S0304-3940(98)00259-6CrossRefPubMed
62.
Marqueste T, Alliez JR, Alluin O, Jammes Y, Decherchi P: Neuromuscular rehabilitation by treadmill running or electrical stimulation after peripheral nerve injury and repair. J Appl Physiol 2004, 96: 1988-1995.CrossRefPubMed
63.
Sabatier MJ, Redmon N, Schwartz G, English AW: Treadmill training promotes axon regeneration in injured peripheral nerves. Exp Neurol 2008, 211: 489-493. 10.1016/j.expneurol.2008.02.013CrossRefPubMedPubMedCentral
64.
Bridges D, Thompson SW, Rice AS: Mechanisms of neuropathic pain. Br J Anaesth 2001, 87: 12-26. 10.1093/bja/87.1.12CrossRefPubMed
65.
Feine JS, Lund JP: An assessment of the efficacy of physical therapy and physical modalities for the control of chronic musculoskeletal pain. Pain 1997, 71: 5-23. 10.1016/S0304-3959(96)03287-3CrossRefPubMed
66.
Mannerkorpi K, Henriksson C: Non-pharmacological treatment of chronic widespread musculoskeletal pain. Best Pract Res Clin Rheumatol 2007, 21: 513-534. 10.1016/j.berh.2007.04.001CrossRefPubMed
67.
Ginis KA, Hicks AL: Exercise research issues in the spinal cord injured population. Exerc Sport Sci Rev 2005, 33: 49-53.PubMed
Metadaten
Titel
Strength training versus robot-assisted gait training after incomplete spinal cord injury: a randomized pilot study in patients depending on walking assistance
verfasst von
Rob Labruyère
Hubertus J A van Hedel
Publikationsdatum
01.12.2014
Verlag
BioMed Central
Erschienen in
Journal of NeuroEngineering and Rehabilitation / Ausgabe 1/2014
Elektronische ISSN: 1743-0003
DOI
https://doi.org/10.1186/1743-0003-11-4

Weitere Artikel der Ausgabe 1/2014

Journal of NeuroEngineering and Rehabilitation 1/2014 Zur Ausgabe

Research

Between-day reliability of centre of pressure measures for balance assessment in hemiplegic stroke patients

Research

Altering length and velocity feedback during a neuro-musculoskeletal simulation of normal gait contributes to hemiparetic gait characteristics

Short report

A pilot investigation using global positioning systems into the outdoor activity of people with severe traumatic brain injury

Research

Postural stabilization during bilateral and unilateral vibration of ankle muscles in the sagittal and frontal planes

Short report

Autonomous exoskeleton reduces metabolic cost of human walking

Research

Effects of walking-induced fatigue on gait function and tripping risks in older adults

Neu in den Fachgebieten Neurologie und Psychiatrie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Frühe Alzheimertherapie lohnt sich

25.04.2024 AAN-Jahrestagung 2024 Nachrichten

Ist die Tau-Last noch gering, scheint der Vorteil von Lecanemab besonders groß zu sein. Und beginnen Erkrankte verzögert mit der Behandlung, erreichen sie nicht mehr die kognitive Leistung wie bei einem früheren Start. Darauf deuten neue Analysen der Phase-3-Studie Clarity AD.

Viel Bewegung in der Parkinsonforschung

25.04.2024 Parkinson-Krankheit Nachrichten

Neue arznei- und zellbasierte Ansätze, Frühdiagnose mit Bewegungssensoren, Rückenmarkstimulation gegen Gehblockaden – in der Parkinsonforschung tut sich einiges. Auf dem Deutschen Parkinsonkongress ging es auch viel um technische Innovationen.

Demenzkranke durch Antipsychotika vielfach gefährdet

23.04.2024 Demenz Nachrichten

Wenn Demenzkranke aufgrund von Symptomen wie Agitation oder Aggressivität mit Antipsychotika behandelt werden, sind damit offenbar noch mehr Risiken verbunden als bislang angenommen.

Bildnachweise