Balance
There were no statistical differences between the changes
in scores due to RAGT and strength training for balance
measures. However, keeping the low statistical power in
mind, improvements in the BBS tended to be larger after
strength training compared to RAGT. At least the effectiveness
of strength training could be anticipated, as it was
observed in other populations, such as patients with
stroke [50] or healthy elderly [51].
While RAGT improved the BBS score in patients with
stroke [9], its effect on static balance has herewith been
investigated for the first time. Neither intervention had
an influence on static balance. With the current hardware
of the Lokomat, one can assume that static balance cannot
really be trained; subjects are firmly attached to the device
and they are secured from falling by different mechanisms
(body weight support, hand rails, foot lifters).
To summarize, it seems that if there is adequate residual
muscle strength (to perform walking with some assistance)
after iSCI, strength training certainly does not perform
worse compared to RAGT when it comes to
improving ambulatory function. Further studies are necessary
to determine what level of muscle strength (motor
score) is needed to recommend strength training (in combination
with over-ground gait training) to produce better
clinical outcome, as an extension to the work done by
Behrman et al. in the field of BWSTT [52]. Nevertheless,
RAGT might play an important role during the acute
phase, when patients have little residual muscle strength.
BalanceThere were no statistical differences between the changesin scores due to RAGT and strength training for balancemeasures. However, keeping the low statistical power inmind, improvements in the BBS tended to be larger afterstrength training compared to RAGT. At least the effectivenessof strength training could be anticipated, as it wasobserved in other populations, such as patients withstroke [50] or healthy elderly [51].While RAGT improved the BBS score in patients withstroke [9], its effect on static balance has herewith beeninvestigated for the first time. Neither intervention hadan influence on static balance. With the current hardwareof the Lokomat, one can assume that static balance cannotreally be trained; subjects are firmly attached to the deviceand they are secured from falling by different mechanisms(body weight support, hand rails, foot lifters).To summarize, it seems that if there is adequate residualmuscle strength (to perform walking with some assistance)after iSCI, strength training certainly does not performworse compared to RAGT when it comes toimproving ambulatory function. Further studies are necessaryto determine what level of muscle strength (motorscore) is needed to recommend strength training (in combinationwith over-ground gait training) to produce betterclinical outcome, as an extension to the work done byBehrman et al. in the field of BWSTT [52]. Nevertheless,RAGT might play an important role during the acutephase, when patients have little residual muscle strength.
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