BODY WEIGHT SUPPORTED AMBULATION TRAINING AFTER SCI

SCI 后体重支持的步行训练

• 批准号: 6615072
• 负责人: Blair Calancie
• 金额: $ 49.99万
• 依托单位: UPSTATE MEDICAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-08-01 至 2004-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6615072
• 关键词: acute disease /disorder; assistive device /technology; balance; bioengineering /biomedical engineering; body weight; chronic disease /disorder; clinical research; cooperative study; functional ability; gait; human subject; human therapy evaluation; medical rehabilitation related tag; physical fitness; physical therapy; psychomotor function; rehabilitation; spinal cord injury; training; videotape /videodisc

Fundamental strategies first adopted in major centers 20 years ago for the physical rehabilitation of persons with sub-acute or chronic spinal cord injury (SCI) have changed little since that time. One novel method of gait rehabilitation involves the use of an overhead support point and a harness. This body weight support' (BWS) strategy has been combined with treadmill-based gait training in several centers throughout the world, with what are claimed to be dramatic results; we also have seen marked improvement in function in our subjects trained in this manner from preliminary studies. It is speculated that this form of training may enhance output of a 'central pattern generator' of stepping movement from circuitry intrinsic to the subject's spinal cord. However, published studies of this type have been limited in their ability to form strong conclusions due to small sample size, inadequate control interventions, and/or limited outcome measures. In particular, only limited attention has been paid to the role that training-induced physical conditioning might play in mediating the functional improvements reported. This study will address these weaknesses to determine whether BWS-gait training is more effective than conventional rehabilitation therapy in improving functional gait in person's with neurologically-incomplete spinal cord injury. Two populations will be studied: persons with chronic SCI (greater than 1 year post-injury), and persons with sub-acute SCI (2 - 8 months post-injury). For the chronic SCI study, subjects will be randomly assigned to one of 3 groups: body weight support and treadmill-based training, body weight support and overground training, and conventional rehabilitation therapy. This design allows us to directly compare whether treadmill-based training, and its inherent advantage of providing highly-rhythmic input to the subject's legs, is superior to overground-based training, and its inherent advantage of allowing use of assistive devices, thereby replicating a more 'natural' training condition. Training sessions will typically last up to 1 hour/session, at a frequency of 3 sessions per week for a 13 week period. Persons with sub-acute injury will be randomized to receive either BWS-treadmill training, or conventional rehabilitation. All subjects will be evaluated with a battery of functional, metabolic and neurophysiologic measures prior to the onset of training, and during the week after training has been completed. The primary outcome measure will be average maximum overground walking velocity without body weight support but with the use of passive assistive devices. Secondary measures will concentrate on function (balance, mobility), fitness (work capacity, strength, gait efficiency), and spinal cord neurophysiology (motor conduction, reflex excitability). These studies will allow us to determine whether the functional improvements associated with BWS-based training are due to neurologic adaptation within the spinal cord, or reflect an increased work capacity secondary to fitness training; both possibilities have important implications with respect to optimizing therapy for persons with spinal cord injury.

20年前，主要中心首次为亚急性或慢性脊髓损伤(SCI)患者的身体康复采取了基本战略，自那时以来，变化很小。一种新的步态康复方法包括使用头顶支撑点和安全带。这种体重支持(BWS)策略已经在世界各地的几个中心与基于跑步机的步态训练相结合，据称取得了显著的效果；我们也从初步研究中看到，以这种方式训练的受试者的机能有了显著的改善。据推测，这种形式的训练可能会从受试者脊髓固有的回路中增强步进运动的“中央模式生成器”的输出。然而，由于样本量小、控制干预措施不足和/或结果衡量标准有限，已发表的这类研究在形成强有力结论的能力方面受到限制。特别是，对训练诱导的身体条件作用在调节已报道的功能改善中可能发挥的作用的关注有限。这项研究将解决这些弱点，以确定BWS步态训练是否比传统康复疗法更有效地改善神经性不完全脊髓损伤患者的功能性步态。将对两个人群进行研究：慢性脊髓损伤患者(损伤后1年以上)和亚急性脊髓损伤患者(损伤后2-8个月)。对于慢性脊髓损伤研究，受试者将被随机分配到3组中的一组：体重支持和基于跑步机的训练，体重支持和地面训练，以及传统的康复治疗。这种设计使我们能够直接比较基于跑步机的训练及其为受试者的腿部提供高节奏输入的固有优势是否优于基于地面的训练，以及其允许使用辅助设备的固有优势，从而复制出更自然的训练条件。培训课程通常长达1小时/课程，频率为每周3次，为期13周。亚急性损伤的患者将随机接受BWS跑步机训练或常规康复。在训练开始前和训练结束后的一周内，所有受试者都将接受一系列功能、代谢和神经生理学测试。主要的结果将是在没有体重支持但使用被动辅助设备的情况下的平均最大地面步行速度。次要措施将集中在功能(平衡、活动)、健康(工作能力、力量、步态效率)和脊髓神经生理学(运动传导、反射兴奋性)。这些研究将使我们能够确定与基于BWS的训练相关的功能改善是由于脊髓内的神经适应，还是反映了健身训练后工作能力的增加；这两种可能性都对优化脊髓损伤患者的治疗具有重要意义。