Article

OBJECTIVE: To describe metabolic responses accompanying 4 different locomotor
training (LT) approaches. DESIGN: Single-blind, randomized controlled trial.
SETTING: Rehabilitation research laboratory, academic medical center.
PARTICIPANTS: Individuals (N=62) with minimal walking function due to chronic
motor-incomplete spinal cord injury. INTERVENTION: Participants trained 5
days/week for 12 weeks. Groups were treadmill-based LT with manual assistance
(TM), transcutaneous electrical stimulation (TS), and a driven gait orthosis
(DGO) and overground (OG) LT with electrical stimulation. MAIN OUTCOME MEASURES:
Oxygen uptake (V o2), walking velocity and economy, and substrate utilization
during subject-selected "slow," "moderate," and "maximal" walking speeds.
RESULTS: V o2 did not increase from pretraining to posttraining for DGO (.00 +/-
.18L/min, P=.923). Increases in the other groups depended on walking speed,
ranging from .01 +/- .18 m/s (P=.860) for TM (slow speed) to .20 +/- .29 m/s
(P=.017) for TS (maximal speed). All groups increased velocity but to varying
degrees (DGO, .01 +/- .18 Ln[m/s], P=.829; TM, .07 +/- .29 Ln[m/s], P=.371; TS,
.33 +/- .45 Ln[m/s], P=.013; OG, .52 +/-.61 Ln[m/s], P=.007). Changes in walking
economy were marginal for DGO and TM (.01 +/- .20 Ln[L/m], P=.926, and .00 +/-
.42 Ln[L/m], P=.981) but significant for TS and OG (.26 +/- .33 Ln[L/m], P=.014,
and .44 +/- .62 Ln[L/m], P=.025). Many participants reached respiratory exchange
ratios >/= 1 at any speed, rendering it impossible to statistically discern
differences in substrate utilization. However, after training, fewer participants
reached this ceiling for each speed (slow: 9 vs 6, n=32; moderate: 12 vs 8, n=29;
and maximal 15 vs 13, n=28). CONCLUSIONS: DGO and TM walking training was less
effective in increasing V o2 and velocity across participant-selected walking
speeds, while TS and OG training was more effective in improving these parameters
and also walking economy. Therefore, the latter 2 approaches hold greater promise
for improving clinically relevant outcomes such as enhanced endurance,
functionality, or in-home/community ambulation.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS