Objective

To describe the effect of robotic locomotor training (RLT) and activity-based training (ABT) on cardiovascular indices during various physiological positions in individuals with spinal cord injury.

Design

Randomized controlled pilot study.

Setting

Private practice: Therapy & Beyond Centre - Walking with Brandon Foundation, Sports Science Institute of South Africa, Cape Town, South Africa.

Participants

Participants with chronic traumatic motor incomplete tetraplegia (N=16) who resided in the Western Cape, South Africa.

Intervention

Robotic locomotor training (Ekso GT) and activity-based training over a 24-week intervention.

Main Outcome Measures

Brachial and ankle blood pressure, heart rate, heart rate variability, and cardiovascular efficiency during 4 physiological positions.

Results

No differences between groups or over time were evident in resting systolic and diastolic blood pressure, ankle systolic pressure, ankle brachial pressure index, and heart rate variability. Standing heart rate at 24 weeks was significantly higher in the ABT group (95.58±12.61 beats/min) compared with the RLT group (75.14±14.96 beats/min) (P=.05). In the RLT group, no significant changes in heart rate variability (standard deviation R-R interval and root mean square of successive differences) was found between the standing and 6-minute walk test physiological positions throughout the intervention. Cardiovascular efficiency in the RLT group during the 6-minute walk test improved from 11.1±2.6 at baseline to 7.5±2.8 beats per meter walked at 6 weeks and was maintained from 6 to 24 weeks.

Conclusions

Large effect sizes and significant differences between groups found in this pilot study support the clinical effectiveness of RLT and ABT for changing cardiovascular indices as early as 6 weeks and up to 24 weeks of rehabilitation. RLT may be more effective than ABT in improving cardiac responses to orthostatic stress. Based on heart rate variability metrics, the stimulus of standing has comparable effects to RLT on the parasympathetic nervous system. Cardiovascular efficiency of exoskeleton walking improved, particularly over the first 6 weeks. Both the RLT and ABT interventions were limited in their effect on brachial and ankle blood pressure. A randomized controlled trial with a larger sample size is warranted to further examine these findings.

中文翻译：

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机器人运动训练导致不完全脊髓损伤患者在 24 周康复期内发生心血管变化：一项随机对照试验研究

客观的

描述机器人运动训练 (RLT) 和基于活动的训练 (ABT) 在脊髓损伤个体的各种生理位置期间对心血管指数的影响。

设计

随机对照试验研究。

环境

私人执业：治疗与超越中心 - 与布兰登基金会一起行走，南非运动科学研究所，南非开普敦。

参与者

居住在南非西开普省的患有慢性创伤性运动不完全性四肢瘫痪的参与者 (N=16)。

干涉

为期 24 周的机器人运动训练 (Ekso GT) 和基于活动的训练。

主要观察指标

4 种生理姿势下的肱动脉和踝关节血压、心率、心率变异性和心血管效率。

结果

静息收缩压和舒张压、踝关节收缩压、踝臂压力指数和心率变异性在组间或随时间推移没有明显差异。与 RLT 组（75.14±14.96 次/分钟）相比，ABT 组（95.58±12.61 次/分钟）的 24 周站立心率显着更高（P = .05）。在 RLT 组中，在整个干预过程中，站立和 6 分钟步行测试生理位置之间的心率变异性（标准偏差 RR 间期和连续差异的均方根）未发现显着变化。在 6 分钟步行测试期间，RLT 组的心血管效率从基线时的 11.1±2.6 提高到 6 周时每米步行 7.5±2.8 次，并在 6 至 24 周期间保持不变。

结论

在这项试点研究中发现的大效应量和组间显着差异支持 RLT 和 ABT 在最早 6 周和长达 24 周的康复中改变心血管指数的临床有效性。在改善心脏对直立性压力的反应方面，RLT 可能比 ABT 更有效。根据心率变异性指标，站立刺激对副交感神经系统的影响与 RLT 相当。外骨骼步行的心血管效率得到改善，尤其是在前 6 周内。RLT 和 ABT 干预对肱动脉和踝部血压的影响都是有限的。需要进行更大样本量的随机对照试验来进一步检验这些发现。