Stepping Training Using External Feedback in Spinal Cord Injury Patients

Study Overview
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Brief Summary
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Does a 4-week stepping training program with or without external feedback clinically change functional ability and reduce risk of fall of ambulatory patients with iSCI? Are there significant differences between 4-weeks stepping training with or without external feedback in ambulatory patients with iSCI?

Detailed Description
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To compare effects of 4-week stepping training with or without external feedback on functional ability and incidence of falls in ambulatory patients with iSCI (between-group comparison). To compare the change of functional ability in a group of 4-week stepping training with or without the utility of external feedback (within-group comparison).

Official Title
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Effects of Stepping Training With External Feedback on Walking and Functional Ability in Ambulatory Patients With Spinal Cord Injury

Conditions
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Spinal Cord Injuries

Intervention / Treatment
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* Other: Stepping training with feedback
* Other: Stepping training without feedback


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Independent ambulatory patients with iSCI Non-traumatic or traumatic causes Independent walking with or without assistive devices at least 17 meters (Functional Independence Measure Locomotor (FIM-L) scores 5-7) Age at least 18 years Body mass index (BMI) between 18.5 - 29.9 kg/m2. Exclusion Criteria: Any conditions or disorders that might affect ability to participate in the study and/or ambulatory ability of the subjects such as Brain function disorders Visual deficits that cannot be corrected using glasses or contact lens Musculoskeletal pain (with an intensity of pain more than 5 out of 10 on a numerical rating pain scale) Deformity of the musculoskeletal system Unable to follow a command of the tests Unstable medical conditions Color blindness

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Stepping training with feedback<br>Subjects will be instructed to perform the stepping task with external feedback continuously until 20 minutes (excluding resting periods) but without fatigue. Then they continue a training program of overground walking for 10 minutes. They have to be involved in a training program of their groups 5 times/week, for 4 weeks in total. | Other: Stepping training with feedback<br>* Subjects stand in a step standing position with placing one leg on the load cells of the device and the other leg at the posterolateral direction to the trained leg outside the load cells, look at the displayed section which will be positioned at their eye level. Then subjects will be instructed to shift/take their body-weight onto the trained leg until the green zone of the displayed section is lightened. When the subjects can take a proper level of their body-weight onto the trained leg, the beep sound will be alarmed to trigger the subjects and therapist that the subjects can step the other leg forward to the marker. Then they have to do the same when steps the leg backward.<br>|
| Active Comparator: Stepping training without feedback<br>Subjects will be instructed to perform the stepping task without external feedback continuously until 20 minutes (excluding resting periods) but without fatigue. Then they continue a training program of overground walking for 10 minutes. They have to be involved in a training program of their groups 5 times/week, for 4 weeks in total. | Other: Stepping training without feedback<br>* Subjects stand in a step standing position with placing one leg on the load cells of the device and the other leg at the posterolateral direction to the trained leg outside the load cells. Then subjects will be instructed to shift/take their body-weight onto the trained leg as most as they can. If the subjects can take a proper level of their body-weight onto the trained leg, the subjects can step the other leg forward to the marker. Then they have to do the same when steps the leg backward.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of walking stability using Timed up and go test [TUGT] | The test was designed to measure mobility and dynamic balance control related to walking. Subjects will be instructed to stand up from a standard chair, walk at a fastest and safe speed for 3 meters, turn around a traffic cone, walk back and sit down on the chair with or without a walking device. Then the average time required for the 3 trials will be recorded. | prior to training, after 2 weeks, after 4 weeks, and 6 months after complete the training program | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of walking speed using 10 meter walk test (10MWT) | The test measures walking speed. Subjects will be instructed to walk at a prefer speed and fastest speed along a 10 meters walkway with or without walking device. The video recording will be captured over the 4 meters in the middle walkway in order to minimize acceleration and deceleration effects. Then the data will be converted to a walking speed using a formula; (v = s/t) | prior to training, after 2 weeks, after 4 weeks, and 6 months after complete the training program | 
| Change of lower limb muscle strength using Five times sit-to-stand [FTSST] | The test has used to quantify lower extremity motor strength. The time taken to complete 5 chair-rise cycles at a fastest and safe speed will be recorded for each subject. Then the average time required for the 3 trials will be used for data analysis. | prior to training, after 2 weeks, after 4 weeks, and 6 months after complete the training program | 
| Change of walking endurance using 6 minute walk test (6MWT) | The test measures the longest walking distance in 6 minute to reflect the responses of the cardiopulmonary and muscular systems. Subjects will be instructed to walk along a rectangular walkway as long as they can with a safety speed. They can walk with or without walking device in 6 minutes and are able to take a resting period as needed and continuing to walk. The distance covered after 6 minutes will be recorded. | prior to training, after 2 weeks, after 4 weeks, and 6 months after complete the training program | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Rehabilitation, Neurological condition, Walking ability, Feedback, External information