Functional electric stimulation to augment partial weight-bearing supported treadmill training for patients with acute incomplete spinal cord injury: a pilot study

Spinal cord injury (SCI) produces paralysis and a unique form of neurogenic disuse osteoporosis that dramatically increases fracture risk at the distal femur and proximal tibia. This bone loss is driven by heightened bone resorption and near-absent bone formation during the acute post-SCI recovery phase and by a more traditional high-turnover osteopenia that emerges more chronically, which is likely influenced by the continual neural impairment and musculoskeletal unloading. These observations have stimulated interest in specialized exercise or activity-based physical therapy (ABPT) modalities (e.g., neuromuscular or functional electrical stimulation cycling, rowing, or resistance training, as well as other standing, walking, or partial weight-bearing interventions) that reload the paralyzed limbs and promote muscle recovery and use-dependent neuroplasticity. However, only sparse and relatively inconsistent evidence supports the ability of these physical rehabilitation regimens to influence bone metabolism or to increase bone mineral density (BMD) at the most fracture-prone sites in persons with severe SCI. This review discusses the pathophysiology and cellular/molecular mechanisms that influence bone loss after SCI, describes studies evaluating bone turnover and BMD responses to ABPTs during acute versus chronic SCI, identifies factors that may impact the bone responses to ABPT, and provides recommendations to optimize ABPTs for bone recovery.

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Short Term Effects of Rhythmic Auditory Stimulation with Body Weight Supported Treadmill Training on Gait and Balance in Individuals with Incomplete Spinal Cord Injury

International Journal of Science and Healthcare Research ◽

10.52403/ijshr.20211027 ◽

2021 ◽

Vol 6 (4) ◽

pp. 191-197

Author(s):

Kanika Singhal ◽

Chitra Kataria

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Body Weight ◽

Gait Training ◽

Auditory Stimulation ◽

Treadmill Training ◽

Incomplete Spinal Cord Injury ◽

Cord Injury ◽

Rhythmic Auditory Stimulation ◽

Gait Trainer

Background: Rhythmic auditory stimulation and body weight supported treadmill training both are standardized gait rehabilitation techniques. However there is limited literature evaluating the effect of rhythmic auditory stimulation and its combination with gait training in spinal cord injury. Aim of this study is to determine the short term effectiveness of rhythmic auditory stimulation with body weight supported treadmill training on gait and balance in individuals with incomplete Spinal Cord Injury. Method: A randomized control study design. 8 subjects with incomplete spinal cord injury who met the inclusion criteria were randomly allocated into two groups: Experimental and Control. Subjects in experimental group were given body weight supported treadmill training with rhythmic auditory stimulation. Subjects in Control Group were given Body weight supported treadmill training alone. Both the groups received conventional rehabilitation as well. Both groups received training for 30 minutes, five times a week for two weeks (10 sessions). Outcome Measures: Gait parameters i.e. cadence, velocity, step length were measured using the Biodex Gait Trainer 2TM, level of walking performance measured using Walking Index for Spinal Cord Injury II, and balance was evaluated using Prokin 252NTM , Berg Balance Scale, and Activity specific Balance Confidence scale. Results: No significant improvement was found on gait parameters i.e. cadence, velocity, step length which were measured using the Gait Trainer, level of walking performance measured using WISCI II, and balance which was evaluated using Prokin 252NTM , Berg Balance Scale, and Activity specific Balance Confidence scale. Conclusion: Rhythmic auditory stimulation didn’t have any positive effect on gait training in incomplete spinal cord injured patients. Further studies are warranted to explore the entrainment effects of rhythmic auditory stimulation in spinal cord injured individuals on gait rehabilitation. Keywords: Rhythmic Auditory Stimulation (RAS), Body Weight Supported Treadmill Training (BWSTT), Metronome, Incomplete spinal cord injury, Biodex Gait Trainer 2.0, Prokin 252N

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Varied movement errors drive learning of dynamic balance control during walking in people with incomplete spinal cord injury: a pilot study

Experimental Brain Research ◽

10.1007/s00221-020-05776-0 ◽

2020 ◽

Vol 238 (4) ◽

pp. 981-993

Author(s):

Jui-Te Lin ◽

Chao-Jung Hsu ◽

Weena Dee ◽

David Chen ◽

W. Zev Rymer ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Pilot Study ◽

Balance Control ◽

Dynamic Balance ◽

Incomplete Spinal Cord Injury ◽

Cord Injury

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Proximal tibia fracture in a patient with incomplete spinal cord injury associated with robotic treadmill training

Spinal Cord ◽

10.1038/sc.2015.27 ◽

2015 ◽

Vol 53 (12) ◽

pp. 875-876 ◽

Cited By ~ 11

Author(s):

T R M Filippo ◽

M C L De Carvalho ◽

L B Carvalho ◽

D R de Souza ◽

M Imamura ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Proximal Tibia ◽

Tibia Fracture ◽

Treadmill Training ◽

Incomplete Spinal Cord Injury ◽

Proximal Tibia Fracture ◽

Cord Injury ◽

Robotic Treadmill Training

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Effects of overground locomotor training on the ventilatory response to volitional treadmill walking in individuals with incomplete spinal cord injury: a pilot study

Spinal Cord Series and Cases ◽

10.1038/scsandc.2017.11 ◽

2017 ◽

Vol 3 (1) ◽

Cited By ~ 2

Author(s):

Gino S Panza ◽

Andrew A Guccione ◽

Lisa M Chin ◽

Jared M Gollie ◽

Jeffery E Herrick ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Pilot Study ◽

Ventilatory Response ◽

Treadmill Walking ◽

Locomotor Training ◽

Incomplete Spinal Cord Injury ◽

Cord Injury

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Robotic-Assisted, Body-Weight–Supported Treadmill Training in Individuals Following Motor Incomplete Spinal Cord Injury

Physical Therapy ◽

10.1093/ptj/85.1.52 ◽

2005 ◽

Vol 85 (1) ◽

pp. 52-66 ◽

Cited By ~ 165

Author(s):

T George Hornby ◽

David H Zemon ◽

Donielle Campbell

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Body Weight ◽

Physical Therapists ◽

Treadmill Training ◽

Neurological Injury ◽

Walking Ability ◽

Incomplete Spinal Cord Injury ◽

Robotic Assisted ◽

Cord Injury

AbstractBackground and Purpose. Performance of therapist-assisted, body-weight–supported treadmill training (BWSTT) to enhance walking ability of people with neurological injury is an area of intense research. Its application in the clinical setting, however, is limited by the personnel and labor requirements placed on physical therapists. Recent development of motorized (“robotic”) rehabilitative devices that provide assistance during stepping may improve delivery of BWSTT. Case Description. This case report describes the use of a robotic device to enhance motor recovery and ambulation in 3 people following motor incomplete spinal cord injury. Interventions. Changes in motor impairment, functional limitations, and locomotor disability were monitored weekly during robotic-assisted BWSTT and following transition to therapist-assisted BWSTT with the assistance of one therapist. Outcomes. Following this training, 2 patients recovered independent over-ground walking and another improved his gait speed and endurance. Discussion. The use of robotic devices may assist physical therapists by providing task-specific practice of stepping in people following neurological injury.

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