Chad Swank, Jaime Gillespie, Dannae Arnold, Lindsey Wynne, Monica Bennett, Faith Meza, Christa Ochoa, Librada Callender, Seema Sikka, Simon Driver
{"title":"不完全脊髓损伤患者住院康复期间的地面机器人外骨骼步态训练-一项随机对照试验。","authors":"Chad Swank, Jaime Gillespie, Dannae Arnold, Lindsey Wynne, Monica Bennett, Faith Meza, Christa Ochoa, Librada Callender, Seema Sikka, Simon Driver","doi":"10.1016/j.apmr.2025.04.015","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To examine the efficacy of a stakeholder-informed overground robotic exoskeleton (ORE) intervention to improve walking function after spinal cord injury (SCI) compared with usual care gait training.</p><p><strong>Design: </strong>Randomized Controlled Trial.</p><p><strong>Setting: </strong>Inpatient Rehabilitation Facility.</p><p><strong>Participants: </strong>Patients (N=106; age, 51.5±18.5y; men, 78.3%; White, 65.1%) with subacute incomplete SCI.</p><p><strong>Interventions: </strong>ORE compared with usual care gait training approaches including body-weight support treadmill training and traditional overground modalities.</p><p><strong>Main outcome measures: </strong>Our primary outcome was walking performance defined by function [Walking Index for Spinal Cord Injury-Revised (WISCI-II)] and gait speed [10-m walk test (10MWT)]. Secondary outcomes were functional independence [Spinal Cord Independence Measure (SCIM) and CARE Tool] and patient-reported outcomes of pain, fatigue, spasticity, depression, anxiety, and quality of life.</p><p><strong>Results: </strong>Patients were tetraplegia (56.6%) and ASIA Impairment Scale (AIS) B (17.9%), AIS C (28.3%), and AIS D (53.8%). Although improvement was observed in both the ORE and usual care groups across WISCI-II, 10MWT, and SCIM measures (all P<.001), there were no significant differences between ORE and usual care gait training on primary and secondary outcomes. Injury severity distinctions were observed for AIS C where the ORE group improved in WISCI-II and SCIM (P=.008 and P<.001, respectively) and the usual care group improved in SCIM (P=.002) only. For AIS D, both groups improved in the WISCI-II, 10MWT, and SCIM (all P<.001). Moderate effects sizes between ORE and usual care gait training were detected for transfer and walking CARE Tool items for people with AIS C injuries.</p><p><strong>Conclusions: </strong>Corollary to our overall equivalence findings between ORE and usual care gait training, ORE may be a more appropriate gait training intervention for patients with AIS C to promote recovery of walking function during inpatient rehabilitation.</p>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Overground Robotic Exoskeleton Gait Training in People With Incomplete Spinal Cord Injury During Inpatient Rehabilitation: A Randomized Control Trial.\",\"authors\":\"Chad Swank, Jaime Gillespie, Dannae Arnold, Lindsey Wynne, Monica Bennett, Faith Meza, Christa Ochoa, Librada Callender, Seema Sikka, Simon Driver\",\"doi\":\"10.1016/j.apmr.2025.04.015\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To examine the efficacy of a stakeholder-informed overground robotic exoskeleton (ORE) intervention to improve walking function after spinal cord injury (SCI) compared with usual care gait training.</p><p><strong>Design: </strong>Randomized Controlled Trial.</p><p><strong>Setting: </strong>Inpatient Rehabilitation Facility.</p><p><strong>Participants: </strong>Patients (N=106; age, 51.5±18.5y; men, 78.3%; White, 65.1%) with subacute incomplete SCI.</p><p><strong>Interventions: </strong>ORE compared with usual care gait training approaches including body-weight support treadmill training and traditional overground modalities.</p><p><strong>Main outcome measures: </strong>Our primary outcome was walking performance defined by function [Walking Index for Spinal Cord Injury-Revised (WISCI-II)] and gait speed [10-m walk test (10MWT)]. Secondary outcomes were functional independence [Spinal Cord Independence Measure (SCIM) and CARE Tool] and patient-reported outcomes of pain, fatigue, spasticity, depression, anxiety, and quality of life.</p><p><strong>Results: </strong>Patients were tetraplegia (56.6%) and ASIA Impairment Scale (AIS) B (17.9%), AIS C (28.3%), and AIS D (53.8%). Although improvement was observed in both the ORE and usual care groups across WISCI-II, 10MWT, and SCIM measures (all P<.001), there were no significant differences between ORE and usual care gait training on primary and secondary outcomes. Injury severity distinctions were observed for AIS C where the ORE group improved in WISCI-II and SCIM (P=.008 and P<.001, respectively) and the usual care group improved in SCIM (P=.002) only. For AIS D, both groups improved in the WISCI-II, 10MWT, and SCIM (all P<.001). 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Overground Robotic Exoskeleton Gait Training in People With Incomplete Spinal Cord Injury During Inpatient Rehabilitation: A Randomized Control Trial.
Objective: To examine the efficacy of a stakeholder-informed overground robotic exoskeleton (ORE) intervention to improve walking function after spinal cord injury (SCI) compared with usual care gait training.
Interventions: ORE compared with usual care gait training approaches including body-weight support treadmill training and traditional overground modalities.
Main outcome measures: Our primary outcome was walking performance defined by function [Walking Index for Spinal Cord Injury-Revised (WISCI-II)] and gait speed [10-m walk test (10MWT)]. Secondary outcomes were functional independence [Spinal Cord Independence Measure (SCIM) and CARE Tool] and patient-reported outcomes of pain, fatigue, spasticity, depression, anxiety, and quality of life.
Results: Patients were tetraplegia (56.6%) and ASIA Impairment Scale (AIS) B (17.9%), AIS C (28.3%), and AIS D (53.8%). Although improvement was observed in both the ORE and usual care groups across WISCI-II, 10MWT, and SCIM measures (all P<.001), there were no significant differences between ORE and usual care gait training on primary and secondary outcomes. Injury severity distinctions were observed for AIS C where the ORE group improved in WISCI-II and SCIM (P=.008 and P<.001, respectively) and the usual care group improved in SCIM (P=.002) only. For AIS D, both groups improved in the WISCI-II, 10MWT, and SCIM (all P<.001). Moderate effects sizes between ORE and usual care gait training were detected for transfer and walking CARE Tool items for people with AIS C injuries.
Conclusions: Corollary to our overall equivalence findings between ORE and usual care gait training, ORE may be a more appropriate gait training intervention for patients with AIS C to promote recovery of walking function during inpatient rehabilitation.
期刊介绍：
The Archives of Physical Medicine and Rehabilitation publishes original, peer-reviewed research and clinical reports on important trends and developments in physical medicine and rehabilitation and related fields. This international journal brings researchers and clinicians authoritative information on the therapeutic utilization of physical, behavioral and pharmaceutical agents in providing comprehensive care for individuals with chronic illness and disabilities.
Archives began publication in 1920, publishes monthly, and is the official journal of the American Congress of Rehabilitation Medicine. Its papers are cited more often than any other rehabilitation journal.
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