This article and any supplementary material should be cited as follows: Craven CT, Gollee H, Coupad S, Purcell MA, Allan DB. Investigation of robotic-assisted tilt-table therapy for early-stage spinal cord injury rehabilitation. J Rehabil Res Dev. 2013:50(3):367-78. http://dx.doi.org/10.1682/JRRD.2012.02.0027

Slideshow ProjectDOI:10.1682/JRRD.2012.02.0027JSP

Investigation of robotic-assisted tilt-table therapy for early-stage spinal cord injury rehabilitation

Colm T. D. Craven, MEngSc; Henrik Gollee, PhD; Sylvie Coupaud, PhD; Mariel A. Purcell, MRCGP; David B. Allan, FRCS

This article and any supplementary material should be cited as follows: Craven CT, Gollee H, Coupad S, Purcell MA, Allan DB. Investigation of robotic-assisted tilt-table therapy for early-stage spinal cord injury rehabilitation. J Rehabil Res Dev. 2013:50(3):367-78. http://dx.doi.org/10.1682/JRRD.2012.02.0027

Slideshow ProjectDOI:10.1682/JRRD.2012.02.0027JSP

• Aim– Investigate physical exertion rate of robotic-assisted tilt-

table therapy (RATTT) in patients with spinal cord injury (SCI).

– Compare response of patients with motor-complete SCI (cSCI) and motor-incomplete SCI (iSCI).

• Relevance– RATTT may provide strong training stimulus to

complement conventional physiotherapy.– RATTT may both increase orthostatic tolerance and

attenuate decline in aerobic fitness.

This article and any supplementary material should be cited as follows: Craven CT, Gollee H, Coupad S, Purcell MA, Allan DB. Investigation of robotic-assisted tilt-table therapy for early-stage spinal cord injury rehabilitation. J Rehabil Res Dev. 2013:50(3):367-78. http://dx.doi.org/10.1682/JRRD.2012.02.0027

Slideshow ProjectDOI:10.1682/JRRD.2012.02.0027JSP

Method• Participants – 3 cSCI.– 3 iSCI.

• Protocol– 5 discrete phases, 5 min each

• Measures– Continuous: pulmonary gas exchange, ventilator,

heart rate.– Final 30 s: blood pressure.

This article and any supplementary material should be cited as follows: Craven CT, Gollee H, Coupad S, Purcell MA, Allan DB. Investigation of robotic-assisted tilt-table therapy for early-stage spinal cord injury rehabilitation. J Rehabil Res Dev. 2013:50(3):367-78. http://dx.doi.org/10.1682/JRRD.2012.02.0027

Slideshow ProjectDOI:10.1682/JRRD.2012.02.0027JSP

Method• Testing phases:– 1. Subject supine; no stepping profile imposed.– 2. Subject tilted to 70 from horizontal at 0.06 rad/s.– 3. Robotic orthoses provided full guidance force. • cSCI: No volitional effort.

– 4a. iSCI only. Guidance force reduced, volitional effort increased.

– 4b. Functional electrical stimulation (FES) applied.• iSCI subjects instructed to continue volitional participation.

This article and any supplementary material should be cited as follows: Craven CT, Gollee H, Coupad S, Purcell MA, Allan DB. Investigation of robotic-assisted tilt-table therapy for early-stage spinal cord injury rehabilitation. J Rehabil Res Dev. 2013:50(3):367-78. http://dx.doi.org/10.1682/JRRD.2012.02.0027

Slideshow ProjectDOI:10.1682/JRRD.2012.02.0027JSP

Results• iSCI– O2 uptake, respiratory exchange ratio (RER), minute ventilation,

heart rate:• Significantly increased in Phases 4a and 4b only.

• cSCI– Minute ventilation:

• Small but significant increase.• iSCI vs cSCI– O2 uptake, RER, minute ventilation, heart rate:

• No difference in Phases 1-3.• Significantly larger in Phase 4b for iSCI.

– Mean arterial pressure significantly larger in all phases for iSCI.

This article and any supplementary material should be cited as follows: Craven CT, Gollee H, Coupad S, Purcell MA, Allan DB. Investigation of robotic-assisted tilt-table therapy for early-stage spinal cord injury rehabilitation. J Rehabil Res Dev. 2013:50(3):367-78. http://dx.doi.org/10.1682/JRRD.2012.02.0027

Slideshow ProjectDOI:10.1682/JRRD.2012.02.0027JSP

Conclusion• Volitional effort led to increased cardio-pulmonary

and ventilatory response during RATTT.– Sustained or improved with addition of FES.

• Patients with iSCI:– Period of training with volitional contribution could

improve cardiopulmonary and ventilatory fitness.

• Patients with cSCI:– FES-assisted RATTT may be sufficient to attenuate

fitness losses.