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FES Driven Stepping in Individuals with Spinal Cord Injury
Improving walking in individuals with Spinal Cord Injury (SCI) is a major current clinical and research goal. Gait training in SCI can be done with therapist-assisted over ground ambulation (with or without assistive device), in a Body Weight Supported Treadmill Training (BWSTT) environment, where assistance for the movement of legs and the pelvis is provided manually by a therapist or by a robotic device (Lokomat, Auto-Ambulator, or Gait Trainer), or in water (weight supported environment, with or without a treadmill).
Functional Electrical Stimulation (FES) has been previously used to enhance the quality of gait training whether as an assistive device (FES orthosis for foot drop) or to enhance muscle strength and improve cardiovascular resistance (FES ergometer), thus decreasing gait induced fatigue. Over ground gait training (with or without an FES orthosis) can only be used for individuals with incomplete SCI, already able to support body weight in an upright position. BWSTT, robotic device gait training, and Aquatherapy gait training (training in water) can potentially be used to enhance loco-motor abilities in both motor complete and incomplete SCI individuals, as lack of trunk balance and ability to bear weight in an upright position are replaced by the supporting abilities of the device or environment used (harness, exoskeleton or water). But they are not typically used in clinical practice to aid in locomotor training in individuals with motor complete SCI as this training would need specialized, center based, expensive environment (i.e. therapeutic pool, robotic exoskeleton) or is very labor intensive (sometimes requiring 2-3 therapists’ sustained effort over long periods of time to achieve a small incremental gain). Combining a robotic device that simulates stepping with FES while the individual is safely supported into a harness has the potential to tap into neuro-plasticity driven loco-motor patterning while increasing muscle strength and cardiovascular endurance and be safely applied in a center OR home-based environment.
We hypothesize that FES driven gait training utilizing the RT600 (Restorative Therapies, Inc.) is safe for both motor complete and incomplete individuals. In addition, we hypothesize that RT600 can increase the walking abilities of individuals with incomplete SCI. If our hypotheses prove right, the RT600 can then be safely used in a home based environment to perform long term gait training in individuals with varying degrees of SCI related paralysis.
We plan to enroll up to 15 adults (age 18-55) with an expected accrued number of subjects of 12; 6 motor complete (ASIA A, B), 6 motor incomplete (ASIA C, D); screening failure of 3.
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