Robotically assisted treadmill exercise training for improving peak fitness in chronic motor incomplete spinal cord injury: A randomized controlled trial

Abstract

Objective: To assess the effectiveness of robotically assisted body weight supported treadmill training (RABWSTT) for improving cardiovascular fitness in chronic motor incomplete spinal cord injury (CMISCI).

Design: Pilot prospective randomized, controlled clinical trial.

Setting: Outpatient rehabilitation specialty hospital.

Participants: Eighteen individuals with CMISCI with American Spinal Injury Association (ASIA) level between C4 and L2 and at least one-year post injury. Interventions CMISCI participants were randomized to RABWSTT or a home stretching program (HSP) three times per week for three months. Those in the home stretching group were crossed over to three months of RABWSTT following completion of the initial three month phase.

Outcome measures: Peak oxygen consumption (peak VO(2)) was measured during both robotic treadmill walking and arm cycle ergometry: twice at baseline, once at six weeks (mid-training) and twice at three months (post-training). Peak VO(2) values were normalized for body mass.

Results: The RABWSTT group improved peak VO(2) by 12.3% during robotic treadmill walking (20.2 ± 7.4 to 22.7 ± 7.5 ml/kg/min, P = 0.018), compared to a non-significant 3.9% within group change observed in HSP controls (P = 0.37). Neither group displayed a significant change in peak VO2 during arm cycle ergometry (RABWSTT, 8.5% (P = 0.25); HSP, 1.76% (P = 0.72)). A repeated measures analysis showed statistically significant differences between treatments for peak VO(2) during both robotic treadmill walking (P = 0.002) and arm cycle ergometry (P = 0.001).

Conclusion: RABWSTT is an effective intervention model for improving peak fitness levels assessed during robotic treadmill walking in persons with CMISCI.

Trial registration: ClinicalTrials.gov NCT00385918.

Keywords: Peak oxygen consumption; Robotic exercise; Spinal cord injury; Treadmill training.

Figures

Figure 1

Photographs of a subject engaging in VO2 peak measurements while performing exercise in the Lokomat (A) and with arm cycle ergometry (B). (Photographic permission on file).

Figure 2

Peak oxygen consumption measured during robotic treadmill ambulation before, at mid-point (1½ months) and after a three month training intervention in individuals randomized to a robotic treatment or control group. Means and standard deviations are displayed for both groups in this figure. The significance level was set at P 

Figure 3

Peak Oxygen Consumption measured during Arm Cycle Ergometry before, at mid-point (1½ months) and after a three month training intervention in individuals randomized to a robotic or control group. Means and standard deviations are displayed in this figure. The significance level was set at P 

Figure 4

Change in VO2 peak across the treatment intervention as measured both during Robotic treadmill ambulation and arm-cycle ergometry. Each pair of bars represents an individual subject. Subjects are presented in rank order of their Delta VO2 peak values during Lokomat ambulation (Robotic Treadmill Walking). Individual subject LEMS are noted along the x-axis of the graph.