Robotic treadmill training improves cardiovascular function in spinal cord injury patients.
BACKGROUND
Body weight supported treadmill training (BWSTT) assisted with a robotic driven gait orthosis (DGO) is an emerging tool in rehabilitating patients with lost sensorimotor function. Few information about the effects of BWSTT on cardiovascular system are available. The purpose of this study was to determine the effects of BWSTT on: 1) left ventricular (LV) systo-diastolic function; 2) coronary flow reserve (CFR); 3) endothelial function in patients with lost sensorimotor function due to neurologic lesions.


METHODS
Fourteen adults (males 10, age 50.6±17.1years) with motor incomplete spinal cord injuries (SCI) due to trauma or spondylotic diseases underwent standard echocardiographic examination, non invasive assessment of CFR by dipyridamole stress echo and determination of plasma asymmetric dimethylarginine (ADMA) levels at baseline and after 6weeks of BWSTT.


RESULTS
At post training evaluation we observed lower LV end-diastolic (P=0.0164) and end-systolic volumes (P=0.0029) with increased ejection fraction (EF) (P=0.0266). We also observed a LV interventricular septum (IVS) (P=0.00469) increase. At the same time, we detected an improvement of LV diastolic function as witnessed by the reduction of isovolumic relaxation time (IVRT) (P=0.0404) and deceleration time (DT) (P=0.0405) with an increased E/A ratio (P=0.0040). Improved CFR (P=0.020) and reduced plasma ADMA levels (P=0.0005) have been observed too, in association with a reduction of the inflammatory status (C-reactive protein (CRP) (P=0.0022) and erythrocyte sedimentation rate (ESR) (P=0.0005)).


CONCLUSIONS
For the first time, this study demonstrated that 6weeks of BWSTT improved not only the sensorimotor function but also systo-diastolic LV function, CFR and endothelial dysfunction associated with a reduction of the inflammatory status in patients with incomplete SCI.
Turiel
Maurizio
M
Cardiology Unit, Department of Health Technologies, IRCCS Galeazzi Orthopedic Institute, Università di Milano, Milan, Italy. maurizio.turiel@unimi.it
Sitia
Simona
S
Cicala
Silvana
S
Magagnin
Valentina
V
Bo
Ivano
I
Porta
Alberto
A
Caiani
Enrico
E
Ricci
Cristian
C
Licari
Vittorio
V
De Gennaro Colonna
Vito
V
Tomasoni
Livio
L
D000328:Adult; D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives / Q000097:blood; D002320:Cardiovascular Physiological Phenomena; D003326:Coronary Circulation / Q000502:physiology; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D004730:Endothelium, Vascular / Q000502:physiology; D005081:Exercise Therapy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness / Q000502:physiology*; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000534:rehabilitation*; D016277:Ventricular Function, Left / Q000502:physiology
C018524:N,N-dimethylarginine; D001120:Arginine