[A robotic system for gait re-education in patients with an incomplete spinal cord injury]. / Sistema robotizado para la reeducación de la marcha en pacientes con lesión medular incompleta.

INTRODUCTION: A spinal cord injury involves the loss or alteration of motor patterns in walking, the recovery of which depends partly on the rearrangement of the preserved neural circuits. AIM. To evaluate the changes that take place in the gait of patients with incomplete spinal cord injuries who were treated with a robotic walking system in association with conventional therapy. PATIENTS AND METHODS: The study conducted was an open-label, prospective, descriptive trial with statistical inference in patients with C2-L3 spinal cord injuries that were classified as degrees C and D according to the American Spinal Injury Association (ASIA) scale. The variables that were analysed on the first and the last day of the study were: number of walkers, 10-m gait test, the Walking Index for Spinal Cord Injury scale revision, technical aids, muscle balance in the lower limbs, locomotor subscale of the measure of functional independence, modified Ashworth scale for spasticity and the visual analogue scale for pain. At the end, data were recorded from the impression of change scale. The analysis was conducted by means of Student's t, chi squared and Pearson's correlation; p < or = 0.05. RESULTS: Forty-five patients, with a mean age of 44 +/- 14.3 years, finished the study; 76% were males, injury was caused by trauma in 58% of cases, and the time of progression was 139 +/- 70 days. Statistically significant increases were observed in the number of subjects capable of walking, walking speed, less need for technical aids, strength in the lower limbs and independence in activities of daily living. CONCLUSIONS: Treatment using the robotic system in association with conventional therapy improves walking capacity in patients with incomplete spinal cord injuries.

Sistema robotizado para la reeducación de la marcha en pacientes con lesión medular incompleta / A Robotic system for gait re-education in patients with an incomplete spinal cord injury

Resumen. Introducción. La lesión medular supone una pérdida o alteración de los patrones motores de marcha, cuya recuperación depende, en parte, de la reorganización de los circuitos neurales preservados. Objetivo. Evaluar los cambios en la marcha de los lesionados medulares incompletos que realizaron tratamiento con un sistema robotizado de marcha asociado a la terapia convencional. Pacientes y métodos. Estudio abierto, prospectivo, descriptivo, con inferencia estadística en lesionados medulares C2-L3 clasificados según la escala de la American Spinal Injury Association (ASIA) en grados C y D. Las variables analizadas el primer y el último día del estudio fueron: número de ambulantes, test de marcha de los 10 m, índice de marcha para la lesión medular Walking Index for Spinal Cord Injury, scale revision, ayudas técnicas, balance muscular de las extremidades inferiores, subescala locomotora de la medida de independencia funcional, escala de Ashworth modificada para la espasticidad y escala visual analógica para el dolor. Al final se registraron los datos de la escala de impresión de cambio. El análisis se realizó mediante la t de Student, chi al cuadrado y la correlación de Pearson; p ≤ 0,05. Resultados. 45 pacientes finalizaron el estudio con una edad media de 44 ± 14,3 años; el 76% fueron hombres, la etiología de la lesión fue traumática en el 58%, y el tiempo de evolución fue de 139 ± 70 días. Aumentaron de forma estadísticamente significativa el número de sujetos con capacidad de marcha, la velocidad en la marcha, la menor necesidad de ayudas técnicas, la fuerza de extremidades inferiores y la independencia en las actividades de la vida diaria. Conclusión. La terapia con el sistema robotizado asociado a la terapia convencional mejora la capacidad de marcha de los lesionados medulares incompletos. (AU)

Summary. Introduction. A spinal cord injury involves the loss or alteration of motor patterns in walking, the recovery of which depends partly on the rearrangement of the preserved neural circuits. Aim. To evaluate the changes that take place in the gait of patients with incomplete spinal cord injuries who were treated with a robotic walking system in association with conventional therapy. Patients and methods. The study conducted was an open-label, prospective, descriptive trial with statistical inference in patients with C2-L3 spinal cord injuries that were classified as degrees C and D according to the American Spinal Injury Association (ASIA) scale. The variables that were analysed on the first and the last day of the study were: number of walkers, 10-m gait test, the Walking Index for Spinal Cord Injury scale revision, technical aids, muscle balance in the lower limbs, locomotor subscale of the measure of functional independence, modified Ashworth scale for spasticity and the visual analogue scale for pain. At the end, data were recorded from the impression of change scale. The analysis was conducted by means of Student’s t, chi squared and Pearson’s correlation; p ≤ 0.05. Results. Forty-five patients, with a mean age of 44 ± 14.3 years, finished the study; 76% were males, injury was caused by trauma in 58% of cases, and the time of progression was 139 ± 70 days. Statistically significant increases were observed in the number of subjects capable of walking, walking speed, less need for technical aids, strength in the lower limbs and independence in activities of daily living. Conclusions. Treatment using the robotic system in association with conventional therapy improves walking capacity in patients with incomplete spinal cord injuries (AU)