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Overground vs. treadmill-based robotic gait training to improve seated balance in people with motor-complete spinal cord injury: a case report

BACKGROUND: Robotic overground gait training devices, such as the Ekso, require users to actively participate in triggering steps through weight-shifting movements. It remains unknown how much the trunk muscles are activated during these movements, and if it is possible to transfer training effects...

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Autores principales: Chisholm, Amanda E., Alamro, Raed A., Williams, Alison M. M., Lam, Tania
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387335/
https://www.ncbi.nlm.nih.gov/pubmed/28399877
http://dx.doi.org/10.1186/s12984-017-0236-z
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author Chisholm, Amanda E.
Alamro, Raed A.
Williams, Alison M. M.
Lam, Tania
author_facet Chisholm, Amanda E.
Alamro, Raed A.
Williams, Alison M. M.
Lam, Tania
author_sort Chisholm, Amanda E.
collection PubMed
description BACKGROUND: Robotic overground gait training devices, such as the Ekso, require users to actively participate in triggering steps through weight-shifting movements. It remains unknown how much the trunk muscles are activated during these movements, and if it is possible to transfer training effects to seated balance control. This study was conducted to compare the activity of postural control muscles of the trunk during overground (Ekso) vs. treadmill-based (Lokomat) robotic gait training, and evaluate changes in seated balance control in people with high-thoracic motor-complete spinal cord injury (SCI). METHODS: Three individuals with motor-complete SCI from C7-T4, assumed to have no voluntary motor function below the chest, underwent robotic gait training. The participants were randomly assigned to Ekso-Lokomat-Ekso or Lokomat-Ekso-Lokomat for 10 sessions within each intervention phase for a total of 30 sessions. We evaluated static and dynamic balance control through analysis of center of pressure (COP) movements after each intervention phase. Surface electromyography was used to compare activity of the abdominal and erector spinae muscles during Ekso and Lokomat walking. RESULTS: We observed improved postural stability after training with Ekso compared to Lokomat during static balance tasks, indicated by reduced COP root mean square distance and ellipse area. In addition, Ekso training increased total distance of COP movements during a dynamic balance task. The trunk muscles showed increased activation during Ekso overground walking compared to Lokomat walking. CONCLUSIONS: Our findings suggest that the Ekso actively recruits trunk muscles through postural control mechanisms, which may lead to improved balance during sitting. Developing effective training strategies to reactivate the trunk muscles is important to facilitate independence during seated balance activity in people with SCI.
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spelling pubmed-53873352017-04-14 Overground vs. treadmill-based robotic gait training to improve seated balance in people with motor-complete spinal cord injury: a case report Chisholm, Amanda E. Alamro, Raed A. Williams, Alison M. M. Lam, Tania J Neuroeng Rehabil Research BACKGROUND: Robotic overground gait training devices, such as the Ekso, require users to actively participate in triggering steps through weight-shifting movements. It remains unknown how much the trunk muscles are activated during these movements, and if it is possible to transfer training effects to seated balance control. This study was conducted to compare the activity of postural control muscles of the trunk during overground (Ekso) vs. treadmill-based (Lokomat) robotic gait training, and evaluate changes in seated balance control in people with high-thoracic motor-complete spinal cord injury (SCI). METHODS: Three individuals with motor-complete SCI from C7-T4, assumed to have no voluntary motor function below the chest, underwent robotic gait training. The participants were randomly assigned to Ekso-Lokomat-Ekso or Lokomat-Ekso-Lokomat for 10 sessions within each intervention phase for a total of 30 sessions. We evaluated static and dynamic balance control through analysis of center of pressure (COP) movements after each intervention phase. Surface electromyography was used to compare activity of the abdominal and erector spinae muscles during Ekso and Lokomat walking. RESULTS: We observed improved postural stability after training with Ekso compared to Lokomat during static balance tasks, indicated by reduced COP root mean square distance and ellipse area. In addition, Ekso training increased total distance of COP movements during a dynamic balance task. The trunk muscles showed increased activation during Ekso overground walking compared to Lokomat walking. CONCLUSIONS: Our findings suggest that the Ekso actively recruits trunk muscles through postural control mechanisms, which may lead to improved balance during sitting. Developing effective training strategies to reactivate the trunk muscles is important to facilitate independence during seated balance activity in people with SCI. BioMed Central 2017-04-11 /pmc/articles/PMC5387335/ /pubmed/28399877 http://dx.doi.org/10.1186/s12984-017-0236-z Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Chisholm, Amanda E.
Alamro, Raed A.
Williams, Alison M. M.
Lam, Tania
Overground vs. treadmill-based robotic gait training to improve seated balance in people with motor-complete spinal cord injury: a case report
title Overground vs. treadmill-based robotic gait training to improve seated balance in people with motor-complete spinal cord injury: a case report
title_full Overground vs. treadmill-based robotic gait training to improve seated balance in people with motor-complete spinal cord injury: a case report
title_fullStr Overground vs. treadmill-based robotic gait training to improve seated balance in people with motor-complete spinal cord injury: a case report
title_full_unstemmed Overground vs. treadmill-based robotic gait training to improve seated balance in people with motor-complete spinal cord injury: a case report
title_short Overground vs. treadmill-based robotic gait training to improve seated balance in people with motor-complete spinal cord injury: a case report
title_sort overground vs. treadmill-based robotic gait training to improve seated balance in people with motor-complete spinal cord injury: a case report
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387335/
https://www.ncbi.nlm.nih.gov/pubmed/28399877
http://dx.doi.org/10.1186/s12984-017-0236-z
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