Anu Piira, Anne M. Lannem, Marit Sørensen, Thomas Glott, Raymond Knutsen, Lone Jørgensen, Knut Gjesdal, Nils Hjeltnes, Synnøve F. Knutsen
Department of Health and Care, Arctic University of Norway,, North Norway Rehabilitation Center, University of Tromsø, 9011 Tromsø, Norway. anu.piira@kurbadet.no
DOI: 10.2340/16501977-2547

Objective: To assess the effects of robot-assisted locomotor training in patients with chronic incomplete spinal cord injury.
Design: Randomized single-blind controlled clinical trial.
Setting: The intervention site was an outpatient clinic, and pre- and post-evaluations were performed in a rehabilitation hospital.
Patients: A total of 24 subjects with American Spinal Injury Association Impairment Scale grades C or D, >?2 years post-injury.
Interventions: Subjects were randomized to 60 days of robot-assisted locomotor training, or to usual care.
Methods: Walking function, lower extremity muscle strength and balance were assessed single-blinded pre- and post-intervention.
Results: After a 9-year recruitment period, only 24 of the planned 30 subjects had been enrolled (mean time since injury 17 (standard deviation (SD) 20) years for all subjects). Walking function, lower extremity muscle strength and balance improved modestly in both groups, with no statistically significant group difference in walking function or muscle strength, whereas postural control declined significantly in the intervention group, compared with controls (p?=?0. 03).
Conclusion: Late-onset robot-assisted locomotor training did not re-establish independent walking function. A modest, but non-significant, effect was seen on muscle strength and balance. However, significant between-group differences were found only in postural control in the control group.

This randomized clinical trial assesses the effects of robot-assisted treadmill training in persons with chronic incomplete spinal cord injury acquired >?2 years earlier. Due to recruitment challenges, it was possible to recruit only 63% of the planned number of participants. The intervention group received gait training 3 days per week for a period of 6 months and the control group received usual care with their local physical therapist. The intervention group showed improvements in lower extremity strength and balance, but no change in walking function. Significant between-group difference was found only in postural control, favouring the control group. Because the target number of study participants was not reached, the study was underpowered and non-significant, and thus the findings are inconclusive. This training method may have benefits, but the robotic device is expensive and training effects are limited when the person’s baseline function is poor and the training starts late in incomplete SCI.