Musselman Kristin E, Fouad Karim, Misiaszek John E, Yang Jaynie F
Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
Phys Ther. 2009 Jun;89(6):601-11. doi: 10.2522/ptj.20080257. Epub 2009 May 7.
Walking in the home and community is an important goal for individuals with incomplete spinal cord injury (iSCI). Walking in the community requires various skills, such as negotiating curbs, doors, and uneven terrain. This case report describes the use of a method to retrain walking overground that is intensive, variable, and relevant to daily walking (skill training). The aims of this case series were to determine the effectiveness of skill training in a small group of people with iSCI and to compare skill training with body-weight-supported treadmill training (BWSTT) in the same individuals.
Four individuals who were a median of 2.7 years (interquartile range [IQR]=12.8) after iSCI participated in alternating phases of intervention, each 3 months long. All patients started with BWSTT. Two patients subsequently engaged in skill training while the other 2 patients engaged in BWSTT, after which a third phase of intervention (opposite to the second) was repeated.
The Modified Emory Functional Ambulation Profile, the 10-Meter Walk Test, the 6-Minute Walk Test, the Berg Balance Scale, and the Activities-specific Balance Confidence Scale were administered before training, monthly throughout training, and 3 months after training.
Overall improvements in walking speed met or exceeded the minimal clinically important difference for individuals with iSCI (> or = 0.05 m/s), particularly during the skill training phase (skill training: median=0.09 m/s, IQR=0.13; BWSTT: median=0.01 m/s, IQR=0.07). Walking endurance, obstacle clearance, and stair climbing also improved with both types of intervention. Three of the 4 patients had retained their gains at follow-up (retention of walking speed: median=92%, IQR=63%). Thus, the findings suggest that skill training was effective in this small group of individuals.
对于不完全性脊髓损伤（iSCI）患者而言，在家庭和社区中行走是一个重要目标。在社区中行走需要多种技能，比如跨越路缘、穿过门以及在不平整地形上行走。本病例报告描述了一种用于强化、多样化且与日常行走相关的地面行走再训练方法（技能训练）。本病例系列的目的是确定技能训练对一小群iSCI患者的有效性，并在同一患者中将技能训练与体重支持 treadmill训练（BWSTT）进行比较。
4名iSCI后中位时间为2.7年（四分位间距[IQR]=12.8）的患者参与了交替进行的干预阶段，每个阶段为期3个月。所有患者均从BWSTT开始。随后，2名患者进行技能训练，另外2名患者进行BWSTT，之后重复第三阶段干预（与第二阶段相反）。
在训练前、训练期间每月以及训练后3个月进行改良埃默里功能步行量表、10米步行测试、6分钟步行测试、伯格平衡量表和特定活动平衡信心量表的评估。
行走速度的总体改善达到或超过了iSCI患者的最小临床重要差异（≥0.05 m/s），尤其是在技能训练阶段（技能训练：中位值=0.09 m/s，IQR=0.13；BWSTT：中位值=0.01 m/s，IQR=0.07）。两种干预方式均使行走耐力、越过障碍物能力和爬楼梯能力得到改善。4名患者中有3名在随访时保持了进步（行走速度保持率：中位值=92%，IQR=63%）。因此，研究结果表明技能训练对这一小群患者有效。
