|Author Year; Country|
|Field-Fote & Roach 2011|
|Population: Patients with chronic SCI at least 1 year post-injury, mean ages between 38 and 45 of each group; TM group (14 males, 3 females), TS group (14 males, 4 females), OG group (11 males, 4 females), LR group (12 males, 2 females)|
Treatment: Training 5 days/week for 12 weeks with: treadmill-based training with manual assistance (TM), treadmill-based training with stimulation (TS), overground training with stimulation (OG), or treadmill-based training with robotic assistance (LR)
Outcome Measures: Walking speed (over 10m), distance walked in 2 minutes, LEMS
|1. There was a significant time effect of training on walking speed: walking speed significantly increased for the OG group (0.19(0.21) to 0.28(0.28) m/s; Effect Size=0.43), TS group (0.18(0.18) to 0.23(0.18) m/s; ER=0.28).|
2. There was a significant time effect of training on walking distance: walking distance significantly increased for the OG group (24.0(35.3) to 38.3(46.1) m; ES=0.40) and the TS group (20.6(23.1) to 24.4(24.3) m; ES=0.16), but not for the TM (22.1(21.4) to 23.0(21.1) m; ES=0.04) or the LR group (16.8(11.3) to 17.9(11.9); ES = 0.11).
3. There was a significant time x group interaction, with the increase in the OG group’s walking distance being significantly greater than the TS, TM and LR groups.
Hitzig et al. 2013
|Population: 34 participants with SCI. For the FES group (n=17, 14M 3F); mean (SD) age= 56.6(14); DOI = 8.75 (9.7); 6 AIS C, 11 AIS D. For the control group (n=17, 12M 5F); mean (SD) age=54.1(16.5); DOI= 10.3 (11.1); 7 AIS C, 10 AIS D.|
Treatment: Participants were randomized to intervention (FES) or control group. The FES group received FES stimulation while ambulating on a BWS treadmill. Control group exercise program consisted of 20-25 min of resistance and 20-25 min of aerobic training.
Outcome Measures: SCIM; SWLS; IADL; CHART, RNL.
|1. The FES group had a significant increase on SCIM mobility subscores (mean(SD)=17.27(7.2) to 21.33(7.6)) compared to the exercise group (mean(SD)=19.9(17.1) to 17.36(5.5)) from baseline to 1-yr follow-up.|
2. No significant between-group differences were detected for other outcomes.
3. Both FES and control group reported positive gains in wellbeing from trial participation.
|Effect Sizes: Forest plot of standardized mean differences (SMD ± 95%C.I.) as calculated from pre- to post-intervention data and pre-intervention to retention/follow-up data|
Kressler et al. 2013
|Population: 62 participants with SCI; AIS C or D; injury at T10 or higher.|
Treatment: Participants trained 5 days/wk for 12 wks. Groups were treadmill-based locomotor training with manual assistance (TM), transcutaneous electrical stimulation (TS), and a driven gait orthosis (DGO) and overground (OG) LT with electrical stimulation.
Outcome Measures: Oxygen uptake, walking velocity and economy, substrate utilization during subject-selected “slow”, “moderate” and “maximal” walking speeds.
|1. All groups increased velocity but to varying degrees: DGO=0.01(0.18) Ln[m/s]; TM=0.07(0.29) Ln[m/s]; TS=0.33(0.45) Ln[m/s]; OG=0.52(0.61) Ln[m/s]. Only the TS and OG groups had significant improvement over DGO (TS: p=.009, OG: p=.001). OG was also significantly higher than TM (p=.015).|
2. Changes in walking economy were only significant for TS (0.26(0.33) Ln[L/m], p=.014) and OG (0.44(0.62)Ln[L/m], p=.025).
|Field-Fote et al. 2005|
N = 27
|Population: 27 males and females; age 21-64 yrs; all participants had an incomplete SCI; C3-T10 lesion level; >1 yr post-injury|
Treatment: Randomized to 4 gait training strategies, 45-50 min, 5x/wk, 12 wks: 1) manual BWSTT (n=7); 2) BWSTT + FES (common peroneal nerve) (n=7); 3) BWS overground + FES (n=7); 4) BWS Lokomat (robotic gait device) (n=6).
Outcome measures: Walking speed over 6 m (short bout) and 24.4 m (long-bout).
|1. Significant increases in short-bout walking speed across participants who received BWSTT + FES.|
2. Equivalent effects on long-bout gait speed between the 4 groups.
3. Tendency for initially slower walkers (<0.1m/s) to show greater improvement (106%) compared to initially faster walkers (17%).
|Postans et al. 2004|
|Population: 14 males and females; ages 19-57 yrs; all participants had an incomplete SCI; C4-T9 lesion level; mean 12.2±5.9 weeks post-injury|
Treatment: Crossover design: Intervention – Partial weight-bearing (PWB) supported treadmill gait training augmented by FES for up to 25 minutes a day, 5 days a week for 4 weeks; Control – 4-week period of standard physiotherapy. Patients were randomly assigned to either an AB (4 weeks control then 4 weeks intervention) or BA (4 weeks intervention then 4 weeks control) group.
Outcome Measures: Overground and treadmill walking endurance and speed.
|1. Between the intervention and control periods for the BA group, there was a significant difference in walking endurance (in metres; Mean: 60.10, CL: 9.2 to 110.9, P=.030) as well as for walking speed (in m/s; Mean: 0.22, CL: 0.05 to 0.37, P= .019)|
2. Between the intervention and control periods for the AB group, there was a significant difference in walking endurance (in metres; Mean: 72.20, CL: 39.8 to 104.6, P= .003) as well as for walking speed (in m/s; Mean: 0.23, CL: 0.13 to 0.33, P=.004).
|Effect Sizes: Forest plot of standardized mean differences (SMD ± 95%C.I.) as calculated from pre- and post-intervention data|
Triolo et al. 2012
|Population: 15 participants with thoracic or low cervical level SCI (14M 1F); 10 AIS A, 4 AIS B, 1 AIS C; Mean (SD) DOI: 72.6(71.87) months.|
Treatment: Participants received the 8-channel neuroprosthesis and completed rehabilitation with the device. This study follows the patients from discharge to follow-up ranging from 6-19 months after discharge (with exception of 1 participant at 56 months).
Outcome Measures: Neuroprosthesis usage, maximum standing time, body weight support, knee strength, knee fatigue index, body weight support, electrode stability, and component survivability.
|1. Levels of maximum standing time, BWS, knee strength, and knee fatigue index were not statistically different from discharge to follow-up.|
2. Neuroprosthesis usage was consistent with participants choosing to use the system on approximately half of the days during each monitoring period. Although the number of hours using the neuroprosthesis remained constant, participants shifted their usage to more functional standing versus more maintenance exercise, suggesting that the participants incorporated the neuroprosthesis into their lives.
3. Safety and reliability of the system were demonstrated by electrode stability and a higher component stability rate (>90%).
|Hesse et al. 2004 Germany|
|Population: 3 males; age 45-62 yrs; all participants had a diagnosis of AIS C or AIS D; C5-T8 lesion level; 8-18 months post-injury.|
Treatment: Electromechanical gait trainer + FES to quadriceps and hamstrings: 20-25 min, 5x/wk, 5 wks.
Outcome measures: Gait velocity and endurance.
|1. Gait ability improved in all patients; 3 could walk independently over ground with aids. Overall gait speed and endurance more than doubled.|
2. Study made no reports of significance levels or testing of results.
|Field-Fote & Tepavac 2002|
|Population: 14 males and females; age 18-50 yrs; all participants had a diagnosis of AIS C; C4-T7 lesion level.|
Treatment: BWSTT + common peroneal nerve FES: <90 min, 3x/wk, 12 wks.
Outcome measures: Over ground gait speed.
|1. All participants showed an increase in walking speed.|
2. Participants with slower walking speeds showed greater improvement.
3. Study made no mention of significance levels or testing of results.
|Population: 19 males and females; mean age 31.7±9.4 yrs; all participants had a diagnosis of AIS C either paraplegia or tetraplegia.|
Treatment: BWSTT + common peroneal nerve FES: <90 min, 3x/wk, 12 wks.
Outcome measures: Gait speed.
|1. Significant increase in walking speed (initial 0.12 ± 0.8m/s; final 0.21 ± 0.15m/s, p = .0008, median change of 77%).|