Table 1.
Characteristics of Bodyweight Supported Locomotor Training in Human Spinal Cord Injury Studies.
| Study | Intervention | Duration | Population | N | Outcomes |
|---|---|---|---|---|---|
| Studies Assessing Gait | |||||
| Dobkin et al., 2007 [185] | Manual-assisted BWSTT vs. OG training |
12 wk | 38 ASIA B, 107 ASIA C&D | 145 | BWSTT increased walking speed from ~0.40 m/s at 2 weeks post-entry to 0.85 m/s for ASIA C&D. OG training increased walking speed from ~0.50 at 2 weeks post-entry to 0.84 m/s for ASIA C&D. Poor walking outcomes were observed for ASIA B participants. |
| Field-Fote et al., 2001 [167] | BWSTT with ES | 3 days/wk, 12 wk | ASIA C | 19 | Walking speed increased from 0.12 to 0.21 m/s. a |
| Alcobendas-Maestro et al., 2012 [218] | Robotic-assisted BWSTT vs. OG training |
3–6 mo | ASIA C&D | 48 M/32F | Robotic-assisted BWSTT and OG training walking speed remained the same from baseline to post-training. Robotic-assisted BWSTT increased 6 min walk distance from 91 to 169 m. a |
| Alexeeva et al., 2011 [179] | BWS training on a fixed track vs. BWSTT vs. Comprehensive PT |
3 days/wk 13 wk | ASIA C&D | 30 M/5 F | BWS on a fixed track increased walking speed from 0.33 to 0.44 m/s. a BWSTT increased walking speed from 0.30 to 0.46 m/s. a PT increased walking speed from 0.41 to 0.51 m/s. a |
| Duffell et al., 2015 [202] | Robotic-assisted BWSTT | 3 days/wk, 4 wk | ASIA C&D | 19 M/7 F | Walking speed increased from ~0.55 to ~0.58 m/s. a |
| Esclarin-Ruz et al., 2014 [219] | Robotic-assisted BWSTT + OG training (LKOGT) vs. Conventional OG training (OGT) | 5 days/wk, 8 wk | ASIA C&D | 59 M/24 F | LKOGT increased walking speed from 0.48 to 0.54 m/s and 6 min walk distance from 122 to 187 m b in participants with upper motor neuron injury. LKOGT increased walking speed from 0.24 to 0.46 m/s and 6 min walk distance from 82 to 157 m b in participants with lower motor neuron injury. OGT increased walking speed from 0.36 to 0.39 m/s and 6 min walk distance from 93 to 119 m in participants with upper motor neuron injury. OGT increased walking speed from 0.28 to 0.45 m/s and 6 min walk distance from 94 to 145 m in participants with lower motor neuron injury. |
| Field-Fote et al., 2005 [220] | Manual-assisted BWSTT (TM) vs. BWSTT + ES (TS) vs. BWS OG training + ES (OGS) vs. Robotic-assisted BWSTT (LR) |
5 days/wk 12 wk | ASIA C&D | 22 M/5 F | TM increased walking speed from ~0.07 to ~0.10. TS increased walking speed from ~0.12 to ~0.16 m/s. a OG increased walking speed from ~0.14 to ~0.19 m/s. a LR increased walking speed from ~0.09 to ~0.11. |
| Field-Fote & Roach 2011 [186] | Manual-assisted BWSTT (TM) vs. BWSTT + ES (TS) vs. BWS OG training +ES (OGS) vs. Robotic-assisted BWSTT (LR) |
5 days/wk, 12 wk | ASIA C&D | 52 M/12 F | TM increased walk speed from 0.17 to 0.22 m/s a and 2 min distance from 22.1 to 23.0 m. TS increased walk speed from 0.18 to 0.23 m/s a and 2 min distance from 20.6 to 24.4 m. a OGS increased walk speed from 0.19 to 0.28 m/s a and 2 min distance from 24.0 to 38.3 m. a,b LR increased walk speed from 0.17 to 0.18 m/s and 2 min distance from 16.8 to 17.9 m. |
| Gorassini et al., 2009 [169] | Manual-assisted BWSTT | 5 days/wk, 14 wk | ASIA C&D | 14 M/3 F | In 9 responders, walking speed increased from 0.31 to 0.55 m/s. a In 8 non-responders, there was no change in walking speed. |
| Harkema et al., 2012 [170] | Manual-assisted BWSTT | 3 day/wk, 4 to 92 wks | ASIA C&D | 148M/48 F | Walking speed increased from 0.31 to 0.51 m/s a and 6 min walk distance increased from 91 to 154 m. a |
| Kapadia et al., 2014 [221] | Robotic-assisted BWSTT + ES | 3 days/wk, 16 wk | ASIA C&D | 13 M/3 F | Walking speed increased from 0.23 to 0.28 m/s and 6 min walk distance increased from 187.9 to 217.1 m. a |
| Knikou 2013 [214] | Manual-assisted BWSTT | 5 days/wk, 1.5–3.5 mo | ASIA C&D | 9 M/3 F | 6 min walk distance increased from 36.25 to 39.05 m for ASIA C and from 252 to 279.5 m for ASIA D participants. |
| Krishnan et al., 2016 [171] | Robotic-assisted BWSTT | 3 day/wk, 4 wk | ASIA C&D | 8 M/8 F | Median walking speed increased from 0.58 to 0.66 m/s. a 6 min walking distance did not change. |
| Labruyere et al., 2014 [222] | Robotic-assisted BWSTT | 4 days/wk, 4 wk | ASIA C&D | 5 M/4 F | Walking speed increased from 0.62 to 0.66 m/s. |
| Lam et al., 2015 [223] | Robotic-assisted BWSTT with resistance (LR) vs. Robotic-assisted BWSTT only (LO) | 3 days/wk, 12 wk | ASIA C&D | 9 M/6 F | LR increased walking speed from 0.29 to 0.40 m/s. LO increased walking speed from 0.33 to 0.44 m/s. |
| Lucarelli et al., 2011 [187] | BWSTT vs. Conventional gait training |
2 days/wk, 12 wk | ASIA C&D | 20 M/10 F | BWSTT increased walking speed from 0.85 to 1.25 m/s a as well as increased cadence, distance, step length and swing phase. Conventional training did not improve gait quality or speed. |
| Morrison et al., 2018 [224] | Manual-assisted BWSTT | 120 sessions | ASIA C&D | 49 M/20 F | Median walking speed increased by 0.25 m/s. a Median 6 min walk distance increased by 66 m. a |
| Niu et al., 2014 [225] | Robotic-assisted BWSTT | 3 days/wk, 4 wk | ASIA C&D | 27 M/13 F | Walking speed increased in the low-walking capacity group from 0.12 to 0.15 m/s and in the high-walking capacity group from 0.84 to 0.97 m/s. 6 min walk distance did not change. |
| Nooijen et al., 2009 [172] | Manual-assisted BWSTT vs. Manual-assisted BWSTT with ES vs. OG training with ES vs. Robotic-assisted BWSTT |
4 days/wk, 12 wk | ASIA C&D | 40 M/11 F | All therapies led to small improvements in gait quality (increased cadence and step length) with no differences among groups. |
| Potsans et al., 2004 [188] | BWSTT with ES Cross-over design: treatment-control (AB); control-treatment (BA) |
5 days/wk, 4 wk | ASIA C&D | 12 M/2 F | In AB group, walking speed increased 0.23 m/s and 6 min walk distance increased 72.2 m. In BA group, walking speed increased 0.17 m/s and 6 min walk distance increased 63.8 m. |
| Thomas et al., 2005 [180] | Manual-assisted BWSTT | 4 days/wk, 16 wk | ASIA C&D | 8 M/2 F | Walking speed increased from 0.15 to 0.53 m/s a and 6 min walk distance increased from 34.2 to 167.6 m. |
| Varoqui et al., 2014 [203] | Robotic-assisted BWSTT | 3 days/wk, 4 wk | ASIA C&D | 14 M/ 1 F | Walking speed increased from 0.56 to 0.64 m/s a and 6 min walk distance did not change (207 to 209 m). |
| Winchester et al., 2005 [226] | Robotic-assisted BWSTT | 3 days/wk 12 wk | ASIA C&D | 4 M | Walking speed increased for 3 participants from 0.0 to 0.11, 0.0 to 0.81, 0.24 to 0.62 m/s and one remained unable to ambulate. |
| Wirz et al., 2005 [175] | Robotic-assisted BWSTT | 4 days/wk, 8 wk | ASIA C&D | 18 M/2 F | Walking speed increased from ~0.37 to ~.48 m/s a and 6 min walk distance 120 to 160 m. a |
| Wu et al., 2012 [227] | 4 wk Robotic-assistance BWSTT + 4 wk Robotic-resistance BWSTT | 3 days/wk, 8 wk | ASIA D | 8 M/2 F | Walking speed increased from 0.67 to 0.76 m/s a and 6 min walk distance increased from 223 to 247 m. Step length and cadence increased. a |
| Studies Assessing Muscle | |||||
| Duffell et al., 2015 [202] | Robotic-assisted BWSTT | 3 days/wk, 4 wk | ASIA C&D | 19 M/7 F | Maximal isometric ankle dorsiflexion torque increased from 12.3 to 13.2 Nm, a but plantar flexion torque did not change (28.1 vs. 28.4 Nm). |
| Galen et al., 2014 [228] | Robotic-assisted BWSTT | 5 days/wk, 6 wk | ASIA C&D | 14 M/4 F | Percent peak torque increased 68% for hip flexion, 54% for hip extension, 93% for knee flexion and 71% for knee extension. |
| Gorassini et al., 2009 [169] | Manual-assisted BWSTT | 5 days/wk, 14 wk | ASIA C&D | 14 M/3 F | In 9 responders, peak electromyography activity increased from 67 to 135 μV in the tibialis anterior muscle and 36 to 50 μV in the hamstrings. In 8 non-responders, there was no change. |
| Jayaraman et al., 2008 [201] | Manual-assisted BWSTT | 5 days/wk, 9 wk | ASIA C&D | 4 M/1 F | Isometric knee extension strength increased 21%. Isometric plantar flexion strength increased 44%. Knee extension and plantar flexion voluntary muscle activation improved. Maximal CSA of the plantar flexors increased and 15%. |
| Krishnan et al., 2016 [171] | Robotic-assisted BWSTT | 3 day/wk, 4 wk | ASIA C&D | 8 M/8 F | BWSTT increased isometric ankle dorsiflexion by 20% and ankle plantar flexion by 22%. |
| Thomas et al., 2005 [180] | Manual-assisted BWSTT | 4 days/wk, 16 wk | ASIA C&D | 8 M/2 F | Peak electromyography activity averaged from four lower limb muscles increased during treadmill walking from 82.4 to 137.1 μV. |
| Varoqui et al., 2014 [203] | Robotic-assisted BWSTT | 3 days/wk, 4 wk | ASIA C&D | 14 M/1 F | Ankle dorsiflexion torque increased from 26.8 to 29.1 Nma and ankle plantar flexion torque increased from 10.9 to 13.5 Nm. a |
BWSTT = bodyweight supported treadmill training; CSA = cross-sectional area; ES = electrical stimulation; m = meter, min = minute; mo = month; OG = overground; PT = physical therapy; wk = week. Note: a indicates statistically different from baseline; b indicates statistically different between training groups.