Human Locomotion Laboratory, School of Human Kinetics, University of British Columbia, 6081 University Blvd, Vancouver, British Columbia, Canada.
Phys Ther. 2011 Jan;91(1):143-51. doi: 10.2522/ptj.20100026. Epub 2010 Dec 2.
The efficacy of task-specific gait training for people with spinal cord injury (SCI) is premised on evidence that the provision of gait-related afferent feedback is key for the recovery of stepping movements. Recent findings have shown that sensory feedback from flexor muscle afferents can facilitate flexor muscle activity during the swing phase of walking. This case report was undertaken to determine the feasibility of using robot-applied forces to resist leg movements during body-weight-supported treadmill training (BWSTT) and to measure its effect on gait and other health-related outcomes.
The patient described in this case report was a 43-year-old man with a T11 incomplete chronic SCI. He underwent 36 sessions of BWSTT using a robotic gait orthosis to provide forces that resist hip and knee flexion.
Tolerance to the training program was monitored using the Borg CR10 scale and heart rate and blood pressure changes during each training session. Outcome measures (ie, 10-Meter Walk Test, Six-Minute Walk Test, modified Emory Functional Ambulation Profile [mEFAP], Activities-specific Balance Confidence Scale, and Canadian Occupational Performance Measure) were completed and kinematic parameters of gait, lower-extremity muscle strength (force-generating capacity), lower-limb girth, and tolerance to orthostatic stress were measured before and after the training program.
The patient could tolerate the training. Overground walking speed, endurance, and performance on all subtasks of the mEFAP improved and were accompanied by increased lower-limb joint flexion and toe clearance during gait. The patient's ambulatory self-confidence and self-perceived performance in walking also improved. These findings suggest that this new approach to BWSTT is a feasible and potentially effective therapy for improving skilled overground walking performance.
任务特异性步态训练对脊髓损伤（SCI）患者的疗效基于以下证据：提供与步态相关的传入反馈对于恢复迈步运动至关重要。最近的研究结果表明，屈肌传入纤维的感觉反馈可以促进步行摆动相期间屈肌活动。本病例报告旨在确定使用机器人施加的力来抵抗身体重量支撑跑步机训练（BWSTT）期间腿部运动的可行性，并测量其对步态和其他健康相关结果的影响。
本病例报告中描述的患者是一名 43 岁的 T11 不完全性慢性 SCI 男性。他接受了 36 次 BWSTT，使用机器人步态矫形器提供抵抗髋关节和膝关节屈曲的力。
使用 Borg CR10 量表监测对训练计划的耐受性，并测量每次训练期间的心率和血压变化。使用 10 米步行测试、6 分钟步行测试、改良 Emory 功能步行量表（mEFAP）、活动特定平衡信心量表和加拿大职业表现测量量表完成了结果测量，并在训练前后测量了步态的运动学参数、下肢肌肉力量（产生力量的能力）、下肢周长和对直立应激的耐受性。
患者能够耐受训练。地面行走速度、耐力和 mEFAP 的所有子任务表现均得到改善，并且伴随着步态时下肢关节屈曲和足趾离地间隙增加。患者的步行自我信心和自我感知步行表现也得到了改善。这些发现表明，这种新的 BWSTT 方法是一种可行且潜在有效的治疗方法，可以提高熟练的地面行走表现。
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