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 (o2), walking velocity and economy, and substrate utilization during subject-selected
“slow,” “moderate,” and “maximal” walking speeds.
Results
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 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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 07, 2013
Footnotes
Supported by the National Institutes of Health (grant no. R01HD41487) and The Miami Project to Cure Paralysis.
No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.
Identification
Copyright
© 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
