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Facilitatory effects of anti-spastic medication on robotic locomotor training in people with chronic incomplete spinal cord injury.

Duffell LD, Brown GL, Mirbagheri MM - J Neuroeng Rehabil (2015)

Bottom Line: The number of subjects that achieved the minimal important difference (MID) for clinical scores was also measured for each group, and the results of those that did attain the MID were compared with those that did not.Those that achieved the MID for walking speed were significantly higher functioning at baseline than those that did not in the TizLTT group, and the change in walking speed was associated with the change in dorsiflexion peak velocity (R(2) = 0.40; P < 0.05).We speculate that this may be due to restoration of inhibitory mechanisms by Tizanidine, resulting in greater stretch in the planterflexor muscles during the LTT.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical Medicine and Rehabilitation, Northwestern University, 345 E Superior Street, Chicago, USA. l.duffell@ucl.ac.uk.

ABSTRACT

Background: The objective of this study was to investigate whether an anti-spasticity medication can facilitate the effects of robotic locomotor treadmill training (LTT) to improve gait function in people with incomplete spinal cord injury (SCI).

Methods: Individuals with chronic incomplete SCI were recruited and carried out a 4 week intervention of either locomotor treadmill training (LTT) alone (n = 26) or LTT combined with Tizanidine (TizLTT), an anti-spasticity medication (n = 22). Gait function was evaluated using clinical outcome measures of gait, speed and endurance. To better understand the underlying mechanisms of the therapeutic effects, maximal strength, active range of motion (AROM) and peak velocity (Vp) of ankle dorsi- and planter-flexor muscles were also measured. Differences were assessed using two-way mixed design analysis of variance. The number of subjects that achieved the minimal important difference (MID) for clinical scores was also measured for each group, and the results of those that did attain the MID were compared with those that did not.

Results: Both LTT and TizLTT resulted in significant improvements in walking speed and dorsiflexion maximum strength, with no significant differences between them, using group-averaging analysis. However, using the MID analysis, a higher proportion of subjects in the TizLTT group achieved the MID for walking speed (40%) compared with LTT alone (13%). Those that achieved the MID for walking speed were significantly higher functioning at baseline than those that did not in the TizLTT group, and the change in walking speed was associated with the change in dorsiflexion peak velocity (R(2) = 0.40; P < 0.05).

Conclusion: Tizanidine appears to facilitate the effects of LTT on gait function in individuals with chronic SCI that are higher functioning at baseline. We speculate that this may be due to restoration of inhibitory mechanisms by Tizanidine, resulting in greater stretch in the planterflexor muscles during the LTT.

No MeSH data available.


Related in: MedlinePlus

Peak velocity (Vp) during dorsiflexion in the combined locomotor treadmill training (LTT; blue) and Tizanidine (TizLTT; red) group. (a) Mean (SEM) at 0, 1, 2 and 4 weeks into the intervention and (b) change in Vp plotted against change in walking speed from baseline to the 4th week assessment, for subjects in the TizLTT group that did (filled diamonds) and did not (open diamonds) achieve the minimal important difference (MID) in the 10MWT.
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Fig3: Peak velocity (Vp) during dorsiflexion in the combined locomotor treadmill training (LTT; blue) and Tizanidine (TizLTT; red) group. (a) Mean (SEM) at 0, 1, 2 and 4 weeks into the intervention and (b) change in Vp plotted against change in walking speed from baseline to the 4th week assessment, for subjects in the TizLTT group that did (filled diamonds) and did not (open diamonds) achieve the minimal important difference (MID) in the 10MWT.

Mentions: Changes in MVIC, AROM and Vp were compared between the subjects that did and did not achieve the MID, based on the 10MWT only, since the number of subjects that achieved the MID was too low in other groups to make meaningful conclusions. Changes in MVIC, AROM and Vp with time did not differ between the subjects that did and did not achieve the MID for walking speed among both intervention groups, however Vp tended to increase in the subjects that achieved the MID within the TizLTT group compared with those that did not attain the MID, and all subjects in the LTT alone group (Figure 3a). There was also a significant moderate correlation between the change in walking speed and change in Vp among the TizLTT group (R2 = 0.40, p < 0.05; Figure 3b).Figure 3


Facilitatory effects of anti-spastic medication on robotic locomotor training in people with chronic incomplete spinal cord injury.

Duffell LD, Brown GL, Mirbagheri MM - J Neuroeng Rehabil (2015)

Peak velocity (Vp) during dorsiflexion in the combined locomotor treadmill training (LTT; blue) and Tizanidine (TizLTT; red) group. (a) Mean (SEM) at 0, 1, 2 and 4 weeks into the intervention and (b) change in Vp plotted against change in walking speed from baseline to the 4th week assessment, for subjects in the TizLTT group that did (filled diamonds) and did not (open diamonds) achieve the minimal important difference (MID) in the 10MWT.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4376342&req=5

Fig3: Peak velocity (Vp) during dorsiflexion in the combined locomotor treadmill training (LTT; blue) and Tizanidine (TizLTT; red) group. (a) Mean (SEM) at 0, 1, 2 and 4 weeks into the intervention and (b) change in Vp plotted against change in walking speed from baseline to the 4th week assessment, for subjects in the TizLTT group that did (filled diamonds) and did not (open diamonds) achieve the minimal important difference (MID) in the 10MWT.
Mentions: Changes in MVIC, AROM and Vp were compared between the subjects that did and did not achieve the MID, based on the 10MWT only, since the number of subjects that achieved the MID was too low in other groups to make meaningful conclusions. Changes in MVIC, AROM and Vp with time did not differ between the subjects that did and did not achieve the MID for walking speed among both intervention groups, however Vp tended to increase in the subjects that achieved the MID within the TizLTT group compared with those that did not attain the MID, and all subjects in the LTT alone group (Figure 3a). There was also a significant moderate correlation between the change in walking speed and change in Vp among the TizLTT group (R2 = 0.40, p < 0.05; Figure 3b).Figure 3

Bottom Line: The number of subjects that achieved the minimal important difference (MID) for clinical scores was also measured for each group, and the results of those that did attain the MID were compared with those that did not.Those that achieved the MID for walking speed were significantly higher functioning at baseline than those that did not in the TizLTT group, and the change in walking speed was associated with the change in dorsiflexion peak velocity (R(2) = 0.40; P < 0.05).We speculate that this may be due to restoration of inhibitory mechanisms by Tizanidine, resulting in greater stretch in the planterflexor muscles during the LTT.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical Medicine and Rehabilitation, Northwestern University, 345 E Superior Street, Chicago, USA. l.duffell@ucl.ac.uk.

ABSTRACT

Background: The objective of this study was to investigate whether an anti-spasticity medication can facilitate the effects of robotic locomotor treadmill training (LTT) to improve gait function in people with incomplete spinal cord injury (SCI).

Methods: Individuals with chronic incomplete SCI were recruited and carried out a 4 week intervention of either locomotor treadmill training (LTT) alone (n = 26) or LTT combined with Tizanidine (TizLTT), an anti-spasticity medication (n = 22). Gait function was evaluated using clinical outcome measures of gait, speed and endurance. To better understand the underlying mechanisms of the therapeutic effects, maximal strength, active range of motion (AROM) and peak velocity (Vp) of ankle dorsi- and planter-flexor muscles were also measured. Differences were assessed using two-way mixed design analysis of variance. The number of subjects that achieved the minimal important difference (MID) for clinical scores was also measured for each group, and the results of those that did attain the MID were compared with those that did not.

Results: Both LTT and TizLTT resulted in significant improvements in walking speed and dorsiflexion maximum strength, with no significant differences between them, using group-averaging analysis. However, using the MID analysis, a higher proportion of subjects in the TizLTT group achieved the MID for walking speed (40%) compared with LTT alone (13%). Those that achieved the MID for walking speed were significantly higher functioning at baseline than those that did not in the TizLTT group, and the change in walking speed was associated with the change in dorsiflexion peak velocity (R(2) = 0.40; P < 0.05).

Conclusion: Tizanidine appears to facilitate the effects of LTT on gait function in individuals with chronic SCI that are higher functioning at baseline. We speculate that this may be due to restoration of inhibitory mechanisms by Tizanidine, resulting in greater stretch in the planterflexor muscles during the LTT.

No MeSH data available.


Related in: MedlinePlus