Spinal Cord Injury Clinical Trial
Official title:
Cardiovascular Parameters for Lokomat Training in Chronic Incomplete SCI
This proposal investigates the hypothesis that progressive aerobic exercise with Lokomat is feasible in people with motor incomplete spinal cord injury, and three months of training will improve cardiovascular fitness and gait functionality when compared to physical therapy controls
Little information is available about the cardiovascular effects of robotically assisted
partial weight support treadmill training devices such as Lokomat in chronic incomplete
spinal cord injured subjects. Task-oriented aerobic exercise has the potential to improve
both neuromuscular function and cardiovascular metabolic fitness in neurological
populations. Since spinal cord injured individuals are at an increased risk of developing
premature cardiovascular disease, the investigation of robotic-assisted interventions in
spinal cord injury (SCI) such as the Lokomat may have important health benefits in both
cardiovascular fitness as well as functional mobility.
This proposal investigates the hypothesis that progressive aerobic exercise with Lokomat is
feasible in motor incomplete SCI, and three months of training will improve cardiovascular
fitness and gait functionality when compared to physical therapy controls. We propose a
two-phase study to examine the feasibility, reliability and utility of aerobic exercise
metabolic testing and training during robotically assisted partial weight support treadmill
walking in individuals with chronic motor incomplete spinal cord injury (CMISCI). During the
first phase of the study we will manipulate Lokomat training parameters of treadmill speed
and percent of partial weight support to assess the effect of these changes on heart rate,
perceived exertion, and oxygen consumption in untrained chronic motor incomplete spinal cord
injured subjects. Subjects will be asked to maintain cardiovascular or muscular effort
during testing and will be monitored in this regard by the force biofeedback system built
into the Lokomat. After determining threshold levels for initial cardiovascular response,
submaximal and then peak exercise testing will be attempted. These studies will be repeated
on a separate day to determine the reliability of the testing results. Thirty-six subjects
with varying levels of injury between C4 and L2 and ASIA (American Spinal Injury) Impairment
Scales of C and D will be recruited. We anticipate that subjects with greater ASIA motor
scores will require either a faster initial treadmill speed or less partial weight support
to produce an initial cardiovascular response. It is also anticipated that peak exercise
testing using open circuit spirometry with subjects on the Lokomat will be a feasible,
reliable and valid measurement. This phase of the study will be aimed at establishing
guidelines for determining initial training parameters for use in an aerobic exercise
protocol using the Lokomat.
The second phase of this pilot study will be a controlled trial of three-month progressive
aerobic Lokomat exercise in chronic incomplete spinal cord injured subjects. The aim of this
trial will be to determine whether progressive Lokomat training will improve cardiovascular
fitness and ambulatory function when compared to matched impairment severity CMISCI subjects
receiving the same duration of usual physical therapy care. Thirty-six subjects will be
recruited into this phase of the study. Open spirometric evaluation of cardiovascular
parameters as outlined in phase one of the proposal will be measured at baseline, 1 months,
and 3 months. Initial, six-week and post-study ambulatory function evaluations including the
WISCI (Walking Index for Spinal Cord Injury), a timed 10 meter walk, a measured walk over 6
minutes, and a gait analysis will also be determined. It is hypothesized that aerobic
Lokomat exercise will improve cardiovascular fitness as determined by an increase in VO2
(oxygen consumption) peak and improve function as determined by timed walks and gait
parameters in these subjects. The results of this pilot and development study will provide
the necessary information to design larger randomized clinical trials.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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