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Escuchar "#49: Lesión medular y entrenamiento de la marcha con soporte de peso"
Síntesis del Episodio
En el episodio de hoy, hablo de la lesión medular y el entrenamiento con sistemas de soporte de peso corporal, una modalidad de tratamiento que cada vez está más en boga y que parece realmente que tiene su lugar asentado dentro de la rehabilitación de la lesión medular. Normalmente colocamos un arnés al paciente, que se une a una máquina que descarga el peso en un cierto porcentaje. Esa idea se cumple a la perfección en el caso de las grúas pero si pensamos en un paciente que quiere caminar, parece que quitarle peso, no es suficiente. ¿Hay algo más en estos sistemas de soporte de peso? ¿Qué hay de interacción humano-máquina? En este episodio, vemos estudios en sujetos sanos y en lesionados medulares, describimos sistemas de soporte de peso y aportamos ideas prácticas para terapia.
Bibliografía:
(1)Alexeeva N, Sames C, Jacobs PL, Hobday L, Distasio MM, Mitchell SA, Calancie B. Comparison of training methods to improve walking in persons with chronic spinal cord injury: a randomized clinical trial. J Spinal Cord Med. 2011;34(4):362-79. doi: 10.1179/2045772311Y.0000000018. PMID: 21903010; PMCID: PMC3152808 (https://pubmed.ncbi.nlm.nih.gov/21903010/).
(2)Apte S, Plooij M, Vallery H. Influence of body weight unloading on human gait characteristics: a systematic review. J Neuroeng Rehabil. 2018 Jun 20;15(1):53. doi: 10.1186/s12984-018-0380-0. Erratum in: J Neuroeng Rehabil. 2018 Aug 8;15(1):73. PMID: 29925400; PMCID: PMC6011391 (https://pubmed.ncbi.nlm.nih.gov/29925400/).
(3)Apte S, Plooij M, Vallery H. Simulation of human gait with body weight support: benchmarking models and unloading strategies. J Neuroeng Rehabil. 2020 Jun 25;17(1):81. doi: 10.1186/s12984-020-00697-z. PMID: 32586398; PMCID: PMC7318415 (https://pubmed.ncbi.nlm.nih.gov/32586398/).
(4)Easthope CS, Traini LR, Awai L, Franz M, Rauter G, Curt A, Bolliger M. Overground walking patterns after chronic incomplete spinal cord injury show distinct response patterns to unloading. J Neuroeng Rehabil. 2018 Nov 12;15(1):102. doi: 10.1186/s12984-018-0436-1. PMID: 30419945; PMCID: PMC6233558 (https://pubmed.ncbi.nlm.nih.gov/30419945/).
(5)Escribano-Ardura S, Cuesta-Gómez A, Fernández-González P, Carratalá-Tejada M, Molina-Rueda F. Entrenamiento en cinta rodante con soporte parcial del peso corporal en pacientes con lesión medular incompleta: revisión sistemática [Treadmill training with partial body weight support in subjects with incomplete spinal cord injury: a systematic review]. Rev Neurol. 2020 Aug 1;71(3):85-92. Spanish. doi: 10.33588/rn.7103.2020054. PMID: 32672346 (https://pubmed.ncbi.nlm.nih.gov/32672346/).
(6)Fenuta AM, Hicks AL. Metabolic demand and muscle activation during different forms of bodyweight supported locomotion in men with incomplete SCI. Biomed Res Int. 2014;2014:632765. doi: 10.1155/2014/632765. Epub 2014 May 21. PMID: 24971340; PMCID: PMC4055602 (https://pubmed.ncbi.nlm.nih.gov/24971340/).
(7)Fenuta AM, Hicks AL. Muscle activation during body weight-supported locomotion while using the ZeroG. J Rehabil Res Dev. 2014;51(1):51-8. doi: 10.1682/JRRD.2013.01.0005. PMID: 24805893 (https://pubmed.ncbi.nlm.nih.gov/24805893/9.
(8)Fischer AG, Debbi EM, Wolf A. Effects of body weight unloading on electromyographic activity during overground walking. J Electromyogr Kinesiol. 2015 Aug;25(4):709-14. doi: 10.1016/j.jelekin.2015.05.001. Epub 2015 May 16. PMID: 26025610 (https://pubmed.ncbi.nlm.nih.gov/26025610/).
(9)Hidler J, Brennan D, Black I, Nichols D, Brady K, Nef T. ZeroG: overground gait and balance training system. J Rehabil Res Dev. 2011;48(4):287-98. doi: 10.1682/jrrd.2010.05.0098. PMID: 21674384 (https://pubmed.ncbi.nlm.nih.gov/21674384/).
(10)Huber JP, Sawaki L. Dynamic body-weight support to boost rehabilitation outcomes in patients with non-traumatic spinal cord injury: an observational study. J Neuroeng Rehabil. 2020 Nov 30;17(1):157. doi: 10.1186/s12984-020-00791-2. PMID: 33256797; PMCID: PMC7706039 (https://pubmed.ncbi.nlm.nih.gov/33256797/).
(11)Lewek MD. The influence of body weight support on ankle mechanics during treadmill walking. J Biomech. 2011 Jan 4;44(1):128-33. doi: 10.1016/j.jbiomech.2010.08.037. Epub 2010 Sep 19. PMID: 20855074 (https://pubmed.ncbi.nlm.nih.gov/20855074/).
(12)Mignardot JB, Le Goff CG, van den Brand R, Capogrosso M, Fumeaux N, Vallery H, Anil S, Lanini J, Fodor I, Eberle G, Ijspeert A, Schurch B, Curt A, Carda S, Bloch J, von Zitzewitz J, Courtine G. A multidirectional gravity-assist algorithm that enhances locomotor control in patients with stroke or spinal cord injury. Sci Transl Med. 2017 Jul 19;9(399):eaah3621. doi: 10.1126/scitranslmed.aah3621. PMID: 28724575 (https://pubmed.ncbi.nlm.nih.gov/28724575/).
(13)Morawietz C, Moffat F. Effects of locomotor training after incomplete spinal cord injury: a systematic review. Arch Phys Med Rehabil. 2013 Nov;94(11):2297-308. doi: 10.1016/j.apmr.2013.06.023. Epub 2013 Jul 9. PMID: 23850614 (https://pubmed.ncbi.nlm.nih.gov/23850614/).
(14)Nooijen CF, Ter Hoeve N, Field-Fote EC. Gait quality is improved by locomotor training in individuals with SCI regardless of training approach. J Neuroeng Rehabil. 2009 Oct 2;6:36. doi: 10.1186/1743-0003-6-36. PMID: 19799783; PMCID: PMC2764722 (https://pubmed.ncbi.nlm.nih.gov/19799783/).
(15)M. Plooij, U. Keller, B. Sterke, S. Komi, H. Vallery and J. von Zitzewitz, "Design of RYSEN: An Intrinsically Safe and Low-Power Three-Dimensional Overground Body Weight Support," in IEEE Robotics and Automation Letters, vol. 3, no. 3, pp. 2253-2260, July 2018, doi: 10.1109/LRA.2018.2812913 (https://ieeexplore.ieee.org/document/8307350).
(16)Plooij M, Apte S, Keller U, Baines P, Sterke B, Asboth L, Courtine G, von Zitzewitz J, Vallery H. Neglected physical human-robot interaction may explain variable outcomes in gait neurorehabilitation research. Sci Robot. 2021 Sep 22;6(58):eabf1888. doi: 10.1126/scirobotics.abf1888. Epub 2021 Sep 22. PMID: 34550719 (https://pubmed.ncbi.nlm.nih.gov/34550719/).
(17)Wessels M, Lucas C, Eriks I, de Groot S. Body weight-supported gait training for restoration of walking in people with an incomplete spinal cord injury: a systematic review. J Rehabil Med. 2010 Jun;42(6):513-9. doi: 10.2340/16501977-0525. PMID: 20549154 (https://pubmed.ncbi.nlm.nih.gov/20549154/).
Bibliografía:
(1)Alexeeva N, Sames C, Jacobs PL, Hobday L, Distasio MM, Mitchell SA, Calancie B. Comparison of training methods to improve walking in persons with chronic spinal cord injury: a randomized clinical trial. J Spinal Cord Med. 2011;34(4):362-79. doi: 10.1179/2045772311Y.0000000018. PMID: 21903010; PMCID: PMC3152808 (https://pubmed.ncbi.nlm.nih.gov/21903010/).
(2)Apte S, Plooij M, Vallery H. Influence of body weight unloading on human gait characteristics: a systematic review. J Neuroeng Rehabil. 2018 Jun 20;15(1):53. doi: 10.1186/s12984-018-0380-0. Erratum in: J Neuroeng Rehabil. 2018 Aug 8;15(1):73. PMID: 29925400; PMCID: PMC6011391 (https://pubmed.ncbi.nlm.nih.gov/29925400/).
(3)Apte S, Plooij M, Vallery H. Simulation of human gait with body weight support: benchmarking models and unloading strategies. J Neuroeng Rehabil. 2020 Jun 25;17(1):81. doi: 10.1186/s12984-020-00697-z. PMID: 32586398; PMCID: PMC7318415 (https://pubmed.ncbi.nlm.nih.gov/32586398/).
(4)Easthope CS, Traini LR, Awai L, Franz M, Rauter G, Curt A, Bolliger M. Overground walking patterns after chronic incomplete spinal cord injury show distinct response patterns to unloading. J Neuroeng Rehabil. 2018 Nov 12;15(1):102. doi: 10.1186/s12984-018-0436-1. PMID: 30419945; PMCID: PMC6233558 (https://pubmed.ncbi.nlm.nih.gov/30419945/).
(5)Escribano-Ardura S, Cuesta-Gómez A, Fernández-González P, Carratalá-Tejada M, Molina-Rueda F. Entrenamiento en cinta rodante con soporte parcial del peso corporal en pacientes con lesión medular incompleta: revisión sistemática [Treadmill training with partial body weight support in subjects with incomplete spinal cord injury: a systematic review]. Rev Neurol. 2020 Aug 1;71(3):85-92. Spanish. doi: 10.33588/rn.7103.2020054. PMID: 32672346 (https://pubmed.ncbi.nlm.nih.gov/32672346/).
(6)Fenuta AM, Hicks AL. Metabolic demand and muscle activation during different forms of bodyweight supported locomotion in men with incomplete SCI. Biomed Res Int. 2014;2014:632765. doi: 10.1155/2014/632765. Epub 2014 May 21. PMID: 24971340; PMCID: PMC4055602 (https://pubmed.ncbi.nlm.nih.gov/24971340/).
(7)Fenuta AM, Hicks AL. Muscle activation during body weight-supported locomotion while using the ZeroG. J Rehabil Res Dev. 2014;51(1):51-8. doi: 10.1682/JRRD.2013.01.0005. PMID: 24805893 (https://pubmed.ncbi.nlm.nih.gov/24805893/9.
(8)Fischer AG, Debbi EM, Wolf A. Effects of body weight unloading on electromyographic activity during overground walking. J Electromyogr Kinesiol. 2015 Aug;25(4):709-14. doi: 10.1016/j.jelekin.2015.05.001. Epub 2015 May 16. PMID: 26025610 (https://pubmed.ncbi.nlm.nih.gov/26025610/).
(9)Hidler J, Brennan D, Black I, Nichols D, Brady K, Nef T. ZeroG: overground gait and balance training system. J Rehabil Res Dev. 2011;48(4):287-98. doi: 10.1682/jrrd.2010.05.0098. PMID: 21674384 (https://pubmed.ncbi.nlm.nih.gov/21674384/).
(10)Huber JP, Sawaki L. Dynamic body-weight support to boost rehabilitation outcomes in patients with non-traumatic spinal cord injury: an observational study. J Neuroeng Rehabil. 2020 Nov 30;17(1):157. doi: 10.1186/s12984-020-00791-2. PMID: 33256797; PMCID: PMC7706039 (https://pubmed.ncbi.nlm.nih.gov/33256797/).
(11)Lewek MD. The influence of body weight support on ankle mechanics during treadmill walking. J Biomech. 2011 Jan 4;44(1):128-33. doi: 10.1016/j.jbiomech.2010.08.037. Epub 2010 Sep 19. PMID: 20855074 (https://pubmed.ncbi.nlm.nih.gov/20855074/).
(12)Mignardot JB, Le Goff CG, van den Brand R, Capogrosso M, Fumeaux N, Vallery H, Anil S, Lanini J, Fodor I, Eberle G, Ijspeert A, Schurch B, Curt A, Carda S, Bloch J, von Zitzewitz J, Courtine G. A multidirectional gravity-assist algorithm that enhances locomotor control in patients with stroke or spinal cord injury. Sci Transl Med. 2017 Jul 19;9(399):eaah3621. doi: 10.1126/scitranslmed.aah3621. PMID: 28724575 (https://pubmed.ncbi.nlm.nih.gov/28724575/).
(13)Morawietz C, Moffat F. Effects of locomotor training after incomplete spinal cord injury: a systematic review. Arch Phys Med Rehabil. 2013 Nov;94(11):2297-308. doi: 10.1016/j.apmr.2013.06.023. Epub 2013 Jul 9. PMID: 23850614 (https://pubmed.ncbi.nlm.nih.gov/23850614/).
(14)Nooijen CF, Ter Hoeve N, Field-Fote EC. Gait quality is improved by locomotor training in individuals with SCI regardless of training approach. J Neuroeng Rehabil. 2009 Oct 2;6:36. doi: 10.1186/1743-0003-6-36. PMID: 19799783; PMCID: PMC2764722 (https://pubmed.ncbi.nlm.nih.gov/19799783/).
(15)M. Plooij, U. Keller, B. Sterke, S. Komi, H. Vallery and J. von Zitzewitz, "Design of RYSEN: An Intrinsically Safe and Low-Power Three-Dimensional Overground Body Weight Support," in IEEE Robotics and Automation Letters, vol. 3, no. 3, pp. 2253-2260, July 2018, doi: 10.1109/LRA.2018.2812913 (https://ieeexplore.ieee.org/document/8307350).
(16)Plooij M, Apte S, Keller U, Baines P, Sterke B, Asboth L, Courtine G, von Zitzewitz J, Vallery H. Neglected physical human-robot interaction may explain variable outcomes in gait neurorehabilitation research. Sci Robot. 2021 Sep 22;6(58):eabf1888. doi: 10.1126/scirobotics.abf1888. Epub 2021 Sep 22. PMID: 34550719 (https://pubmed.ncbi.nlm.nih.gov/34550719/).
(17)Wessels M, Lucas C, Eriks I, de Groot S. Body weight-supported gait training for restoration of walking in people with an incomplete spinal cord injury: a systematic review. J Rehabil Med. 2010 Jun;42(6):513-9. doi: 10.2340/16501977-0525. PMID: 20549154 (https://pubmed.ncbi.nlm.nih.gov/20549154/).
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