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Combined use of body weight support, functional electric stimulation, and treadmill training to improve walking ability in individuals with chronic incomplete spinal cord injury,☆☆,,★★,

https://doi.org/10.1053/apmr.2001.23752Get rights and content

Abstract

Field-Fote EC. Combined use of body weight support, functional electric stimulation, and treadmill training to improve walking ability in individuals with chronic incomplete spinal cord injury. Arch Phys Med Rehabil 2001;82:818-24. Objective: To assess the effect of an intervention combining body weight support (BWS), functional electric stimulation (FES), and treadmill training on overground walking speed (OGWS), treadmill walking speed, speed and distance, and lower extremity motor scores (LEMS). Design: Before and after comparison. Setting: Miami Project to Cure Paralysis. Participants: Nineteen subjects with American Spinal Injury Association class C injury who were at least 1 year postinjury and had asymmetrical lower extremity function. Intervention: Subjects trained 1.5 hours per day, 3 days per week, for 3 months. The training consisted of body weight\Nsupported treadmill walking assisted by electric stimulation. Stimulation was applied to common peroneal nerve of the weaker lower extremity (LE) and timed to assist with the swing phase of the step cycle. Main Outcome Measures: OGWS in the absence of both BWS and FES; LEMS, and treadmill training parameters of speed and distance. Results: Over the course of training, there was a significant increase in OGWS (from.12 ± 0.8m/s to.21 ±.15m/s, p =.0008), treadmill walking speed (from.23 ±.12m/s to.49 ±.20m/s, p =.00003), and treadmill walking distance (from 93 ± 84m to 243 ± 139m, p =.000001). The median LEMS increased significantly for both the stimulated and nonstimulated leg (from 8 to 11 in the FES-assisted leg, from 15 to 18 in the nonassisted leg, p <.005 for each). Conclusions: All subjects showed improvement in OGWS and overall LE strength. Further research is required to delineate the essential elements of these particular training strategies.

Section snippets

Subjects

Nineteen individuals (13 men, 6 women; mean age, 31.7 ± 9.4yr) participated in this study. Thirteen subjects presented with tetraplegia, 6 with paraplegia. All subjects had ASIA class C injuries (sensory and motor function are preserved below the level of the lesion, but at least half of the muscles below the level of the lesion have a grade < 3). Median time postinjury was 56 months (range, 12-171mo). All subjects signed an informed consent consistent with University of Miami regulations for

Walking parameters

Individual subject data for OGWS (tested pre-, posttraining) and TWS and treadmill distance per session are given in figure 1.

. Initial and final values for (a) OGWS (independent: no BWS, no stimulation); (b) TWS (assisted by BWS and stimulation); and (c) TWS (assisted by BWS and stimulation). changes in speed were in the positive direction, 2 subjects (S8, S15) had lower treadmill walking distances in the final test compared with initial values (see text).

The OGWS reflects the speed the subjects

Conclusions

Subjects with incomplete SCI, who retain some capacity for ambulation, would likely benefit from a walking program that combines BWS, FES, and treadmill training. Although the amount of improvement in walking speed (as measured by increased OGWS) varies with individual participant characteristics, this training clearly has positive effects on function. Use of FES for assistance with limb advancement offers advantages over other forms of assistance. This training regimen employs the principles

Acknowledgements

The author thanks Blair Calancie, PhD, for input during design of this study and for review of the manuscript. Thanks also to Carol Vandenakker, MD, for providing medical clearance for the subjec's participation, and to Monica Perez, PT, for her assistance with training the subjects.

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  • Cited by (0)

    Supported in part by the National Institutes of Health (grant no. HD01193-03) and by the Miami Project to Cure Paralysis.

    ☆☆

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

    Reprint requests to Edelle C. Field-Fote, PhD, PT, c/o University of Miami, Division of Physical Therapy, 5915 Ponce de Leon Blvd, Ste 500, Coral Gables, FL 33146, e-mail: [email protected].

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