Results Horizontal force developed on the MotionMaker ™

1. Robotic rehabilitation and recovery of motor performance in a spinal cord injured population F. Reynard, T. Nesa, R. Dalla Palma, A. Al-Khodairy Clinique romande de réadaptationSuvaCare, Sion, Switzerland • Introduction • After a spinal lesion, early mobilisation of the paralysed limbs is necessary in order to promote recovery of voluntary motor activity through neural plasticity and to prevent secondary damages due to immobility. • The MotionMaker™, a stationary testing and training device : • allows to carry out lower limb mobilisation with an active participation of the paralysed limbs through residual lower extremity activity and/or electromyostimulation. The patient performs actively, repetitively and intensively precise physiological movements with a real-time feedback of the performance; • is designed to train the muscle strength and endurance of the legs and to prepare the patient for gait activities; • consists of two motorised orthoses which include hip, knee and ankle joints and a closed loop electrical muscle stimulation system. The presence of force and position sensors allows continuous adaptation of the muscle stimulation and the action of the motors to produce the pre-programmed movement. • Methods • Seven spinal cord injured (SCI) patients underwent a training program on the MotionMaker™. • This twice-a-week training consisted of repetitive isokinetic leg press movements in extension, in concentric and in eccentric modes. • Functional electrical stimulation of the glutei, quadriceps and triceps surae muscles was superimposed on the residual voluntary muscle strength, if any, to maximise the output torque. • The horizontal force developed at the feet (average of the left and right lower extremity) during the movement was measured before and after the training period, in three different conditions: • the movement is performed with the residual strength of the lower extremities, • the movement is performed with the electrical stimulation only, • the movement is performed with a combination of residual strength and electromyostimulation. • Neurological evaluation and functional tests were also realised in a pre-post design: ASIA lower extremity motor score, Walking index for spinal cord injury (WISCI-II), six-minute walking test (6 MWT), gait speed and Spinal Cord Independence Measure (SCIM-II). • Due to several limitations of the study design (small sample size, influence of other therapies, absence of control group), data were analysed only descriptively. • Results • Horizontal force developed on the MotionMaker™ All patients increased their electroinduced strength (median increase: 240%, range: 125-8247%) and their residual + electroinduced strength (median increase:178%, range: 48-1107%). The residual voluntary strength of the extensor leg muscles increased by 156% (range 0-965%); 2 patients (P5,P6) did not recover any voluntary strength. • Neurological and functional evaluation • Five patients showed an improvement in their neurological status (ASIA lower extremity motor score) and four of them recovered some walking capacities (WISCI-II, 6MWT and gait speed). Functional independence (SCIM-II) improved in all situations. • Subjective impressions • Patients found an increased awareness of their muscles and felt more confident in their functional activities, such as bed mobility, transfers and gait. • Conclusion • Mobilisation exercises realised with robotic rehabilitation device including electrical stimulation can stimulate the sensorimotor system. It seems to be helpful to gain forces, to improve the proprioceptive functionand to facilitate locomotor performances. This can be the result of peripheral mechanisms – better contractibility properties of the muscles fibres – and of central action of the nervous system – improved function of the spinal motor system related to neural plasticity. • These preliminary findings suggest that the MotionMaker™ is an interesting adjunctive neuromuscular treatment for SCI patients. Further investigations are needed to assess the real effectiveness and efficiency of the MotionMaker™ device. ESMAC LONDON 2009 ,17-19 september 2009 Contact: Fabienne.Reynard@crr-suva.ch