Robotic locomotor training in a low-resource setting: a randomized pilot and feasibility trial

Claire Shackleton; Robert Evans; Sacha West; Jason Bantjes; Leslie Swartz; Wayne Derman; Yumna Albertus

doi:10.1080/09638288.2023.2245751

Robotic locomotor training in a low-resource setting: a randomized pilot and feasibility trial

Disabil Rehabil. 2023 Aug 22:1-10. doi: 10.1080/09638288.2023.2245751. Online ahead of print.

Authors

Claire Shackleton¹, Robert Evans¹, Sacha West², Jason Bantjes³, Leslie Swartz⁴, Wayne Derman^{5

6}, Yumna Albertus¹

Affiliations

¹ Physical Activity, Lifestyle and Sport Research Centre (HPALS), Department of Human Biology, University of Cape Town, Cape Town, South Africa.
² Department of Sport Management, Cape Peninsula University of Technology, Cape Town, Western Cape, South Africa.
³ Mental Health, Alcohol, Substance Use and Tobacco (MAST) Research Unit, South African Medical Research Council, Cape Town, South Africa.
⁴ Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch, South Africa.
⁵ Institute of Sport and Exercise Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa.
⁶ International Olympic Committee Research Center, South Africa.

PMID: 37605978
DOI: 10.1080/09638288.2023.2245751

Abstract

Purpose: Activity-based Training (ABT) represents the current standard of neurological rehabilitation. Robotic Locomotor Training (RLT), an innovative technique, aims to enhance rehabilitation outcomes. This study aimed to conduct a randomized pilot and feasibility trial of a locomotor training program within South Africa.

Materials and methods: Individuals with chronic traumatic motor incomplete tetraplegia (n = 16). Each intervention involved 60-minute sessions, 3x per week, for 24-weeks. Outcomes included feasibility measures and functional capacity.

Results: 17 out of 110 individuals initiated the program (recruitment rate = 15.4%) and 16 completed the program (drop-out rate = 5.8%) and attended sessions (attendance rate = 93.9%). Both groups showed a significant increase in upper extremity motor score (MS) and abdominal strength post intervention. Only the RLT group showed a significant change in lower extremity MS, with a mean increase of 3.00 [0.00; 16.5] points over time. Distance walked in the Functional Ambulatory Inventory (SCI-FAI) increased significantly (p = 0.02) over time only for the RLT group.

Conclusions: Feasibility rates of the intervention and functional outcomes justify a subsequent powered RCT comparing RLT to ABT as an effective rehabilitation tool for potentially improving functional strength and walking capacity in people with incomplete SCI.

Keywords: SCI-FAI; Spinal cord injuries; exercise therapy; exoskeleton device; gait; muscle strength; rehabilitation; robotics.

Plain language summary

Spinal cord injury causes severe limitations to functional capacity, independence, and quality of life.Robotic Locomotor Training is growing rehabilitation modality for people with spinal cord injury, but currently its effects on functional capacity are limited.In a relatively small sample, this study shows that large, randomized control trials are feasible within a low-income setting.The preliminary findings of this study show that 12 weeks of locomotor training can improve ambulatory function and functional strength in individuals with spinal cord injury.