Effects of four-week lower limb loading training with and without augmented feedback on mobility, walking device use, and falls among ambulatory individuals with spinal cord injury: a randomized controlled trial

PURPOSE

To compare the effects of lower limb loading training (LLLT) with or without augmented loading feedback during stepping activity on mobility, walking device use, and falls among ambulatory individuals with chronic spinal cord injury (SCI).

STUDY DESIGN

Randomized controlled trial (assessor-blinded) with prospective fall data follow-up, clinical trial registration (NCT03254797).

METHODS

Forty-four ambulatory participants (22 participants/group) were prospectively monitored for their baseline fall data over six months, with baseline assessments for their mobility and walking device used after six months. Then participants involved in the LLLT programs with or without loading feedback according to their groups for 30 min/day, 5 days/week, over 4 weeks. Mobility outcomes were re-assessed at week two and week four, with prospective fall data monitoring over six months, and mobility measured thereafter.

RESULTS

Mobility outcomes of the participants were significantly improved from their baseline ability, especially in those who were trained using augmented feedback (the difference in main outcome, timed up and go, between the groups was 1.8 s; 95% confidence interval = 1.0-3.5s).

CONCLUSIONS

LLLT during stepping activity, especially with augmented loading feedback, could be applied effectively to promote mobility and safety of ambulatory individuals with chronic SCI (post-injury time of approximately four years).

The use of lower limb loading ability as an indicator for independence and safety in ambulatory individuals with spinal cord injury

BACKGROUND

Data relating to weight-bearing or lower limb loading ability (LLLA) have been reported wildly in several individuals, mostly with unilateral impairments, but not in ambulatory individuals with spinal cord injury (SCI) who have bilateral sensorimotor deterioration.

AIM

To assess the LLLA of ambulatory individuals with SCI who walk independently with and without a walking device, and explore the optimal threshold of the LLLA to determine the independence and safety of these individuals.

DESIGN

Cross-sectional study.

SETTING

Tertiary rehabilitation centers and communities.

POPULATION

Ninety ambulatory participants with SCI.

METHODS

Participants were assessed for their LLLA during stepping of the contralateral leg using a digital load cell. In addition, they were assessed using functional mobility tests and interviewed for fall data over the past six months.

RESULTS

Participants who walked independently with or without a walking device had an average LLLA of at least 79% of their bodyweight. In addition, the amount of LLLA at least 94-95% of the bodyweight had moderate diagnostic properties to indicate the independence and safety of these individuals (sensitivity =68-77%, specificity =66-81%, and AUC=0.73-0.80).

CONCLUSIONS

The clear and objective data relating to LLLA can be used as a critical indicator for the safe and steady mobility, specifically for ambulatory individuals with SCI. These data can be used as an optimal threshold in rehabilitation training, screening and monitoring of their functional alteration over time in clinical, community, and home-based settings.

CLINICAL REHABILITATION IMPACT

The LLLA of at least 79% of the bodyweight could determine the ability of independent walking with a walking device, while an LLLA of at least 94-95% of the bodyweight could indicate the ability of walking without a walking device and no multiple falls. These data can be used as an optimal target in rehabilitation training, screening and monitoring of functional alteration over time in various clinical and home-based settings, specifically for ambulatory individuals with SCI.

Immediate effects of lower limb loading exercise during stepping with and without augmented loading feedback on mobility of ambulatory individuals with spinal cord injury: a single-blinded, randomized, cross-over trial

STUDY DESIGN

Single-blinded, randomized, cross-over design.

OBJECTIVES

To compare the immediate effects of bodyweight shifting and lower limb loading (LLL) exercise during stepping with and without augmented loading feedback, followed by overground walking, on the mobility of ambulatory individuals with spinal cord injury (SCI).

SETTING

Academic laboratory center.

METHODS

Thirty participants with SCI were trained using a single intervention session consisting of repetitive bodyweight shifting and LLL exercises during stepping with or without external feedback (10 min/leg) followed by overground walking (10 min) with a 2-week washout period, in a random sequence. The timed up-and-go test (TUG) (primary outcome), 10-m walk test (10MWT), five times sit-to-stand test (FTSST), and maximal LLL were measured 1 day before and immediately after each training session.

RESULTS

Significant improvement was found following both training sessions, excepting the TUG and LLL of the less-affected leg, where improvement was found only after training using augmented feedback. Moreover, the improvement following the training with feedback was significantly greater than that after training without feedback. The mean (95% CI) between-group differences for the TUG = 1.9 [0.6-3.3]s, 10MWT = 0.1 [0.0-0.1]m/s, FTSST = 1.0 [1.5-4.8]s, LLL = 3.1 [1.5-4.8]-2.8 [0.8-4.9]%bodyweight, p < 0.05.

CONCLUSIONS

The training programs immediately enhanced the mobility of ambulatory individuals with chronic SCI (post-injury time >6 years), particularly the training with augmented loading feedback. The findings offer another effective rehabilitation strategy that can be applied in various clinical and home-based settings.