BODY WEIGHT SUPPORTED AMBULATION TRAINING AFTER SCI

SCI 后体重支持的步行训练

• 批准号: 6617864
• 负责人: Blair Calancie
• 金额: $ 51.47万
• 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/6617864
• 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，主要中心首次采用亚急性或慢性脊髓损伤（SCI）患者物理康复的基本策略，自那时以来几乎没有改变。一种新的步态康复方法涉及使用头顶支撑点和安全带。在世界各地的几个中心，这种体重支持（BWS）策略已与基于跑步机的步态训练相结合，据称效果显著；从初步研究中，我们也看到以这种方式训练的受试者的功能有了明显的改善。据推测，这种形式的训练可能会增强“中央模式发生器”的输出，从主体脊髓固有的电路中进行步进运动。然而，由于样本量小、对照干预措施不足和/或结果测量有限，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，只有有限的关注，训练诱导的身体条件可能在中介功能的改善报告中发挥作用。本研究将解决这些弱点，以确定bws -步态训练是否比传统康复治疗更有效地改善神经不完全性脊髓损伤患者的功能步态。将研究两个人群：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：体重支持和跑步机训练组，体重支持和地面训练组，以及常规康复治疗组。这个设计让我们可以直接比较基于跑步机的训练，以及它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，以及它允许使用辅助设备的固有优势，从而复制更“自然”的训练条件。培训课程通常持续1小时/次，频率为每周3次，为期13周。亚急性损伤患者将随机接受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，所有受试者将接受一系列功能、代谢和神经生理指标的评估。主要结果测量将是在没有体重支持但使用被动辅助装置的情况下平均最大地上行走速度。次要测量将集中于功能（平衡，活动能力），适应性（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；这两种可能性对于优化脊髓损伤患者的治疗具有重要意义。