Jochen Kressler1, Christine K Thomas2, Edelle C Field-Fote3, Justin Sanchez4, Eva Widerström-Noga5, Deena C Cilien6, Katie Gant6, Kelly Ginnety6, Hernan Gonzalez7, Adriana Martinez6, Kimberley D Anderson6, Mark S Nash8. 1. The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL. Electronic address: JKressler@med.miami.edu. 2. The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL; Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Physiology and Biophysics, Miller School of Medicine, University of Miami, Miami, FL. 3. The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL; Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Rehabilitation Medicine, Miller School of Medicine, University of Miami, Miami, FL; Department of Physical Therapy, Miller School of Medicine, University of Miami, Miami, FL. 4. The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL; Department of Biomedical Engineering, Miller School of Medicine, University of Miami, Miami, FL. 5. The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL; Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Rehabilitation Medicine, Miller School of Medicine, University of Miami, Miami, FL. 6. The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL. 7. Department of Biomedical Engineering, Miller School of Medicine, University of Miami, Miami, FL. 8. The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL; Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Rehabilitation Medicine, Miller School of Medicine, University of Miami, Miami, FL; Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL.
Abstract
OBJECTIVE: To explore responses to overground bionic ambulation (OBA) training from an interdisciplinary perspective including key components of neuromuscular activation, exercise conditioning, mobility capacity, and neuropathic pain. DESIGN: Case series. SETTING: Academic research center. PARTICIPANTS: Persons (N=3; 2 men, 1 woman) aged 26 to 38 years with complete spinal cord injury (SCI) (American Spinal Injury Association Impairment Scale grade A) between the levels of T1 and T10 for ≥1 year. INTERVENTION: OBA 3d/wk for 6 weeks. MAIN OUTCOME MEASURES: To obtain a comprehensive understanding of responses to OBA, an array of measures were obtained while walking in the device, including walking speeds and distances, energy expenditure, exercise conditioning effects, and neuromuscular and cortical activity patterns. Changes in spasticity and pain severity related to OBA use were also assessed. RESULTS: With training, participants were able to achieve walking speeds and distances in the OBA device similar to those observed in persons with motor-incomplete SCI (10-m walk speed, .11-.33m/s; 2-min walk distance, 11-33m). The energy expenditure required for OBA was similar to walking in persons without disability (ie, 25%-41% of peak oxygen consumption). Subjects with lower soleus reflex excitability walked longer during training, but there was no change in the level or amount of muscle activity with training. There was no change in cortical activity patterns. Exercise conditioning effects were small or nonexistent. However, all participants reported an average reduction in pain severity over the study period ranging between -1.3 and 1.7 on a 0-to-6 numeric rating scale. CONCLUSIONS: OBA training improved mobility in the OBA device without significant changes in exercise conditioning or in neuromuscular or cortical activity. However, pain severity was reduced and no severe adverse events were encountered during training. OBA therefore opens the possibility to reduce the common consequences of chronic, complete SCI such as reduced functional mobility and neuropathic pain.
OBJECTIVE: To explore responses to overground bionic ambulation (OBA) training from an interdisciplinary perspective including key components of neuromuscular activation, exercise conditioning, mobility capacity, and neuropathic pain. DESIGN: Case series. SETTING: Academic research center. PARTICIPANTS: Persons (N=3; 2 men, 1 woman) aged 26 to 38 years with complete spinal cord injury (SCI) (American Spinal Injury Association Impairment Scale grade A) between the levels of T1 and T10 for ≥1 year. INTERVENTION: OBA 3d/wk for 6 weeks. MAIN OUTCOME MEASURES: To obtain a comprehensive understanding of responses to OBA, an array of measures were obtained while walking in the device, including walking speeds and distances, energy expenditure, exercise conditioning effects, and neuromuscular and cortical activity patterns. Changes in spasticity and pain severity related to OBA use were also assessed. RESULTS: With training, participants were able to achieve walking speeds and distances in the OBA device similar to those observed in persons with motor-incomplete SCI (10-m walk speed, .11-.33m/s; 2-min walk distance, 11-33m). The energy expenditure required for OBA was similar to walking in persons without disability (ie, 25%-41% of peak oxygen consumption). Subjects with lower soleus reflex excitability walked longer during training, but there was no change in the level or amount of muscle activity with training. There was no change in cortical activity patterns. Exercise conditioning effects were small or nonexistent. However, all participants reported an average reduction in pain severity over the study period ranging between -1.3 and 1.7 on a 0-to-6 numeric rating scale. CONCLUSIONS: OBA training improved mobility in the OBA device without significant changes in exercise conditioning or in neuromuscular or cortical activity. However, pain severity was reduced and no severe adverse events were encountered during training. OBA therefore opens the possibility to reduce the common consequences of chronic, complete SCI such as reduced functional mobility and neuropathic pain.
Authors: Arvind Ramanujam; Christopher M Cirnigliaro; Erica Garbarini; Pierre Asselin; Rakesh Pilkar; Gail F Forrest Journal: J Spinal Cord Med Date: 2017-04-20 Impact factor: 1.985
Authors: Pierre K Asselin; Manuel Avedissian; Steven Knezevic; Stephen Kornfeld; Ann M Spungen Journal: J Vis Exp Date: 2016-06-16 Impact factor: 1.355