Advantage in muscle activation in gait with support of body weight in spinal cord injury

Abstract Introduction: The locomotor training with body weight support has been proposed as an alternative for the rehabilitation of people with spinal cord injury, in order to develop most of the residual potential of the body. Objective: To compare the levels of muscle activation of the main muscle involved in gait during body weight-supported treadmill training and body weight-supported overground training in incomplete spinal cord injured patients. Methods: It was a prospective cross-sectional study, in which 11 incomplete injured patients were submitted to two modalities of gait with body weight support, the first one on the treadmill (two different speeds: 1 and 4km/h), and the second one with the walker on fixed floor. The electromyographical acquisition was done in the rectus femoris (RF), vastus medialis (VM), vastus lateralis (VL) and gluteus maximus (GM). Results: There was a greater muscle activation of all muscles analyzed in the treadmill training as compared to the over groundtraining, both at 4 km/h (RF: p=0.00), (VM: p=0.00), (VL: p=0.00) e (GM: p=0.00) and at 1km/h (RF: p=0.00), (VM: p=0.00), (VL: p=0.00) e (GM: p=0.00). When comparing the two modalities of treadmill training, at 4 and 1km/h, there was no statically significant difference between them (RF: p=0.36), (VM: p=1.00), (VL: p=1.00) e (GM: p=0.16). Conclusion: The gait training with body weight support is more effective in activating the muscles involved in the gait training on treadmill compared to overground training in patients with incomplete spinal cord injury.摘要引言：减重支持步行训练（locomotor training with body weight support）曾被提出作为脊髓损伤患者康复的替代方案，以期最大化开发机体残余运动潜能。 研究目的：对比不完全性脊髓损伤患者在减重支持跑台训练与减重支持地面步行训练时，步态主要参与肌肉的激活水平。 研究方法：本研究为前瞻性横断面研究，纳入11例不完全性脊髓损伤患者，令其完成两种减重支持步行模式：第一种为跑台步行（设置两种速度：1km/h与4km/h），第二种为借助助行器在固定地面步行。采用肌电采集技术检测股直肌（rectus femoris, RF）、股内侧肌（vastus medialis, VM）、股外侧肌（vastus lateralis, VL）及臀大肌（gluteus maximus, GM）的肌电信号。 研究结果：相较于地面步行训练，跑台训练中所有被分析肌肉的激活水平均更高，无论是4km/h速度下（股直肌：p=0.00；股内侧肌：p=0.00；股外侧肌：p=0.00；臀大肌：p=0.00），还是1km/h速度下（股直肌：p=0.00；股内侧肌：p=0.00；股外侧肌：p=0.00；臀大肌：p=0.00）。对比两种跑台训练模式（4km/h与1km/h），各肌肉激活水平均无统计学显著性差异（股直肌：p=0.36；股内侧肌：p=1.00；股外侧肌：p=1.00；臀大肌：p=0.16）。 研究结论：对于不完全性脊髓损伤患者，减重支持步行训练中，跑台训练相较于地面步行训练，能更有效地激活步态相关肌肉。