Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, Florida, USA.
J Rehabil Med. 2010 Sep;42(8):795-8. doi: 10.2340/16501977-0593.
The prognosis for further recovery of motor function 2 years after complete spinal cord injury is poor. This case report describes recovery of walking function in an a 33-year old man two years post T7 spinal cord injury American Spinal Injury Association Impairment Scale A following intensive physical therapy and robotic locomotor training.
Case report.
The subject engaged in an intensive clinic-based physical therapy program and research-based robotic locomotor training study over a 7-month period. Physical therapy was initiated 4 months prior to entry into the research study, and targeted trunk control, upper extremity strength, and upright mobility. On initial entry into the robotic locomotor training study the subject's AIS A classification was substantiated. Initial, interim, and follow-up tests of sensation, strength, sitting balance, spasticity, and mobility were performed.
Lower extremity motor scores improved from 0/50 to 4/50, bilateral hip flexors increased from grade 0/5 to 2/5, warranting injury re-classification from American Spinal Injury Association Impairment Scale A to C. Intensive physical therapy combined with robotic locomotor training was associated with restoration of short distance walking function with lower extremity braces and a walker.
To our knowledge, this is the first report of an individual with chronic spinal cord injury American Spinal Injury Association Impairment Scale A improving in over-ground walking ability following intensive physical therapy and robotic locomotor training. The presence of a neurophysiologically discomplete lesion probably permitted training of operational neural pathways and enabled the development of useful voluntary movement.
完全性脊髓损伤 2 年后运动功能进一步恢复的预后较差。本病例报告描述了一名 33 岁男性 T7 脊髓损伤后 2 年，美国脊髓损伤协会损伤分级（AIS）A 级，在强化物理治疗和机器人步行训练后行走功能的恢复。
病例报告。
受试者在 7 个月的时间内接受了强化临床物理治疗计划和基于研究的机器人步行训练研究。物理治疗在进入研究前 4 个月开始，针对躯干控制、上肢力量和直立移动能力。在进入机器人步行训练研究时，受试者的 AIS A 分级得到证实。进行了初始、中期和随访的感觉、力量、坐平衡、痉挛和移动性测试。
下肢运动评分从 0/50 提高到 4/50，双侧髋关节屈肌从 0/5 提高到 2/5，需要重新分类为美国脊髓损伤协会损伤分级 A 到 C。强化物理治疗结合机器人步行训练与下肢支具和助行器辅助下短距离行走功能的恢复有关。
据我们所知，这是第一个报告慢性脊髓损伤美国脊髓损伤协会损伤分级 A 级的个体在强化物理治疗和机器人步行训练后在地面行走能力上得到改善的病例。存在神经生理学上不完全的损伤可能允许操作神经通路的训练，并使有用的自主运动得以发展。
