ABSTRACT
For evaluating the patterns of brain activation in sensorimotor areas following motor rehabilitation, seven male patients diagnosed with TBI underwent an fMRI study before and after being subjected to motor rehabilitation. Six patients showed a reduction in the BOLD signal of their motor cortical areas during the second fMRI evaluation. A decrease in cerebellum activation was also observed in two patients. Newly activated areas, were observed in four patients after treatment. In addition, an increase in the activation of the supplementary motor area (SMA) following rehabilitation was observed in only one test subject. The findings show that motor rehabilitation in TBI patients produces a decrease in the BOLD signal for the sensorimotor areas that were activated prior to treatment. In addition, we observed the recruitment of different brain areas to compensate for functional loss due to TBI in line with the cortical reorganisation mechanism.
Subject(s)
Brain Injuries/pathology , Brain Injuries/rehabilitation , Motor Cortex/pathology , Somatosensory Cortex/pathology , Adult , Body Weight , Cerebellum/physiology , Data Interpretation, Statistical , Gait/physiology , Humans , Image Processing, Computer-Assisted , Magnetic Resonance Imaging , Male , Oxygen/blood , Physical Education and Training , Recruitment, Neurophysiological , Young AdultABSTRACT
STUDY DESIGN: Single-blind randomized, controlled clinical study. OBJECTIVES: To evaluate, using kinematic gait analysis, the results obtained from gait training on a treadmill with body weight support versus those obtained with conventional gait training and physiotherapy. SETTING: Thirty patients with sequelae from traumatic incomplete spinal cord injuries at least 12 months earlier; patients were able to walk and were classified according to motor function as ASIA (American Spinal Injury Association) impairment scale C or D. METHODS: Patients were divided randomly into two groups of 15 patients by the drawing of opaque envelopes: group A (weight support) and group B (conventional). After an initial assessment, both groups underwent 30 sessions of gait training. Sessions occurred twice a week, lasted for 30 min each and continued for four months. All of the patients were evaluated by a single blinded examiner using movement analysis to measure angular and linear kinematic gait parameters. Six patients (three from group A and three from group B) were excluded because they attended fewer than 85% of the training sessions. RESULTS: There were no statistically significant differences in intra-group comparisons among the spatial-temporal variables in group B. In group A, the following significant differences in the studied spatial-temporal variables were observed: increases in velocity, distance, cadence, step length, swing phase and gait cycle duration, in addition to a reduction in stance phase. There were also no significant differences in intra-group comparisons among the angular variables in group B. However, group A achieved significant improvements in maximum hip extension and plantar flexion during stance. CONCLUSION: Gait training with body weight support was more effective than conventional physiotherapy for improving the spatial-temporal and kinematic gait parameters among patients with incomplete spinal cord injuries.
Subject(s)
Body Weight/physiology , Exercise Test/methods , Exercise Therapy/methods , Gait Disorders, Neurologic/rehabilitation , Physical Therapy Modalities , Spinal Cord Injuries/rehabilitation , Adolescent , Adult , Female , Gait Disorders, Neurologic/physiopathology , Humans , Male , Middle Aged , Physical Therapy Modalities/instrumentation , Prospective Studies , Single-Blind Method , Spinal Cord Injuries/physiopathology , Treatment Outcome , Young AdultABSTRACT
INTRODUCTION: Over recent years it has become possible to retrain motor activity among patients with partial spinal cord injury, especially for walking. AIM. To assess the impact of gait training on a treadmill with body weight support, regarding temporospatial parameters and quality of life. PATIENTS AND METHODS: Twelve patients of both sexes were evaluated. They had been diagnosed with partial spinal cord injury of traumatic origin at least 12 months earlier. They were able to walk and their motor function below the level of the injury was partially preserved and classified as level C or D. After the initial evaluation, the participants were trained on a treadmill with body weight support, with two sessions per week lasting 30 minutes each, over a four-month period, thus totaling 30 sessions. The patients' temporospatial gait parameters and quality of life were analyzed before and after the training. RESULTS: There were improvements in all the temporospatial parameters evaluated (p < 0.0001), but no changes in quality of life were seen (p > 0.05). CONCLUSION: Treadmill training with body weight support among patients with spinal cord injury was effective in improving the temporospatial gait parameters, but without changing their quality of life.
Subject(s)
Gait , Quality of Life , Spinal Cord Injuries/physiopathology , Spinal Cord Injuries/rehabilitation , Female , Humans , MaleABSTRACT
Durante los últimos años ha sido posible rehabilitar la actividad motora en los pacientes con lesiónmedular parcial, especialmente para poder caminar. Objetivo. Evaluar el impacto del entrenamiento de la marcha en una cinta sin fin con soporte del peso corporal con respecto a los parámetros temporoespaciales y la calidad de vida. Pacientes y métodos.Se estudió a 12 pacientes de ambos sexos. Se les había diagnosticado una lesión medular parcial de origen traumático al menos 12 meses antes. Podían caminar, y su función motora por debajo del nivel de la lesión estaba parcialmente preservada y clasificada como nivel C o D. Después de la evaluación inicial, los participantes se entrenaron en una cinta sin fin consoporte del peso corporal, con dos sesiones por semana de 30 minutos de duración cada una, durante un período de cuatro meses, lo que supuso un total de 30 sesiones. Los parámetros temporoespaciales de la marcha y la calidad de vida de los pacientesse analizaron antes y después del entrenamiento. Resultados. Hubo mejoras importantes en todos los parámetros temporoespaciales evaluados (p < 0,0001), pero no se observaron cambios en la calidad de vida (p > 0,05). Conclusión. El entrenamiento en una cinta sin fin con soporte del peso corporal en pacientes con lesión medular fue eficaz a la hora de mejorar los parámetros temporoespaciales de la marcha, pero no se produjeron cambios en su calidad de vida
Over recent years it has become possible to retrain motor activity among patients with partial spinalcord injury, especially for walking. Aim. To assess the impact of gait training on a treadmill with body weight support, regarding temporospatial parameters and quality of life. Patients and methods. Twelve patients of both sexes were evaluated. They had been diagnosed with partial spinal cord injury of traumatic origin at least 12 months earlier. They were able to walkand their motor function below the level of the injury was partially preserved and classified as level C or D. After the initial evaluation, the participants were trained on a treadmill with body weight support, with two sessions per week lasting 30minutes each, over a four-month period, thus totaling 30 sessions. The patients temporospatial gait parameters and quality of life were analyzed before and after the training. Results. There were improvements in all the temporospatial parameters evaluated (p < 0.0001), but no changes in quality of life were seen (p > 0.05). Conclusion. Treadmill training with body weightsupport among patients with spinal cord injury was effective in improving the temporospatial gait parameters, but without changing their quality of life
