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


METHODS
Case series.


METHODS
Academic research center.


METHODS
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.


METHODS
OBA 3d/wk for 6 weeks.


METHODS
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.
The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL. Electronic address: JKressler@med.miami.edu.
Jochen
J
Kressler
The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL; Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Physiology and Biophysics, Miller School of Medicine, University of Miami, Miami, FL.
Christine K
CK
Thomas
The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL; Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Rehabilitation Medicine, Miller School of Medicine, University of Miami, Miami, FL; Department of Physical Therapy, Miller School of Medicine, University of Miami, Miami, FL.
Edelle C
EC
Field-Fote
The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL; Department of Biomedical Engineering, Miller School of Medicine, University of Miami, Miami, FL.
Justin
J
Sanchez
The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL; Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Rehabilitation Medicine, Miller School of Medicine, University of Miami, Miami, FL.
Eva
E
Widerström-Noga
The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL.
Deena C
DC
Cilien
The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL.
Katie
K
Gant
The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL.
Kelly
K
Ginnety
Department of Biomedical Engineering, Miller School of Medicine, University of Miami, Miami, FL.
Hernan
H
Gonzalez
The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL.
Adriana
A
Martinez
The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL.
Kimberley D
KD
Anderson
The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL; Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL; Department of Rehabilitation Medicine, Miller School of Medicine, University of Miami, Miami, FL; Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL.
Mark S
MS
Nash
D000328:Adult; D001701:Bionics; D002908:Chronic Disease; D004569:Electroencephalography; D004576:Electromyography; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D008297:Male; D009044:Motor Cortex / Q000502:physiology; D009119:Muscle Contraction; D009128:Muscle Spasticity / Q000209:etiology / Q000534:rehabilitation; D018482:Muscle, Skeletal / Q000502:physiology*; D009437:Neuralgia / Q000209:etiology / Q000534:rehabilitation; D010101:Oxygen Consumption; D010147:Pain Measurement; D064797:Physical Conditioning, Human / Q000502:physiology; D012371:Robotics; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology* / Q000534:rehabilitation*; D013904:Thoracic Vertebrae; D016138:Walking / Q000502:physiology*
Ambulation; Bionics; Evaluation; Rehabilitation; Spinal cord injuries