Effects of Robotic Versus Manually-Assisted Locomotor Training for Individuals With Incomplete Spinal Cord Injury

Spinal cord injury (SCI) is one of the most disabling health problems facing adults today,
with one of the consequences often being inability to walk or difficulty walking. Recent
studies suggest that intensive step training on a treadmill using body-weight support (BWS)
and manual assistance that provides repetitive task-specific sensory cues to the neural axis
can improve the recovery of walking for persons with incomplete SCI. More recently, robotics
have been developed as an alternative to manually-assisted training. Robotic-assisted
training may allow for increased intensity of training, improve the reproducibility and
consistency of training, and reduce the personnel needed to implement the training. However,
the effects of robotic-assisted training compared to manually-assisted training are not
known. An improved understanding of these differential effects and the mechanisms of
improvement in walking can facilitate continued advances in evidenced-based practice of
neuro-rehabilitation, therefore improving the treatment of persons with SCI.

The primary objective of this project is to assess and compare the effects of
robotic-assisted versus manually-assisted locomotor training (LT) using the body-weight
support (BWS) on sub-tasks of walking. Specifically, we believe that at least four sub-tasks
of walking are differentially affected by the robotic-assisted training when compared to
manually-assisted training (propulsion, transition from stance to step, stepping, and
equilibrium). The investigators hypothesize that robotic-assisted training will have a
greater effect on improving propulsion, transition and equilibrium. The effect of these two
modalities on adaptability, a fifth sub-task of walking, is unclear; therefore, a development
component of the pilot project will involve establishing a quantitative measure of
adaptability and assessing differential effects of training. Participants will be randomized
to one of two training groups: robotic-assisted or manually-assisted, and evaluated for
performance on sub-tasks of walking.

Inclusion Criteria:

- Adults at least 18 years of age

- Spinal cord injury (SCO) at least 6 months since injury

- Motor I-SCI, upper motor neuron lesion only at cervical or thoracic levels

- A diagnosis of first time SCI including etiology from trauma, vascular, or orthopedic
pathology

- SCI as defined by the American ASIA Impairment Scale categories C or D

- Medically stable condition that is asymptomatic for bladder infection, decubiti,
osteoporosis, cardiopulmonary disease, pain, contractures or other significant medical
complications that would prohibit or interfere with testing of walking function and
training or alter compliance with the training protocol

- Documented medical approval from the participant's personal physician verifying the
participant's medical status at time of enrollment

- Ability to walk a minimum of 30 feet with or without an assistive device,
independently or with minimal assistance

- Over ground gait speed < 0.8 m/s

- Persons using anti-spasticity medication must maintain stable medication dosage during
the study

- Able to give informed consent

Exclusion Criteria:

- Current participation in a rehabilitation program/research protocol that could
interfere or influence the outcome measures of the current study

- History of congenital SCI (e.g. myelomeningocele, intraspinal neoplasm, Friedreich's
ataxia) or other degenerative spinal disorders (e.g. spinocerebellar degeneration,
syringomyelia) that may complicate the protocol

- Inappropriate or unsafe fit of the harness or robotic trainer due to the participant's
body size and/or joint contractures or severe spasticity that would prohibit the safe
provision of either training modality