Differences in Cardiovascular Intensity Between Gait Training Approaches After Incomplete Spinal Cord Injury-A...

Area of Science:

• Neurology
• Rehabilitation Medicine
• Biomedical Engineering

Background:

• Spinal cord injury (SCI) frequently causes significant mobility deficits, requiring intensive rehabilitation.
• Overground robotic exoskeletons (ORE) are novel tools for gait training, but their effectiveness in eliciting moderate-to-vigorous intensity (MVI) in subacute SCI is not well-established.

Purpose of the Study:

• To compare the training intensity of usual care (UC) versus ORE gait training in individuals with subacute, motor incomplete SCI.
• To investigate the association between gait training intensity and improvements in walking function.

Main Methods:

• A single-blind randomized controlled trial involving 106 patients with subacute SCI (AIS B, C, D).
• Participants were randomized to either UC or ORE gait training.
• Key outcomes included percentage of session time at MVI, rating of perceived exertion (RPE), step count, and change in the Walking Index for Spinal Cord Injury (WISCI-II).

Main Results:

• Both UC and ORE groups achieved similar percentages of session time in MVI (17.6% vs. 19.5%) and comparable step counts (387.1 vs. 461.8).
• Rating of perceived exertion (RPE) was significantly higher in the UC group compared to the ORE group (5.6 vs. 4.5).
• Step count showed a moderate correlation with WISCI-II improvement (r = 0.38-0.51), whereas MVI percentage showed a weak correlation (r = 0.23).

Conclusions:

• Overground robotic exoskeletons (ORE) and usual care (UC) provide a comparable physiological training dose for subacute SCI patients.
• ORE may facilitate intense training with a lower perceived exertion.
• Step count emerges as a more reliable indicator of training intensity associated with functional recovery in SCI gait rehabilitation.