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Title: Effect of EMG-biofeedback robotic-assisted body weight supported treadmill training on walking ability and cardiopulmonary function on people with subacute spinal cord injuries - a randomized controlled trial
Authors: Cheung, EYY 
Yu, KKK 
Kwan, RLC
Ng, CKM 
Chau, RMW
Cheing, GLY 
Issue Date: 2019
Source: BMC Neurology, 24 June 2019, v. 19, 140, p. 1-9
Abstract: Background: Body weight supported treadmill training (BWSTT) is a frequently used approach for restoring the ability to walk after spinal cord injury (SCI). However, the duration of BWSTT is usually limited by fatigue of the therapists and patients. Robotic-assisted body weight supported treadmill training (RABWSTT) was developed to tackle the aforesaid limitation. Currently, limited randomized controlled trials are available to investigate its effectiveness, especially on cardiopulmonary function. The aim of this two-arm, parallel-group randomized controlled trial is to examine the feasibility of adapting an EMG-biofeedback system for assist-as-needed RABWSTT and its effects on walking and cardiopulmonary function in people with SCI.
Methods: Sixteen incomplete SCI subjects were recruited and randomly allocated into an intervention group or control group. The intervention group received 30min of RABWSTT with EMG biofeedback system over the vastus lateralis muscle to enhance active participation. Dose equivalent passive lower limbs mobilization exercise was provided to subjects in the control group.
Results: Significant time-group interaction was found in the Walking Index for Spinal Cord Injury version II (WISCI II) (p=0.020), Spinal Cord Independence Measure version III (SCIM III) mobility sub-score (p<0.001), bilateral symmetry (p=0.048), maximal oxygen consumption (p=0.014) and peak expiratory flow rate (p=0.048). Wilcoxon signed-rank test showed that the intervention group had significant improvement in the above-mentioned outcomes after the intervention except WISCI II, which also yielded marginal significance level.
Conclusion: The present study demonstrated that the use of EMG-biofeedback RABWSTT enhanced the walking performance for SCI subjects and improve cardiopulmonary function. Positive outcomes reflect that RABSTT training may be able to enhance their physical fitness.
Trial registrationThe study protocol was approved by the Research Ethics Committee (Kowloon Central/ Kowloon East), Hospital Authority on 6 December 2013, and the Human Subjects Ethics Sub-committee of The Hong Kong Polytechnic University on 15 May 2013, with reference numbers KC/KC-13-0181/ER-2 and HSEARS20130510002 respectively. The study was registered in on 20 November 2013, with reference number NCT01989806.)
Keywords: Locomotion
Oxygen consumption
Publisher: BioMed Central
Journal: BMC Neurology 
EISSN: 1471-2377
DOI: 10.1186/s12883-019-1361-z
Rights: © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0International License (, which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver( applies to the data made available in this article, unless otherwise stated.
The following publication Cheung, E. Y. Y., Yu, K. K. K., Kwan, R. L. C., Ng, C. K. M., Chau, R. M. W., & Cheing, G. L. Y. (2019). Effect of EMG-biofeedback robotic-assisted body weight supported treadmill training on walking ability and cardiopulmonary function on people with subacute spinal cord injuries - a randomized controlled trial. BMC Neurology, 19, 140, 1-9 is available at
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