Abstract
Objective
To describe the effect of robotic locomotor training (RLT) and activity-based training
(ABT) on cardiovascular indices during various physiological positions in individuals
with spinal cord injury.
Design
Randomized controlled pilot study.
Setting
Private practice: Therapy & Beyond Centre - Walking with Brandon Foundation, Sports
Science Institute of South Africa, Cape Town, South Africa.
Participants
Participants with chronic traumatic motor incomplete tetraplegia (N=16) who resided
in the Western Cape, South Africa.
Intervention
Robotic locomotor training (Ekso GT) and activity-based training over a 24-week intervention.
Main Outcome Measures
Brachial and ankle blood pressure, heart rate, heart rate variability, and cardiovascular
efficiency during 4 physiological positions.
Results
No differences between groups or over time were evident in resting systolic and diastolic
blood pressure, ankle systolic pressure, ankle brachial pressure index, and heart
rate variability. Standing heart rate at 24 weeks was significantly higher in the
ABT group (95.58±12.61 beats/min) compared with the RLT group (75.14±14.96 beats/min)
(P=.05). In the RLT group, no significant changes in heart rate variability (standard
deviation R-R interval and root mean square of successive differences) was found between
the standing and 6-minute walk test physiological positions throughout the intervention.
Cardiovascular efficiency in the RLT group during the 6-minute walk test improved
from 11.1±2.6 at baseline to 7.5±2.8 beats per meter walked at 6 weeks and was maintained
from 6 to 24 weeks.
Conclusions
Large effect sizes and significant differences between groups found in this pilot
study support the clinical effectiveness of RLT and ABT for changing cardiovascular
indices as early as 6 weeks and up to 24 weeks of rehabilitation. RLT may be more
effective than ABT in improving cardiac responses to orthostatic stress. Based on
heart rate variability metrics, the stimulus of standing has comparable effects to
RLT on the parasympathetic nervous system. Cardiovascular efficiency of exoskeleton
walking improved, particularly over the first 6 weeks. Both the RLT and ABT interventions
were limited in their effect on brachial and ankle blood pressure. A randomized controlled
trial with a larger sample size is warranted to further examine these findings.
Keywords
List of abbreviations:
6MAT (6-minute arm ergometry test), 6MWT (6-minute walk test), ABPI (ankle brachial pressure index), ABT (activity-based training), ANOVA (analysis of variance), CV (coefficient of variation), ES (effect size), HRV (heart rate variability), RCT (randomized controlled trial), RLT (robotic locomotor training), RMSSD (root mean square of successive differences), SCI (spinal cord injury), SD RR (standard deviation of the R-R interval), THBI (Total Heart Beat Index)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 08, 2021
Accepted:
March 2,
2021
Received in revised form:
February 9,
2021
Received:
September 9,
2020
Footnotes
Supported by the National Research Foundation of South Africa, University of Cape Town Development Grant (grant no. 91421) and the Oppenheimer Memorial Trust (grant no. 20523).
Clinical Trial Register No. (Pan African Register): PACTR201608001647143.
Disclosures: none.
Identification
Copyright
© 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
