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.

自从那时以来，20年前首次在大型中心采用的基本策略是针对亚急性或慢性脊髓损伤（SCI）的身体康复（SCI）几乎没有改变的。 步态康复的一种新型方法涉及使用高架支撑点和安全带。 这种体重支持'（BWS）策略与全世界多个中心的基于跑步机的步态训练相结合，据称这是巨大的结果；我们还看到，从初步研究中以这种方式训练的受试者的功能方面有明显的改善。 据推测，这种形式的训练可能会增强从固有电路到受试者的脊髓的“中央模式发生器”的输出。 但是，由于样本量较小，控制干预措施不足和/或有限的结果指标，对这种类型的已发表的研究受到了其形成强大结论的能力的限制。 特别是，只注意到训练引起的身体调节可能在调解报告的功能改进方面发挥的作用有限。这项研究将解决这些弱点，以确定BWS基准训练是否比常规康复疗法更有效，以改善神经学上脊髓损伤的人的功能步态。 将研究两个人群：患有慢性SCI的人（受伤后1年）和急性SCI的患者（受伤后2-8个月）。 对于慢性SCI研究，受试者将随机分配给3组之一：体重支持和基于跑步机的训练，体重支持和地面训练以及常规的康复疗法。 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提供高度节律输入的固有优势，它优于地面训练，以及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。培训课程通常会持续1小时/会议，每周3周的频率为13周。 急性受伤的人将被随机接受BWS-Streadmill培训或常规康复。所有受试者将在训练开始前以及培训完成后的一周完成，以一系列功能，代谢和神经生理学措施进行评估。主要结局指标将是无体重支撑，而是使用被动辅助设备的平均最大地面步行速度。 次要措施将集中于功能（平衡，活动能力），健身（工作能力，强度，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进是由于脊髓中的神经系统适应性所致，还是反映了适应性训练继发的工作能力提高；两种可能性都在优化脊髓损伤患者的治疗方面具有重要意义。