Effects of four-week lower limb loading training with and without augmented feedback on mobility, walking device use, and falls among ambulatory individuals with spinal cord injury: a randomized controlled trial

Abstract

Purpose

To compare the effects of lower limb loading training (LLLT) with or without augmented loading feedback during stepping activity on mobility, walking device use, and falls among ambulatory individuals with chronic spinal cord injury (SCI).

Study design

Randomized controlled trial (assessor-blinded) with prospective fall data follow-up, clinical trial registration (NCT03254797).

Methods

Forty-four ambulatory participants (22 participants/group) were prospectively monitored for their baseline fall data over six months, with baseline assessments for their mobility and walking device used after six months. Then participants involved in the LLLT programs with or without loading feedback according to their groups for 30 min/day, 5 days/week, over 4 weeks. Mobility outcomes were re-assessed at week two and week four, with prospective fall data monitoring over six months, and mobility measured thereafter.

Results

Mobility outcomes of the participants were significantly improved from their baseline ability, especially in those who were trained using augmented feedback (the difference in main outcome, timed up and go, between the groups was 1.8 s; 95% confidence interval = 1.0–3.5s).

Conclusions

LLLT during stepping activity, especially with augmented loading feedback, could be applied effectively to promote mobility and safety of ambulatory individuals with chronic SCI (post-injury time of approximately four years).

Implication for Rehabilitation

• A training program of bodyweight shifting and lower limb loading training during stepping activity significantly improved mobility, walking ability, and fall rates of ambulatory individuals with chronic spinal cord injury.

• The improvement in those who were trained using augmented loading feedback was significantly greater than those who were trained without feedback.

• Such training programs may be applied to distribute effective community-based rehabilitation and home healthcare services.

Keywords:

• Balance
• fall
• movement
• rehabilitation
• walking
• weight-bearing

Acknowledgements

The researchers sincerely thank for the kind support and contribution for staff and patients’ data from the Department of Rehabilitation Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen; and training equipment from Rajamangala University of Technology Isan, Nakhon Ratchasima, Thailand.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work received funding support from the Royal Golden Jubilee Ph.D. Program (RGJ-PhD) under the National Research Council of Thailand [PHD57K0194], and the research and Graduate Studies, Khon Kaen University [RP64016], Thailand.