Dose-response relationship of locomotor training in patients with spinal cord injury : preliminary results

Wirz, Markus; Dietz, Volker; Esclarin, Ana; Benito, Jesus; Mach, Orpheus; Schneider, Sandra; Bastiaenen, Carolien; de Bie, Rob

doi:10.21256/zhaw-2735

Please use this identifier to cite or link to this item: https://doi.org/10.21256/zhaw-2735

Publication type:	Conference poster
Type of review:	Peer review (abstract)
Title:	Dose-response relationship of locomotor training in patients with spinal cord injury : preliminary results
Authors:	Wirz, Markus Dietz, Volker Esclarin, Ana Benito, Jesus Mach, Orpheus Schneider, Sandra Bastiaenen, Carolien de Bie, Rob
DOI:	10.21256/zhaw-2735
Conference details:	World Confederation for Physical Therapy Congress 2015, Singapore, 1-4 May 2015
Issue Date:	May-2015
Publisher / Ed. Institution:	World Confederation for Physical Therapy (WCPT)
Language:	English
Subject (DDC):	615.82: Physical therapy 617: Surgery
Abstract:	Background: A large proportion of patients with spinal cord injury (SCI) regain ambulatory function. However, during the first 3 months most patients are unable to walk without support. To enable ambulatory training at such an early stage the body weight is partially relieved and leg movement assisted by two therapists. A more recent approach is the application of robotic-based assistance, which allows for longer training duration. From the science of motor learning and studies including patients with stroke, it is known that training effects depend on the duration of the training. Longer training results in a better walking function. Purpose: The aim of the present study is to evaluate whether prolonged robot-assisted walking training leads to a better walking outcome in patients with incomplete SCI, who are initially unable to walk independently (i.e. B and C according to the International Standards for Neurological Classification of SCI-ISNCSCI), and whether such training is feasible or is associated with undesirable effects. Methods: Patients from three sites with an acute incomplete SCI (within 60 days after injury) were randomized to either standard training (session duration 25 minutes) or intensive training (session duration 50 minutes). After 8 weeks of training walking ability (Walking Index for SCI-WISCI, scale 0-20: 0=not able to walk, 20= able to walk independently), the occurrence of adverse events and the rate of perceived exertion (RPE, scale 1-10: 1=very light, 10= very, very hard), as well as patients’ global impression of change (PGIC, scale 0 -10: 0= much better, 5= no change, 10= much worse) were compared between groups. Results: Seventeen patients with incomplete SCI were randomly assigned either to standard training (ISNCSCI B: n=6; C: n=2) or to intensive training (B: n=3; C: n=6). The average duration of training of the standard group was half the length of the intensive group (24.9±0.6 minutes vs. 48.3±3.2 minutes; p=0.01). Both groups performed an equal number of training sessions within 8 weeks (33.8±6.8 and 34.9±6.0; n.s.). The median WISCI changed from 0 to 4 in the standard group (n.s.) and from 0 to 10.5 (p<0.05) in the intensive group. However, the group difference after training did not reach statistical significance. The median RPE (standard: 6.5, range 1-10 and intensive: 6, range 1-10; n.s.) and the PGIC (standard: 3.5, range 0-5; intensive: 2.5, range 1-4; n.s.) did not differ between the standard and intensive training groups. Conclusions: Longer training using a robotic device is feasible and is not associated with undesirable effects in patients with incomplete SCI. Results show a trend towards a positive dose-response relationship. However, there was a larger proportion of patients with a motor incomplete SCI (i.e. ISNCSCI: C) in the intensive training group. Implications: The duration of a standard training session needs to be re-addressed. Results indicate that more intensive training leads to a better outcome.
URI:	https://digitalcollection.zhaw.ch/handle/11475/12031
Fulltext version:	Published version
License (according to publishing contract):	Licence according to publishing contract
Departement:	School of Health Sciences
Organisational Unit:	Institute of Physiotherapy (IPT)
Appears in collections:	Publikationen Gesundheit

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Wirz, M., Dietz, V., Esclarin, A., Benito, J., Mach, O., Schneider, S., Bastiaenen, C., & de Bie, R. (2015, May). Dose-response relationship of locomotor training in patients with spinal cord injury : preliminary results. World Confederation for Physical Therapy Congress 2015, Singapore, 1-4 May 2015. https://doi.org/10.21256/zhaw-2735

Wirz, M. et al. (2015) ‘Dose-response relationship of locomotor training in patients with spinal cord injury : preliminary results’, in World Confederation for Physical Therapy Congress 2015, Singapore, 1-4 May 2015. World Confederation for Physical Therapy (WCPT). Available at: https://doi.org/10.21256/zhaw-2735.

M. Wirz et al., “Dose-response relationship of locomotor training in patients with spinal cord injury : preliminary results,” in World Confederation for Physical Therapy Congress 2015, Singapore, 1-4 May 2015, May 2015. doi: 10.21256/zhaw-2735.

WIRZ, Markus, Volker DIETZ, Ana ESCLARIN, Jesus BENITO, Orpheus MACH, Sandra SCHNEIDER, Carolien BASTIAENEN und Rob DE BIE, 2015. Dose-response relationship of locomotor training in patients with spinal cord injury : preliminary results. In: World Confederation for Physical Therapy Congress 2015, Singapore, 1-4 May 2015. Conference poster. World Confederation for Physical Therapy (WCPT). Mai 2015

Wirz, Markus, Volker Dietz, Ana Esclarin, Jesus Benito, Orpheus Mach, Sandra Schneider, Carolien Bastiaenen, and Rob de Bie. 2015. “Dose-Response Relationship of Locomotor Training in Patients with Spinal Cord Injury : Preliminary Results.” Conference poster. In World Confederation for Physical Therapy Congress 2015, Singapore, 1-4 May 2015. World Confederation for Physical Therapy (WCPT). https://doi.org/10.21256/zhaw-2735.

Wirz, Markus, et al. “Dose-Response Relationship of Locomotor Training in Patients with Spinal Cord Injury : Preliminary Results.” World Confederation for Physical Therapy Congress 2015, Singapore, 1-4 May 2015, World Confederation for Physical Therapy (WCPT), 2015, https://doi.org/10.21256/zhaw-2735.