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Metabolic Responses to 4 Different Body Weight-Supported Locomotor Training Approaches in Persons With Incomplete Spinal Cord Injury

  • Jochen Kressler
    Correspondence
    Corresponding author: Jochen Kressler, PhD, The Miami Project to Cure Paralysis, University of Miami, Miller School of Medicine, 1095 NW 14th Ter, R-48, Miami, FL 33136.
    Affiliations
    The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL
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  • Mark S. Nash
    Affiliations
    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
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  • Patricia A. Burns
    Affiliations
    The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL
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  • Edelle C. Field-Fote
    Affiliations
    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
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Published:March 07, 2013DOI:https://doi.org/10.1016/j.apmr.2013.02.018

      Abstract

      Objective

      To describe metabolic responses accompanying 4 different locomotor training (LT) approaches.

      Design

      Single-blind, randomized controlled trial.

      Setting

      Rehabilitation research laboratory, academic medical center.

      Participants

      Individuals (N=62) with minimal walking function due to chronic motor-incomplete spinal cord injury.

      Intervention

      Participants trained 5 days/week for 12 weeks. Groups were treadmill-based LT with manual assistance (TM), transcutaneous electrical stimulation (TS), and a driven gait orthosis (DGO) and overground (OG) LT with electrical stimulation.

      Main Outcome Measures

      Oxygen uptake ( V ˙ o2), walking velocity and economy, and substrate utilization during subject-selected “slow,” “moderate,” and “maximal” walking speeds.

      Results

      V ˙ o2 did not increase from pretraining to posttraining for DGO (.00±.18L/min, P=.923). Increases in the other groups depended on walking speed, ranging from .01±.18m/s (P=.860) for TM (slow speed) to .20±.29m/s (P=.017) for TS (maximal speed). All groups increased velocity but to varying degrees (DGO, .01±.18Ln[m/s], P=.829; TM, .07±.29Ln[m/s], P=.371; TS, .33±.45Ln[m/s], P=.013; OG, .52±.61Ln[m/s], P=.007). Changes in walking economy were marginal for DGO and TM (.01±.20Ln[L/m], P=.926, and .00±.42Ln[L/m], P=.981) but significant for TS and OG (.26±.33Ln[L/m], P=.014, and .44±.62Ln[L/m], P=.025). Many participants reached respiratory exchange ratios ≥1 at any speed, rendering it impossible to statistically discern differences in substrate utilization. However, after training, fewer participants reached this ceiling for each speed (slow: 9 vs 6, n=32; moderate: 12 vs 8, n=29; and maximal 15 vs 13, n=28).

      Conclusions

      DGO and TM walking training was less effective in increasing V ˙ o2 and velocity across participant-selected walking speeds, while TS and OG training was more effective in improving these parameters and also walking economy. Therefore, the latter 2 approaches hold greater promise for improving clinically relevant outcomes such as enhanced endurance, functionality, or in-home/community ambulation.

      Keywords

      List of abbreviations:

      ANOVA (analysis of variance), CRF (cardiorespiratory fitness), DGO (driven gait orthosis), LT (locomotor training), LTA (locomotor training approach), MLI (motor level of injury), OG (overground), SCI (spinal cord injury), TM (manual assistance on a treadmill), TS (transcutaneous electrical stimulation), V˙o2 (oxygen uptake), Vo2peak (peak oxygen consumption)
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