Impact of Robotic-Assisted Gait Training in Subacute Spinal Cord Injury Patients on Outcome Measure

Abstract

The improvement of walking ability is a primary goal for spinal cord injury (SCI) patients. Robotic-assisted gait training (RAGT) is an innovative method for its improvement. This study evaluates the influence of RAGT vs. dynamic parapodium training (DPT) in improving gait motor functions in SCI patients. In this single-centre, single-blinded study, we enrolled 105 (39 and 64 with complete and incomplete SCI, respectively) patients. The investigated subjects received gait training with RAGT (experimental S1-group) and DPT (control S0-group), with six training sessions per week over seven weeks. The American Spinal Cord Injury Association Impairment Scale Motor Score (MS), Spinal Cord Independence Measure, version-III (SCIM-III), Walking Index for Spinal Cord Injury, version-II (WISCI-II), and Barthel Index (BI) were assessed in each patient before and after sessions. Patients with incomplete SCI assigned to the S1 rehabilitation group achieved more significant improvement in MS [2.58 (SE 1.21, p < 0.05)] and WISCI-II [3.07 (SE 1.02, p < 0.01])] scores in comparison with patients assigned to the S0 group. Despite the described improvement in the MS motor score, no progression between grades of AIS (A to B to C to D) was observed. A nonsignificant improvement between the groups for SCIM-III and BI was found. RAGT significantly improved gait functional parameters in SCI patients in comparison with conventional gait training with DPT. RAGT is a valid treatment option in SCI patients in the subacute phase. DPT should not be recommended for patients with incomplete SCI (AIS-C); in those patients, RAGT rehabilitation programs should be taken into consideration.

Keywords: SCI; Walking Index; disability scales; rehabilitation; robotic therapy.

Figure 1

Patient with spinal cord injury undergoing exoskeleton EKSO-GT, model EKSO 1.

Figure 2

Patient with spinal cord injury undergoing Lokomat-Pro, model LO218.

Figure 3

Flowchart of patients’ recruitment.

Figure 4

(A–C) Parameter changes after rehabilitation relative to the initial value between investigated groups: rehabilitation with DPT (S0) and rehabilitation with RAGT (S1) in all (A), in complete (B), and incomplete (C) subgroups; * p ≤ 0.05, ** p ≤ 0.01, *** p ≤ 0.001.

Figure 5

(A–F) Comparison of final and initial parameter values (WISCI-II, SCIM-III, MS and BI) in S0 and S1 group patients with incomplete SCI: (A) WISCI-II rehabilitation type S0 (p = 0.1); (B) WISCI-II rehabilitation type S1 (p < 0.001); (C) SCIM-III rehabilitation type S0 (p < 0.001); (D) SCIM-III rehabilitation type S1 (p < 0.001); (E) MS rehabilitation type S0 (p = 0.001); (F) MS rehabilitation type S1 (p < 0.001); (G) BI rehabilitation type S0 (p = 0.003); (H) BI rehabilitation type S1 (p < 0.001).