Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands.
Neurorehabil Neural Repair. 2024 Jun;38(6):413-424. doi: 10.1177/15459683241248088. Epub 2024 Apr 25.
Balance and walking capacity are often impaired in people with motor incomplete spinal cord injury (iSCI), frequently resulting in reduced functional ambulation and participation. This study aimed to assess the efficacy of walking adaptability training compared to similarly dosed conventional locomotor and strength training for improving walking capacity, functional ambulation, balance confidence, and participation in ambulatory people with iSCI.
We conducted a 2-center, parallel-group, pragmatic randomized controlled trial. Forty-one people with iSCI were randomized to 6 weeks of (i) walking adaptability training (11 hours of Gait Real-time Analysis Interactive Lab (GRAIL) training-a treadmill in a virtual reality environment) or (ii) conventional locomotor and strength training (11 hours of treadmill training and lower-body strength exercises). The primary measure of walking capacity was maximal walking speed, measured with an overground 2-minute walk test. Secondary outcome measures included the Spinal Cord Injury Functional Ambulation Profile (SCI-FAP), the Activities-specific Balance Confidence (ABC) scale, and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P).
No significant difference in maximal walking speed between the walking adaptability (n = 17) and conventional locomotor and strength (n = 18) training groups was found 6 weeks after training at follow-up (-0.05 m/s; 95% CI = -0.12-0.03). In addition, no significant group differences in secondary outcomes were found. However, independent of intervention, significant improvements over time were found for maximal walking speed, SCI-FAP, ABC, and USER-P restrictions scores. . Our findings suggest that walking adaptability training may not be superior to conventional locomotor and strength training for improving walking capacity, functional ambulation, balance confidence, or participation in ambulatory people with iSCI.
Dutch Trial Register; Effect of GRAIL training in iSCI.
平衡和步行能力常因运动性不完全性脊髓损伤（iSCI）而受损，常导致功能性步行和参与度降低。本研究旨在评估与常规的运动和力量训练相比，步行适应性训练在提高步行能力、功能性步行、平衡信心和参与度方面的疗效，对象为有步行能力的 iSCI 患者。
我们开展了一项 2 中心、平行组、实用随机对照试验。41 名 iSCI 患者被随机分为 6 周的（i）步行适应性训练组（11 小时的步态实时分析互动实验室（GRAIL）训练-虚拟现实环境下的跑步机）或（ii）常规运动和力量训练组（11 小时的跑步机训练和下肢力量练习）。步行能力的主要测量指标是最大步行速度，采用地面 2 分钟步行测试测量。次要结局指标包括脊髓损伤功能步行量表（SCI-FAP）、活动特异性平衡信心量表（ABC）和康复参与度评定量表（USER-P）。
在随访时（训练后 6 周），步行适应性训练组（n=17）和常规运动和力量训练组（n=18）的最大步行速度之间没有发现显著差异（-0.05m/s；95%CI=-0.12 到 0.03）。此外，两组间的次要结局也没有发现显著差异。然而，无论干预措施如何，最大步行速度、SCI-FAP、ABC 和 USER-P 限制评分都有显著的随时间改善。我们的发现表明，步行适应性训练可能并不优于常规的运动和力量训练，以提高有步行能力的 iSCI 患者的步行能力、功能性步行、平衡信心或参与度。
荷兰试验注册中心；GRAIL 训练对 iSCI 的影响。
