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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?
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).
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Stepping training with feedback | Experimental | 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. |
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| Stepping training without feedback | Active Comparator | 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. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Stepping training with feedback | Other | 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. |
| 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 |
| 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) |
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Inclusion Criteria:
Exclusion Criteria:
Any conditions or disorders that might affect ability to participate in the study and/or ambulatory ability of the subjects such as
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| Name | Affiliation | Role |
|---|---|---|
| Sugalya Amatachaya | School of Physical Therapy, Khon Kaen University, Thailand | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Faculty of Associated Medical Science | Khon Kaen | Muang | 40002 | Thailand |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 19208261 | Background | Ada L, Dean CM, Lindley R, Lloyd G. Improving community ambulation after stroke: the AMBULATE Trial. BMC Neurol. 2009 Feb 11;9:8. doi: 10.1186/1471-2377-9-8. | |
| 24090447 | Background | Amatachaya S, Amatachaya P, Keawsutthi M, Siritaratiwat W. External cues benefit walking ability of ambulatory patients with spinal cord injury. J Spinal Cord Med. 2013 Nov;36(6):638-44. doi: 10.1179/2045772312Y.0000000086. Epub 2013 Apr 12. |
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| ID | Term |
|---|---|
| D013119 | Spinal Cord Injuries |
| ID | Term |
|---|---|
| D013118 | Spinal Cord Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D020196 | Trauma, Nervous System |
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| Stepping training without feedback | Other | 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. |
|
| 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 |
| 19139759 | Background | Amatachaya S, Keawsutthi M, Amatachaya P, Manimmanakorn N. Effects of external cues on gait performance in independent ambulatory incomplete spinal cord injury patients. Spinal Cord. 2009 Sep;47(9):668-73. doi: 10.1038/sc.2008.168. Epub 2009 Jan 13. |
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| 36472135 | Derived | Amatachaya S, Nithiatthawanon T, Amatachaya P, Thaweewannakij T. 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. Disabil Rehabil. 2023 Dec;45(26):4431-4439. doi: 10.1080/09638288.2022.2152502. Epub 2022 Dec 6. |
| D014947 | Wounds and Injuries |