Highest ambulatory speed using Lokomat gait training for individuals with a motor-complete spinal cord injury: a clinical pilot study.

BACKGROUND: Motor impairment and loss of ambulatory function are major consequences of a spinal cord injury (SCI). Exoskeletons are robotic devices that allow SCI patients with limited ambulatory function to walk. The mean walking speed of SCI patients using an exoskeleton is low: 0.26 m/s. Moreover, literature shows that a minimum speed of 0.59 m/s is required to replace wheelchairs in the community. OBJECTIVE: To investigate the highest ambulatory speed for SCI patients in a Lokomat. METHODS: This clinical pilot study took place in the Rehabilitation Center Kladruby, in Kladruby (Czech Republic). Six persons with motor-complete sub-acute SCI were recruited. Measurements were taken at baseline and directly after a 30 min Lokomat training. The highest achieved walking speed, vital parameters (respiratory frequency, heart rate, and blood pressure), visual analog scale for pain, and modified Ashworth scale for spasticity were recorded for each person. RESULTS: The highest reached walking speed in the Lokomat was on average 0.63 m/s (SD 0.03 m/s). No negative effects on the vital parameters, pain, or spasticity were observed. A significant decrease in pain after the Lokomat training was observed: 95% CI [0.336, 1.664] (p = 0.012). CONCLUSION: This study shows that it is possible for motor-complete SCI individuals to ambulate faster on a Lokomat (on average 0.63 m/s) than what is currently possible with over-ground exoskeletons. No negative effects were observed while ambulating on a Lokomat. Further research investigating walking speed in exoskeletons after SCI is recommended.

Evaluation of the effect of heel lift on postural stability and symmetry of muscle activity.

BACKGROUND: Although a leg length inequality (LLI) has the effect on the performed movement, more complex indices for the evaluation of kinematic variables of postural stability and a symmetry of a muscle activity during standing in subjects with the LLI were never used before. OBJECTIVE: The objective is to present appropriate parameters for an evaluation of kinematic variables of postural stability and muscle activity during standing, i.e. to consider EMG signals, in patients with LLI. METHODS: New indices are offered, such as a sway velocity (i.e. the mCTSIB method) and a modified symmetry index (SI), for a quantitative evaluation of EMG signals. The set of data for evaluating the effect of a heel lift was measured on patients with the LLI and healthy volunteers. RESULTS: Prior to the heel lift application, significant statistic differences were found between the mCTSIB of patients and the CG. These differences were no longer statistically significant after the heel lift was applied. As for the SI, the lowest values were found in the CG, while the greatest values were collected among patients before applying the heel lift. CONCLUSIONS: The results point out the benefits of using the newly applied indices in patients with the LLI. Both methods may become useful tools for the evaluation of the physical state of patients with the LLI in a medical practice.