Influence of a Locomotor Training Approach on Walking Speed and Distance in People With Chronic Spinal Cord Injury: A Randomized Clinical Trial
Influence of a Locomotor Training Approach on Walking Speed and Distance in People With Chronic Spinal Cord Injury: A Randomized Clinical Trial
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DOI：
10.2522/ptj.20090359
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发表时间：
2011-01-01
期刊：
影响因子：
3.2
通讯作者：
Roach, Kathryn E.
中科院分区：
文献类型：
--
作者：
Field-Fote, Edelle C.;Roach, Kathryn E.
背景。脊髓损伤 (SCI) 后行走受损会限制功能，但即使对于慢性运动不完全性 SCI 患者，训练相关的改善也是可能的。 目的。本研究的目的是比较与 4 种运动训练方法相关的步行速度和距离的变化。设计。这项研究是一项单盲、随机临床试验。这项研究是在康复研究实验室进行的。参与者。参与者是因慢性 SCI 干预而导致步行功能最弱的人。参与者 (n = 74) 每周训练 5 天，持续 12 周，采用以下方法：基于跑步机的手动辅助训练 (TM)、基于跑步机的刺激训练 (TS)、地面刺激训练 (OG) 以及基于跑步机的机器人辅助训练 (LR)。测量。地面步行速度和距离是主要结果指标。结果。在完成训练的参与者 (n = 64) 中，速度（效应大小指数 [d] = 0.33）和距离（d = 0.35）存在总体影响。就速度而言，组间没有显着差异；然而，OG 的距离增益最大。 OG 对速度和距离的影响最大（分别为 d = 0.43 和 d = 0.40）。 TM 和 TS 的速度效应大小相同 (d = 0.28)；对LR没有影响。 TS (d = 0.16) 的距离影响大小比 TM 或 LR 更大，而 TM 或 LR 没有影响。通过培训取得进步的 10 名参与者在培训后至少 6 个月进行了重新测试；此时的步行速度比训练结束时慢，但仍比训练前快。 局限性。目前尚不清楚训练剂量和对训练速度的重视程度是否最佳。需要积极参与的机器人训练可能会产生不同的结果。结论。对于患有慢性运动不完全性脊髓损伤的人来说，地上训练和跑步机训练都可以提高步行速度；然而，通过地面训练，步行距离可以得到更大程度的改善。
Background. Impaired walking limits function after spinal cord injury (SCI), but training-related improvements are possible even in people with chronic motor incomplete SCI.Objective. The objective of this study was to compare changes in walking speed and distance associated with 4 locomotor training approaches.Design. This study was a single-blind, randomized clinical trial.Setting. This study was conducted in a rehabilitation research laboratory.Participants. Participants were people with minimal walking function due to chronic SCI.Intervention. Participants (n = 74) trained 5 days per week for 12 weeks with the following approaches: treadmill-based training with manual assistance (TM), treadmill-based training with stimulation (TS), overground training with stimulation (OG), and treadmill-based training with robotic assistance (LR).Measurements. Overground walking speed and distance were the primary outcome measures.Results. In participants who completed the training (n = 64), there were overall effects for speed (effect size index [d] = 0.33) and distance (d = 0.35). For speed, there were no significant between-group differences; however, distance gains were greatest with OG. Effect sizes for speed and distance were largest with OG (d = 0.43 and d = 0.40, respectively). Effect sizes for speed were the same for TM and TS (d = 0.28); there was no effect for LR. The effect size for distance was greater with TS (d = 0.16) than with TM or LR, for which there was no effect. Ten participants who improved with training were retested at least 6 months after training; walking speed at this time was slower than that at the conclusion of training but remained faster than before training.Limitations. It is unknown whether the training dosage and the emphasis on training speed were optimal. Robotic training that requires active participation would likely yield different results.Conclusions. In people with chronic motor incomplete SCI, walking speed improved with both overground training and treadmill-based training; however, walking distance improved to a greater extent with overground training.