Restoring walking ability in people with spinal cord injury unable to walk independently with the aid of robot-assisted therapy

To assess improvements in walking ability against pre-defined thresholds for gait speed and walking distance.

Retrospective analysis of data from 119 patients with iSCI (mean age 58, SD 17 years, 92% ≤6 months after onset, 50% caused by injury, 49% paraparesis) who underwent inpatient multidisciplinary rehabilitation for at least 20 days with the addition of RAGT (Lokomat, DIH Medical) was performed. They participated in an average of 18 sessions (SD 8) with average session duration of 28 minutes (SD 7). The Six-minute Walk Test (6MWT) and the Ten-meter Walk Test at a comfortable speed (10MWT) were performed according to the guidelines on a 60 meter and 14 meter walkway, respectively. Inclusion criterion was the inability to perform the 10MWT at admission without physical assistance (speed 0 m/s). At admission, all participants also covered 0 meters on the 6MWT. Participants were categorized into Walking Ability Categories according to their walking tests outcomes: no walking/non-functional walking (0 m; 0 m/s), in-home walking (≤204 m; ≤0.48 m/s), limited community walking (≤287 m; ≤0.92 m/s), or unlimited community walking (≥288 m; ≥0.93 m/s). Descriptive statistics of changes between admission and discharge were calculated, including the proportions of participants who fitted into each of the four categories at discharge, and those who exceeded the minimal clinically important difference (MCID) of 6MWT (69 m) and 10MWT (0.18 m/s).

The mean change for 6MWT was 98 meters (SD 99) and for 10MWT 0.3 m/s (SD 0.3). The MCID of 6MWT was exceeded by 54% and the MCID of 10MWT by 57% of participants. At discharge, 35% for 6MWT and 34% for 10MWT remained in the no walking/non-functional walking category, 49% for 6MWT and 37% for 10MWT improved to in-home walkers, 13% for 6MWT and 26% for 10MWT became limited community walkers, 3% for both tests regained unlimited community walking ability. 

The results show substantial improvement in walking capacity, implying improvement in walking performance in real life in patients who were unable to walk independently on admission to rehabilitation. We can assume that RAGT played an important role in this, as we enrolled mostly patients with subacute iSCI without or with limited walking capacity, but this role remains uncertain.

Until the most appropriate subpopulation of iSCI for RAGT is determined, it is suggested that non-ambulatory patients and those requiring assistance for a 10-m walk be included in RAGT in addition to conventional physiotherapy.