LOCOMOTOR THERAPY TRIAL FOR SPINAL CORD INJURY

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。创伤性脊髓损伤(SCI)后，独立行走能力的恢复是患者康复的重要目标之一。大多数人将无法恢复行走能力，或者步子缓慢，能源成本高，阻碍了社区的流动性。在改善运动功能独立性或最大限度提高步行速度方面，没有哪种特定的康复策略比另一种更好。我们提出了第一个针对急性脊髓损伤的面向任务的运动干预的多中心随机临床试验(RCT)。这一策略应用了基础神经科学研究和初步临床研究，这些研究涉及协调腿部运动的腰骶神经回路和棘上神经元中依赖使用的运动学习。这种干预措施被称为体重支持跑步机训练(BWSTT)，通过与受试者佩戴的安全带相连的头顶升降机来部分支持患者的体重。然后，治疗师可以系统地训练患者以越来越多的功能速度在更少的重量支持下在Trea磨床上行走。他们纠正步态偏差，并操纵感官输入，以增强对行走的站姿和摆动阶段的控制。在拟议的试验中，5个优秀的脊髓损伤康复中心的治疗师将接受这项技术的培训。加州大学洛杉矶分校协调和数据管理中心将在未来两年内随机分配符合条件的受试者参加常规活动治疗计划，而不是传统治疗加BWSTT的相同强度和持续时间。100例C4以下至T10/11的不完全性脊髓损伤患者和100例T12至L3损伤的患者将在脊髓损伤后5周内进入并接受12周的治疗。两个主要的结果指标是行走的独立性水平和50英尺的最大行走速度，在治疗12周后以及随机分组后的6个月和12个月后进行测试。这一结果也将适用于慢性或完全性脊髓损伤患者，他们未来可能会接受生物干预和运动训练相结合。此外，它还将展示RCT在制定循证康复PRA方面的价值和可行性

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. After a traumatic spinal cord injury (SCI), recovery of independent ambulation is one of the most important goals for patients during rehabilitation. Most will not recover the ability to walk or will step slowly at a high energy cost that prevents community mobility. No particular rehabilitation strategy has been shown to be better than another at improving locomotor functional independence or maximizing walking speed. We propose the first multicenter, randomized clinical trial (RCT) of a task-oriented locomotor intervention for acute SCI. This strategy applies basic neuroscience research and pilot clinical studies about use-dependent locomotor learning in the lumbosacral neural circuits and supraspinal neurons that coordinate leg movements. The intervention, called body weight-supported treadmill training (BWSTT), partially supports the weight of patients via an overhead lift attached to a harness worn by the subject. Therapists can then systematically train patients to walk on a trea dmill at increasingly more functional speeds with less weight support. They correct gait deviations and manipulate sensory inputs that enhance control of the stance and swing phases of walking. For the proposed trial, therapists at 5 outstanding SCI rehabilitation centers will be trained in the technique. The University of California Los Angeles coordinating and data management center will randomly assign eligible subjects over the next 2 years to a conventional therapy program for mobility versus the same intensity and duration of a combination of conventional therapy plus BWSTT. One hundred subjects with incomplete SCI from below C4 to T10/11 and 100 subjects with lesions at T12 to L3 will be entered within 5 weeks of a SCI and treated for 12 weeks. The two primary outcome measures are the level of independence for ambulation and the maximal speed for walking 50 feet, tested after 12 weeks of therapy and 6 and 12 months after randomization. The results will also be relevant to people with chronic or complete SCI who, in the future, may receive biologic interventions combined with locomotor training. In addition, it will demonstrate the value and feasibility of the RCT for developing evidence-based rehabilitation pra