Spinal Cord Unit, IRCCS Santa Lucia Foundation, Rome, Italy.
Eur J Phys Rehabil Med. 2013 Jun;49(3):353-64. Epub 2013 Mar 13.
Walking is considered the most important goal after an incomplete spinal cord injury (SCI). Only recently it has been demonstrated that balance is a key factor of walking recovery, but no data on the efficacy of balance training in supporting walking function in SCI subjects are available.
The object of the study was to determine the efficacy of visual biofeedback task-specific balance training (vBFB) in improving balance performance and gait in SCI subjects compared with conventional over-ground rehabilitation (Rehab).
Open-case study with retrospective matched control.
Chronic SCI outpatients and healthy subjects (H).
Twelve SCI subjects with ASIA impairment scale grade D-6 in the vBFB group (EXP) and 6 in the Rehab group (CTRL)-and 6 H.
Data from H were used as reference for physiological balance and gait parameters. CTRL and EXP groups underwent 8 weeks of rehabilitation 5 times/week (CTRL group: 60 minutes devoted to Rehab; EXP group: 40 minutes of Rehab plus 20 of vBFB). At baseline (T0), every 10 vBFB sessions (T1-T2-T3), at the end of training (T4) and 1 and 2 months after vBFB was halted, data on the following parameters were collected and compared between groups and training steps: Berg Balance Scale, Walking Index for Spinal Cord Injury, 6-minute walking, 10-meter walk and timed up and go tests, balance performance (assessed with a stabilometric platform), and kinematic spatio-temporal gait parameters (collected using a 2-dimensional motion analysis system).
At T4, only the EXP group experienced a significant improvement in balance and gait demonstrated by clinical and instrumental evaluation; the improvement was maintained at follow-up examinations. Further, in the EXP group, the enhancement in balance that existed at T1 preceded the improvement in gait, and significant correlations between the improvements in gait and balance were observed. In comparison with H data, vBFB treatment demonstrated a significant higher level of effectiveness than conventional Rehab.
vBFB training is effective in improving balance and gait in chronic SCI subjects.
Inclusion of vBFB in rehabilitation protocols for chronic SCI subjects effects greater improvements in gait than conventional rehabilitation alone.
行走被认为是不完全性脊髓损伤（SCI）后最重要的目标。直到最近才发现平衡是行走恢复的关键因素，但目前尚无关于平衡训练在支持 SCI 患者行走功能方面的疗效的数据。
本研究旨在确定视觉生物反馈任务特异性平衡训练（vBFB）与传统地面康复（Rehab）相比，在改善 SCI 患者平衡表现和步态方面的疗效。
开放性病例研究，采用回顾性匹配对照。
慢性 SCI 门诊患者和健康受试者（H）。
vBFB 组（EXP）有 12 名 ASIA 损伤量表 D-6 级的 SCI 受试者和 6 名 Rehab 组（CTRL）受试者-和 6 名 H 受试者。
使用 H 的数据作为生理平衡和步态参数的参考。CTRL 和 EXP 组每周接受 5 次 8 周的康复治疗（CTRL 组：60 分钟用于 Rehab；EXP 组：40 分钟 Rehab 加 20 分钟 vBFB）。在基线（T0）、每次 10 次 vBFB 治疗时（T1-T2-T3）、训练结束时（T4）以及 vBFB 停止后 1 和 2 个月，收集以下参数的数据，并在组间和训练步骤之间进行比较：伯格平衡量表、脊髓损伤步行指数、6 分钟步行、10 米步行和计时起立行走测试、平衡表现（使用平衡平台评估）和运动时空步态参数（使用二维运动分析系统收集）。
在 T4，仅 EXP 组在临床和仪器评估中表现出平衡和步态的显著改善；在随访检查中，这种改善得以维持。此外，在 EXP 组中，在 T1 时存在的平衡增强先于步态的改善，并且观察到步态和平衡改善之间存在显著相关性。与 H 数据相比，vBFB 治疗比传统 Rehab 具有更高的疗效。
vBFB 训练可有效改善慢性 SCI 患者的平衡和步态。
将 vBFB 纳入慢性 SCI 患者的康复方案中，与单独进行传统康复相比，可更有效地改善步态。
