Polysomnography in patients with spinal cord injury who underwent robotic assisted gait training
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Research Institute for Innovative Methods of Rehabilitation of Patients with Spinal Cord Injury in Kamień Pomorski, Health Resort Kamień Pomorski, Poland
Rehabilitation Clinic, Medical University of Warsaw, Poland
Rehabilitation Clinic, National Institute of Geriatrics, Reumatology and Rehabilitation, Warsaw, Poland
Submission date: 2023-04-11
Final revision date: 2023-11-15
Acceptance date: 2023-11-16
Online publication date: 2023-11-28
Corresponding author
Tarnacka Beata   

Rehabilitation Clinic, Medical University of Warsaw, Spartańska 1, 02-637 Warsaw, Poland.
Pol. Ann. Med. 2023;30(2):114-120
Obstructive sleep apnea in spinal cord injured (SCI) patients is an important but underestimated clinical problem. Spinal cord injury weakens the muscles responsible for breathing, resulting in a reduction in lung capacity. Training of respiratory muscles may present an effective method of increasing respiratory muscle strength and lung volume.

The aim of study was to evaluate the effectiveness of robot-assisted gait training (RAGT) in 34 patients with SCI in sleep-disordered breathing (SDB) reduction.

Material and methods:
We conducted a control trail to compare RAGT (exoskeleton EKSO-GT or Locomat Pro) with conventional gait training using conventional physiotherapy with dynamic parapodium. We included patients with SCI (above T8 level of injury) recruited between 3 months and 2 years post injury. Polysomnographic studies were performed before and after the completion of the 7-week rehabilitation program. Patients were divided into 2 groups above and up 40 years old.

Results and discussion:
The comparison of all polysomnographic parameters before and after rehabilitation with RAGT revealed the decline in all polysomnographic parameters (the apnea-hypopnea index – AHI; score reached statistically significant value – P < 0.02). In comparison in patients aged up to 40 years with conventional gait rehabilitation the number of apnoea’s and shortness of breath during sleep even increased: the AHI index increased after rehabilitation from 1.7 to 3.2 values.

RAGT therapy should be considered as a therapeutic option for SDB reduction in patients after SCI. Additionally, the study identified the need to conduct further studies on larger groups of patients.

We thank our colleagues from Research Institute for Innovative Methods of Rehabilitation of Patients with Spinal Cord Injury in Kamień Pomorski, Health Resort Kamień Pomorski, Poland.
The study was supported by a grant from the National Centre for Research and Development, Poland. The grant title was “Advanced programme rehabilitation of patients after spinal cord injury using robotic rehabilitation robots". Implemented under Measure 1.1.1: R&D projects enterprises of the Intelligent Development Operational Programme 2014–2020. Co-financed by the European Regional Development Fund No. agreement: POIR.01.01.01-00-0848/17-00 of 22.06.2018.
The authors report there are no competing interests to declare.
Kang Y, Ding H, Zhou H, et al. Epidemiology of worldwide spinal cord injury: a literature review. J Neurorestoratol. 2018;6:1–9.
Sankari A, Vaughan S, Bascom A, Martin JL, Badr M. Sleep-disordered breathing and spinal cord injury contemporary reviews in sleep medicine. Chest. 2019;155(2): 438–445.
Chiodo AE, Sitrin RG, Bauman KA. Sleep disordered breathing in spinal cord injury: A systematic review. J Spinal Cord Med. 2016;39(4):374–382.
Sankari A, Martin JL, Badr MS. Sleep disordered breathing and spinal cord injury: Challenges and opportunities. Curr Sleep Med Rep. 2017;3(4):272–278.
Bascom A, Sankari A, Goshgarian HG, Badr MS. Sleep onset hypoventilation in chronic spinal cord injury. Physiol Rep. 2015;3(8):e12490.
Bauman KA, Kurili A, Schotland HM, Rodriguez GM,Chiodo AE, Sitrin RG. Simplified approach to diagnosing sleep-disordered breathing and nocturnal hypercapnia in individuals with spinal cord injury. Arch Phys Med Rehabil. 2016;97(3):363–371.
Pływaczewski R, Brzecka A, Bielicki P, et al. Sleep related breathing disorders in adults – recommendations of Polish Society of Lung Diseases [in Polish]. Pneumonol Alergol Pol. 2013;81(3):221–225.
Schwartz I, Meiner Z. Robotic-assisted gait training in neurological patients: who may benefit? Ann Biomed Eng. 2015;43(5):1260–1269.
Donati AR, Shokur S, Morya E, et al. Long-term training with a brain-machine Interface-based gait protocol induces partial neurological recovery in paraplegic patients. Sci Rep. 2016;6:30383.
Aach M, Cruciger O, Sczesny-Kaiser M, et al. Voluntary driven exoskeleton as a new tool for rehabilitation in chronic spinal cord injury: a pilot study. Spine J. 2014;14(12):2847–2853.
Yildirim MA, Önes K, Gökşenoğlu G. Early term effects of robotic assisted gait training on ambulation and functional capacity in patients with spinal cord injury. Turk J Med Sci. 2019;49(3):838–843.
Esquenazi A, Talaty M, Jayaraman A. Powered exoskeletons for walking assistance in persons with central nervous system injuries: a narrative review. PM R. 2017;9(1):46–62.
ASIA. International Standards of Neurological Classification of SCI (ISNCSCI) Worksheet. Richmond VA: ASIA. 2019. Accessed: 11.23.2023.
rmarkdown: Dynamic Documents for R [computer program]. R package v. 2.14. Boston, MA: RS Studio; 2022.
qwraps2: Quick Wraps 2 [computer program]. R package v. 0.5.2. DeWitt P; 2021.
FSA: Fisheries Stock Analysis [computer program]. R package v. 0.8.22. Ogle DH, Wheeler P, Dinno A. USA: fishR-Core-Team; 2018.
Wickham H . ggplot2: Elegant Graphics for Data Analysis. New York: Springer-Verlag. 2016.
Kassambara A. ggpubr: “ggplot2” Based Publication Ready Plots. 2018.
Sarkar D. Lattice: Multivariate Data Visualization with R. New York: Springer. 2008. http://lmdvr.r-forge.r-project.... Accessed: November 23, 2023.
Wickham H. Welcome to the tidyverse. J Open Source Softw. 2019;4(43):1686.
Lemos JR, da Cunha FA, Lopes AJ, Guimarães FS, do Amaral Vasconcellos FV, Dos Santos Vigário P. Respiratory muscle training in non-athletes and athletes with spinal cord injury: A systematic review of the effects on pulmonary function, respiratory muscle strength and endurance, and cardiorespiratory fitness based on the FITT principle of exercise prescription. J Back Musculoskelet Rehabil. 2020;33(4):655–667.
Sankari A, Martin J, Badr M. A retrospective review of sleep-disordered breathing, hypertenstion and cardiovascular diseases in spinal cord injury patients. Spinal Cord. 2015;53(6):496–497.
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