Field-Fote Edelle C, Lindley Stephen D, Sherman Andrew L
Department of Physical Therapy, Miller School of Medicine, University of Miami, Miami, FL, USA.
J Neurol Phys Ther. 2005 Sep;29(3):127-37. doi: 10.1097/01.npt.0000282245.31158.09.
Body weight supported (BWS) locomotor training improves overground walking ability in individuals with motor-incomplete spinal cord injury (SCI). While there are various approaches available for locomotor training, there is no consensus regarding which of these is optimal. The purpose of this ongoing investigation is to compare outcomes associated with these different training approaches.
Twenty-seven subjects with chronic motor-incomplete SCI have completed training and initial and final testing at the time of this preliminary report. Subjects were randomly assigned to 1 of 4 different BWS assisted-stepping groups, including: (1) treadmill training with manual assistance (TM), (2) treadmill training with stimulation (TS), (3) overground training with stimulation (OG), or (4) treadmill training with robotic assistance (LR). Prior to and following participation we assessed walking-related outcome measures including overground walking speed, training speed, step length, and step symmetry.
Data pooled across all subject groups showed a significant effect of training on walking speed. While the differences between groups were not statistically significant, there was a trend toward greater improvement in the TS and OG groups. Post hoc subgroup analysis of outcomes from subjects with slower initial walking speed (< 0.1 m/s; n = 15) compared to those with faster initial walking speeds (> or = 0.1 m/s; n = 12) identified meaningful differences in outcomes with walking speed increasing by 85% in the slower group and by only 9% in the faster group. Step length of both stronger and weaker limb increased in all groups with the exception of those in the LR group. Step symmetry was increased in the TM and LR groups.
These results represent preliminary findings of changes in walking-related function associated with different forms of BWS locomotor training for individuals with chronic, motor-incomplete SCI. Early data indicates that locomotor outcomes in these individuals appear to be comparable across training approaches. For the individuals in this study sample, those with the greatest deficits in walking function benefitted the most from locomotor training.
体重支持（BWS）运动训练可改善运动不完全性脊髓损伤（SCI）患者的地面行走能力。虽然有多种运动训练方法可供选择，但对于哪种方法最为理想尚无共识。这项正在进行的研究旨在比较这些不同训练方法的效果。
在本初步报告发布时，27例慢性运动不完全性SCI患者已完成训练以及初始和最终测试。受试者被随机分配到4个不同的BWS辅助步行组之一，包括：（1）手动辅助跑步机训练（TM），（2）刺激辅助跑步机训练（TS），（3）刺激辅助地面训练（OG），或（4）机器人辅助跑步机训练（LR）。在参与训练前后，我们评估了与行走相关的结果指标，包括地面行走速度、训练速度、步长和步对称性。
汇总所有受试者组的数据显示，训练对行走速度有显著影响。虽然组间差异无统计学意义，但TS组和OG组有更大改善的趋势。对初始行走速度较慢（<0.1 m/s；n = 15）的受试者与初始行走速度较快（≥0.1 m/s；n = 12）的受试者进行事后亚组分析，发现结果存在有意义的差异，较慢组的行走速度提高了85%，而较快组仅提高了9%。除LR组外，所有组的优势侧和非优势侧步长均增加。TM组和LR组的步对称性增加。
这些结果代表了慢性运动不完全性SCI患者不同形式的BWS运动训练与行走相关功能变化的初步发现。早期数据表明，这些个体的运动训练结果在不同训练方法之间似乎具有可比性。对于本研究样本中的个体，行走功能缺陷最大的个体从运动训练中获益最多。
