Understanding therapeutic benefits of overground bionic ambulation: Exploratory case series in persons with chronic, complete spinal cord injury

Jochen Kressler, Christine K Thomas, Edelle C. Field-Fote, Justin C. Sanchez, Eva Widerstrom-Noga, Deena C. Cilien, Katie Gant, Kelly Ginnety, Hernan Gonzalez, Adriana Martinez, Kimberly D Anderson, Mark S Nash

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Objective To explore responses to overground bionic ambulation (OBA) training from an interdisciplinary perspective including key components of neuromuscular activation, exercise conditioning, mobility capacity, and neuropathic pain.

Design Case series.

Setting Academic research center.

Participants Persons (N=3; 2 men, 1 woman) aged 26 to 38 years with complete spinal cord injury (SCI) (American Spinal Injury Association Impairment Scale grade A) between the levels of T1 and T10 for ≥1 year.

Intervention OBA 3d/wk for 6 weeks.

Main Outcome Measures To obtain a comprehensive understanding of responses to OBA, an array of measures were obtained while walking in the device, including walking speeds and distances, energy expenditure, exercise conditioning effects, and neuromuscular and cortical activity patterns. Changes in spasticity and pain severity related to OBA use were also assessed.

Results With training, participants were able to achieve walking speeds and distances in the OBA device similar to those observed in persons with motor-incomplete SCI (10-m walk speed,.11-.33m/s; 2-min walk distance, 11-33m). The energy expenditure required for OBA was similar to walking in persons without disability (ie, 25%-41% of peak oxygen consumption). Subjects with lower soleus reflex excitability walked longer during training, but there was no change in the level or amount of muscle activity with training. There was no change in cortical activity patterns. Exercise conditioning effects were small or nonexistent. However, all participants reported an average reduction in pain severity over the study period ranging between -1.3 and 1.7 on a 0-to-6 numeric rating scale.

Conclusions OBA training improved mobility in the OBA device without significant changes in exercise conditioning or in neuromuscular or cortical activity. However, pain severity was reduced and no severe adverse events were encountered during training. OBA therefore opens the possibility to reduce the common consequences of chronic, complete SCI such as reduced functional mobility and neuropathic pain.

Original languageEnglish
Pages (from-to)1878-1887
Number of pages10
JournalArchives of Physical Medicine and Rehabilitation
Volume95
Issue number10
DOIs
StatePublished - Jan 1 2014

Fingerprint

Bionics
Spinal Cord Injuries
Walking
Therapeutics
Exercise
Neuralgia
Pain
Equipment and Supplies
Energy Metabolism
Oxygen Consumption
Reflex

Keywords

  • Ambulation
  • Bionics
  • Evaluation
  • Rehabilitation
  • Spinal cord injuries

ASJC Scopus subject areas

  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Understanding therapeutic benefits of overground bionic ambulation : Exploratory case series in persons with chronic, complete spinal cord injury. / Kressler, Jochen; Thomas, Christine K; Field-Fote, Edelle C.; Sanchez, Justin C.; Widerstrom-Noga, Eva; Cilien, Deena C.; Gant, Katie; Ginnety, Kelly; Gonzalez, Hernan; Martinez, Adriana; Anderson, Kimberly D; Nash, Mark S.

In: Archives of Physical Medicine and Rehabilitation, Vol. 95, No. 10, 01.01.2014, p. 1878-1887.

Research output: Contribution to journalArticle

Kressler, Jochen ; Thomas, Christine K ; Field-Fote, Edelle C. ; Sanchez, Justin C. ; Widerstrom-Noga, Eva ; Cilien, Deena C. ; Gant, Katie ; Ginnety, Kelly ; Gonzalez, Hernan ; Martinez, Adriana ; Anderson, Kimberly D ; Nash, Mark S. / Understanding therapeutic benefits of overground bionic ambulation : Exploratory case series in persons with chronic, complete spinal cord injury. In: Archives of Physical Medicine and Rehabilitation. 2014 ; Vol. 95, No. 10. pp. 1878-1887.
@article{370eb7800ce440c49d8bfd64acfc1eeb,
title = "Understanding therapeutic benefits of overground bionic ambulation: Exploratory case series in persons with chronic, complete spinal cord injury",
abstract = "Objective To explore responses to overground bionic ambulation (OBA) training from an interdisciplinary perspective including key components of neuromuscular activation, exercise conditioning, mobility capacity, and neuropathic pain.Design Case series.Setting Academic research center.Participants Persons (N=3; 2 men, 1 woman) aged 26 to 38 years with complete spinal cord injury (SCI) (American Spinal Injury Association Impairment Scale grade A) between the levels of T1 and T10 for ≥1 year.Intervention OBA 3d/wk for 6 weeks.Main Outcome Measures To obtain a comprehensive understanding of responses to OBA, an array of measures were obtained while walking in the device, including walking speeds and distances, energy expenditure, exercise conditioning effects, and neuromuscular and cortical activity patterns. Changes in spasticity and pain severity related to OBA use were also assessed.Results With training, participants were able to achieve walking speeds and distances in the OBA device similar to those observed in persons with motor-incomplete SCI (10-m walk speed,.11-.33m/s; 2-min walk distance, 11-33m). The energy expenditure required for OBA was similar to walking in persons without disability (ie, 25{\%}-41{\%} of peak oxygen consumption). Subjects with lower soleus reflex excitability walked longer during training, but there was no change in the level or amount of muscle activity with training. There was no change in cortical activity patterns. Exercise conditioning effects were small or nonexistent. However, all participants reported an average reduction in pain severity over the study period ranging between -1.3 and 1.7 on a 0-to-6 numeric rating scale.Conclusions OBA training improved mobility in the OBA device without significant changes in exercise conditioning or in neuromuscular or cortical activity. However, pain severity was reduced and no severe adverse events were encountered during training. OBA therefore opens the possibility to reduce the common consequences of chronic, complete SCI such as reduced functional mobility and neuropathic pain.",
keywords = "Ambulation, Bionics, Evaluation, Rehabilitation, Spinal cord injuries",
author = "Jochen Kressler and Thomas, {Christine K} and Field-Fote, {Edelle C.} and Sanchez, {Justin C.} and Eva Widerstrom-Noga and Cilien, {Deena C.} and Katie Gant and Kelly Ginnety and Hernan Gonzalez and Adriana Martinez and Anderson, {Kimberly D} and Nash, {Mark S}",
year = "2014",
month = "1",
day = "1",
doi = "10.1016/j.apmr.2014.04.026",
language = "English",
volume = "95",
pages = "1878--1887",
journal = "Archives of Physical Medicine and Rehabilitation",
issn = "0003-9993",
publisher = "W.B. Saunders Ltd",
number = "10",

}

TY - JOUR

T1 - Understanding therapeutic benefits of overground bionic ambulation

T2 - Exploratory case series in persons with chronic, complete spinal cord injury

AU - Kressler, Jochen

AU - Thomas, Christine K

AU - Field-Fote, Edelle C.

AU - Sanchez, Justin C.

AU - Widerstrom-Noga, Eva

AU - Cilien, Deena C.

AU - Gant, Katie

AU - Ginnety, Kelly

AU - Gonzalez, Hernan

AU - Martinez, Adriana

AU - Anderson, Kimberly D

AU - Nash, Mark S

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Objective To explore responses to overground bionic ambulation (OBA) training from an interdisciplinary perspective including key components of neuromuscular activation, exercise conditioning, mobility capacity, and neuropathic pain.Design Case series.Setting Academic research center.Participants Persons (N=3; 2 men, 1 woman) aged 26 to 38 years with complete spinal cord injury (SCI) (American Spinal Injury Association Impairment Scale grade A) between the levels of T1 and T10 for ≥1 year.Intervention OBA 3d/wk for 6 weeks.Main Outcome Measures To obtain a comprehensive understanding of responses to OBA, an array of measures were obtained while walking in the device, including walking speeds and distances, energy expenditure, exercise conditioning effects, and neuromuscular and cortical activity patterns. Changes in spasticity and pain severity related to OBA use were also assessed.Results With training, participants were able to achieve walking speeds and distances in the OBA device similar to those observed in persons with motor-incomplete SCI (10-m walk speed,.11-.33m/s; 2-min walk distance, 11-33m). The energy expenditure required for OBA was similar to walking in persons without disability (ie, 25%-41% of peak oxygen consumption). Subjects with lower soleus reflex excitability walked longer during training, but there was no change in the level or amount of muscle activity with training. There was no change in cortical activity patterns. Exercise conditioning effects were small or nonexistent. However, all participants reported an average reduction in pain severity over the study period ranging between -1.3 and 1.7 on a 0-to-6 numeric rating scale.Conclusions OBA training improved mobility in the OBA device without significant changes in exercise conditioning or in neuromuscular or cortical activity. However, pain severity was reduced and no severe adverse events were encountered during training. OBA therefore opens the possibility to reduce the common consequences of chronic, complete SCI such as reduced functional mobility and neuropathic pain.

AB - Objective To explore responses to overground bionic ambulation (OBA) training from an interdisciplinary perspective including key components of neuromuscular activation, exercise conditioning, mobility capacity, and neuropathic pain.Design Case series.Setting Academic research center.Participants Persons (N=3; 2 men, 1 woman) aged 26 to 38 years with complete spinal cord injury (SCI) (American Spinal Injury Association Impairment Scale grade A) between the levels of T1 and T10 for ≥1 year.Intervention OBA 3d/wk for 6 weeks.Main Outcome Measures To obtain a comprehensive understanding of responses to OBA, an array of measures were obtained while walking in the device, including walking speeds and distances, energy expenditure, exercise conditioning effects, and neuromuscular and cortical activity patterns. Changes in spasticity and pain severity related to OBA use were also assessed.Results With training, participants were able to achieve walking speeds and distances in the OBA device similar to those observed in persons with motor-incomplete SCI (10-m walk speed,.11-.33m/s; 2-min walk distance, 11-33m). The energy expenditure required for OBA was similar to walking in persons without disability (ie, 25%-41% of peak oxygen consumption). Subjects with lower soleus reflex excitability walked longer during training, but there was no change in the level or amount of muscle activity with training. There was no change in cortical activity patterns. Exercise conditioning effects were small or nonexistent. However, all participants reported an average reduction in pain severity over the study period ranging between -1.3 and 1.7 on a 0-to-6 numeric rating scale.Conclusions OBA training improved mobility in the OBA device without significant changes in exercise conditioning or in neuromuscular or cortical activity. However, pain severity was reduced and no severe adverse events were encountered during training. OBA therefore opens the possibility to reduce the common consequences of chronic, complete SCI such as reduced functional mobility and neuropathic pain.

KW - Ambulation

KW - Bionics

KW - Evaluation

KW - Rehabilitation

KW - Spinal cord injuries

UR - http://www.scopus.com/inward/record.url?scp=84908509536&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84908509536&partnerID=8YFLogxK

U2 - 10.1016/j.apmr.2014.04.026

DO - 10.1016/j.apmr.2014.04.026

M3 - Article

C2 - 24845221

AN - SCOPUS:84908509536

VL - 95

SP - 1878

EP - 1887

JO - Archives of Physical Medicine and Rehabilitation

JF - Archives of Physical Medicine and Rehabilitation

SN - 0003-9993

IS - 10

ER -