The Effects of Two Months Body Weight Supported Treadmill Training on Balance and Quality of Life of Patients With Incomplete Spinal Cord Injury

Abstract

Objective Spinal cord injury is a major problem for all communities that affect personal and social aspects of the patient's life. The most common issues that spinal cord injury patients face are paralysis, muscle atrophy, pain, and spasticity. The ability to walk also may be disrupted or lost in many of the patients with spinal cord injury. Most common approaches to rehabilitation for patients with spinal cord injury are the emphasis on healthy neuromuscular sections to promote these sectors and compensate existing defects. But recent studies have reported that the neuromuscular system is capable of plasticity and after spinal cord injury is necessary to pay attention to health and impaired neuromuscular parts of the body. Gait training is one of the rehabilitation approaches that is trying to recruit impaired neuromuscular parts and improve them. This reha-bilitation is performed in different ways. In this study, the effect of body weight supported treadmill training on balance and quality of life in patients with incomplete spinal cord injury was evaluated. Materials & Methods This is a quasi-experimental study. Patients with incomplete spinal cord injury (n=15) aged 26 and 48 years with a chronic (>1 year post-injury), grade D=4 and C=11 (according to American spinal cord injury association scale [ASIA]) voluntarily participated in this study. Sampling was conducted from hospi-tals and spinal cord injury rehabilitation centers of Tehran. For intervention, the patient was in the body weight support system. Patients' weight supported and suspended with harnesses and lifter of the body weight sup-port system to the extent that knees were not bent in stance phase and fingers can't be dragged into swing phase. Treadmill speed and amount of weight support adjusted depending on the patient's conditions. Inter-vention applied for eight weeks and three sessions a week. Each session lasted 30 minutes. Outcome mea-sures were Berg balance scale and SF-36 questioner. The quality of life evaluated before and after the inter-vention. Berg balance scale was evaluated at baseline and every two weeks throughout the intervention. The results were compared with each assessment. Repeated measure ANOVA test used for analysis of the scores of Berg balance scale and SF-36, paired t-test used. Results The evaluation results indicated that the scores of Berg balance scale, increased significantly compared to the previous stage in each reevaluation. Between the various stages of evaluation, the maximum difference was between the second and third stages (P=0.008) that were after two and four weeks after the first session respectively. The score of SF-36 showed no significant difference. Between 8 items that measured in SF-36 questioner, just score of »emotional roll functioning « increased significantly (P=0.006). Conclusion According to achieved results, eight weeks body weight supported treadmill training can improve the balance of the patients with spinal cord injury. It was observed that the gait training with stimulation and use of proprioceptors and increase of patient's confidence in walking and standing positions improve the patient's balance. The patients were also able to control the internal and external perturbations and maintain the better balance. But eight weeks gait training had no significant effect on the quality of life in patients with spinal cord injury which suggest that more extended rehabilitation is required. Use your device to scan and read the article online 4 ‫شماره‬ . 18 ‫دوره‬ . 1396 ‫زمستان‬ 329 ‫بیماران‬ ‫زندگی‬ ‫کیفیت‬ ‫و‬ ‫تعادل‬ ‫بر‬ ‫تردمیل‬ ‫روی‬ ‫وزن‬ ‫حمایت‬ ‫با‬ ‫همراه‬ ‫رفتن‬ ‫راه‬ ‫آموزش‬ ‫ماه‬ ‫دو‬ ‫تأثیر‬ ‫ناکامل‬ ‫نخاعی‬ ‫ضایعه‬ ‫مشکالتی‬ ‫ترین‬ ‫شایع‬ .‫گذارد‬ ‫می‬ ‫تأثیر‬ ‫فرد‬ ‫زندگی‬ ‫اجتماعی‬ ‫و‬ ‫فردی‬ ‫های‬ ‫جنبه‬ ‫بر‬ ‫که‬ ‫است‬ ‫جوامع‬ ‫همه‬ ‫مشکالت‬ ‫از‬ ‫یکی‬ ‫نخاعی‬ ‫ضایعه‬ ‫هدف‬ ‫رفتن‬ ‫راه‬ ‫توانایی‬ ‫است‬ ‫ممکن‬ ،‫همچنین‬ .‫است‬ ‫اسپاستیسیته‬ ‫و‬ ‫درد‬ ،‫عضالنی‬ ‫آتروفی‬ ‫و‬ ‫فلج‬ ،‫هستند‬ ‫مواجه‬ ‫آن‬ ‫با‬ ‫نخاعی‬ ‫ضایعه‬ ‫بیماران‬ ‫که‬ ‫وجود‬ ‫نخاعی‬ ‫ضایعه‬ ‫بیماران‬ ‫توانبخشی‬ ‫برای‬ ‫که‬ ‫متداولی‬ ‫رویکردهای‬ ‫بیشتر‬ .‫برود‬ ‫بین‬ ‫از‬ ‫یا‬ ‫شود‬ ‫مواجه‬ ‫اختالل‬ ‫با‬ ‫بیماران‬ ‫این‬ ‫از‬ ‫بسیاری‬ ‫در‬ ‫مطالعات‬ ‫اساس‬ ‫بر‬ .‫شود‬ ‫جبران‬ ‫موجود‬ ‫های‬ ‫نقص‬ ،‫ها‬ ‫بخش‬ ‫این‬ ‫ارتقای‬ ‫طریق‬ ‫از‬ ‫تا‬ ‫کند‬ ‫می‬ ‫تأکید‬ ‫سالم‬ ‫عضالنی‬ ‫عصبی‬ ‫های‬ ‫بخش‬ ‫بر‬ ،‫دارد‬ ،‫سالم‬ ‫های‬ ‫بخش‬ ‫بر‬ ‫عالوه‬ ‫است‬ ‫بهتر‬ ‫نخاعی‬ ‫ضایعه‬ ‫بیماران‬ ‫شرایط‬ ‫بهبود‬ ‫برای‬ ‫و‬ ‫دارد‬ ‫پالستیسیتی‬ ‫قابلیت‬ ‫عضالنی‬ ‫عصبی‬ ‫سیستم‬ ،‫اخیر‬ ‫تالش‬ ،‫آن‬ ‫طی‬ ‫که‬ ‫درمانی‬ ‫رویکردهای‬ ‫از‬ ‫یکی‬ .‫گیرد‬ ‫قرار‬ ‫مدنظر‬ ‫نیز‬ ‫ها‬ ‫بخش‬ ‫این‬ ‫بهبود‬ ‫ظرفیت‬ ‫و‬ ‫شود‬ ‫توجه‬ ‫نیز‬ ‫دیده‬ ‫آسیب‬ ‫های‬ ‫بخش‬ ‫به‬ ‫های‬ ‫روش‬ ‫به‬ ‫که‬ ‫است‬ ‫رفتن‬ ‫راه‬ ‫آموزش‬ ،‫یابد‬ ‫بهبود‬ ‫ها‬ ‫بخش‬ ‫این‬ ‫وضعیت‬ ‫و‬ ‫شود‬ ‫گرفته‬ ‫کار‬ ‫به‬ ‫دیده‬ ‫آسیب‬ ‫عضالنی‬ ‫عصبی‬ ‫های‬ ‫بخش‬ ‫شود‬ ‫می‬ ‫ضایعه‬ ‫بیماران‬ ‫زندگی‬ ‫کیفیت‬ ‫و‬ ‫تعادل‬ ‫بر‬ ،‫وزن‬ ‫حمایت‬ ‫با‬ ‫تردمیل‬ ‫روی‬ ‫رفتن‬ ‫راه‬ ‫آموزش‬ ‫تأثیر‬ ،‫مطالعه‬ ‫این‬ ‫در‬ .‫پذیرد‬ ‫می‬ ‫صورت‬ ‫مختلفی‬ .‫شود‬ ‫می‬ ‫بررسی‬ ‫ناکامل‬ ‫نخاعی‬ ‫معیار‬ ‫طبق‬ D ‫یا‬ C ‫درجه‬ ‫با‬ ‫نخاعی‬ ‫ضایعه‬ ‫دچار‬ ‫ساله‬ 48 ‫تا‬ 26 ‫بیمار‬ 15 ‫آن‬ ‫در‬ ‫که‬ ‫است‬ ‫تجربی‬ ‫شبه‬ ‫ای‬ ‫مطالعه‬ ،‫تحقیق‬ ‫این‬ ‫بررسی‬ ‫روش‬ ‫و‬ ‫ساده‬ ‫صورت‬ ‫به‬ ‫گیری‬ ‫نمونه‬ .‫گذشت‬ ‫می‬ ‫آنان‬ ‫آسیب‬ ‫از‬ ‫سال‬ ‫یک‬ ‫حداقل‬ ‫و‬ ‫کردند‬ ‫شرکت‬ ‫داوطلبانه‬ ‫صورت‬ ‫به‬ ،‫آمریکا‬ ‫نخاعی‬ ‫ضایعه‬ ‫انجمن‬ ‫با‬ ‫و‬ ‫گرفت‬ ‫قرار‬ ‫وزن‬ ‫حمایت‬ ‫دستگاه‬ ‫در‬ ‫بیمار‬ ،‫مداخله‬ ‫این‬ ‫انجام‬ ‫برای‬ .‫شد‬ ‫انجام‬ ‫تهران‬ ‫شهر‬ ‫نخاعی‬ ‫ضایعه‬ ‫توانبخشی‬ ‫مراکز‬ ‫و‬ ‫ها‬ ‫بیمارستان‬ ‫از‬ ‫تردمیل‬ ‫به‬ ‫آونگی‬ ‫فاز‬ ‫موقع‬ ‫پا‬ ‫انگشتان‬ ‫و‬ ‫نشوند‬ ‫خم‬ ‫رفتن‬ ‫راه‬ ‫ایستایی‬ ‫فاز‬ ‫موقع‬ ‫زانوها‬ ‫که‬ ‫جایی‬ ‫تا‬ ‫بیمار‬ ‫وزن‬ ،‫دستگاه‬ ‫باالبر‬ ‫و‬ ‫جلیقه‬ ‫از‬ ‫استفاده‬ ‫همه‬ ‫برای‬ .‫شد‬ ‫تنظیم‬ ‫بیمار‬ ‫شرایط‬ ‫به‬ ‫بسته‬ ‫و‬ ‫جلسه‬ ‫هر‬ ‫در‬ ‫وزن‬ ‫حمایت‬ ‫میزان‬ ‫و‬ ‫تردمیل‬ ‫سرعت‬ .‫شد‬ ‫تعلیق‬ ‫و‬ ‫حمایت‬ ،‫نشوند‬ ‫کشیده‬ ‫شده‬ ‫گیری‬ ‫اندازه‬ ‫موارد‬ .‫شد‬ ‫انجام‬ ‫ساعت‬ ‫نیم‬ ‫مدت‬ ‫به‬ ‫جلسه‬ ‫یک‬ ‫روز‬ ‫هر‬ ‫و‬ ‫هفته‬ ‫در‬ ‫روز‬ ‫سه‬ ،‫هفته‬ ‫هشت‬ ‫مدت‬ ‫به‬ ‫یکسان‬ ‫مداخله‬ ،‫بیماران‬ ‫همچنین‬ ‫و‬ ‫مداخله‬ ‫از‬ ‫بعد‬ ‫و‬ ‫قبل‬ ‫صورت‬ ‫به‬ ‫ِرگ‬ ‫ب‬ ‫تعادل‬ ‫مقیاس‬ .‫بود‬ ‫سؤالی‬ 36 ‫زندگی‬ ‫کیفیت‬ ‫نامه‬ ‫پرسش‬ ‫و‬ ‫ِرگ‬ ‫ب‬ ‫تعادل‬ ‫مقیاس‬ ‫شامل‬ ‫نتیجه‬ .‫کردند‬ ‫تکمیل‬ ‫مداخله‬ ‫انجام‬ ‫از‬ ‫بعد‬ ‫و‬ ‫قبل‬ ‫را‬ ‫سؤالی‬ 36 ‫زندگی‬ ‫کیفیت‬ ‫نامه‬ ‫پرسش‬ ‫بیماران‬ .‫شد‬ ‫گیری‬ ‫اندازه‬ ‫بار‬ ‫یک‬ ‫هفته‬ ‫دو‬ ‫هر‬ ‫برای‬ ‫و‬ ‫شد‬ ‫مکرر‬ ‫گیری‬ ‫اندازه‬ ‫واریانس‬ ‫تحلیل‬ ‫آزمون‬ ‫از‬ ‫استفاده‬ ‫با‬ ‫برگ‬ ‫تعادل‬ ‫مقیاس‬ ‫های‬ ‫داده‬ .‫شد‬ ‫مقایسه‬ ‫خودش‬ ‫با‬ ‫فرد‬ ‫هر‬ ‫های‬ ‫ارزیابی‬ .‫شد‬ ‫وتحلیل‬ ‫تجزیه‬ SPSS ‫آماری‬ ‫افزار‬ ‫نرم‬ 19 ‫نسخه‬ ‫کمک‬ ‫به‬ ،‫مورد‬ ‫به‬ ‫وابسته‬ ‫دانشجویی‬ ‫تی‬ ‫آزمون‬ ‫از‬ ‫سؤالی‬ 36 ‫زندگی‬ ‫کیفیت‬ ‫نامه‬ ‫پرسش‬