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Innovative spinal cord injury rehabilitation in the context of a middle-income country: a pilot randomised control study investigating physiological and psychological effects
A spinal cord injury (SCI) is life-altering, resulting in neurological deficits and a multitude of secondary complications. South Africa holds one of the highest traumatic SCI incidence rates in the world, where the social need for SCI prevention and rehabilitation is immense. Robotic locomotor trai...
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| Format: | Thesis |
| Language: | English |
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Division of Exercise Science and Sports Medicine
2022
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| _version_ | 1867613190246891520 |
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| access_status_str | Open Access |
| author | Evans, Robert William |
| author2 | Albertus, Yumna |
| author_browse | Albertus, Yumna Evans, Robert William |
| author_facet | Albertus, Yumna Evans, Robert William |
| author_sort | Evans, Robert William |
| collection | Thesis |
| description | A spinal cord injury (SCI) is life-altering, resulting in neurological deficits and a multitude of secondary complications. South Africa holds one of the highest traumatic SCI incidence rates in the world, where the social need for SCI prevention and rehabilitation is immense. Robotic locomotor training (RLT) is a novel rehabilitation technique that may improve health and wellbeing after SCI. A systematic review was conducted across 27 studies and 308 participants to explore the systemic effects of RLT. This review demonstrated that RLT shows promise as a tool for improving neurological rehabilitation outcomes; providing individuals with a SCI the ability to walk safely while improving their walking performance, as well as potentially improving cardiovascular outcomes and psychosocial factors. However, the studies reviewed were non-controlled with small, heterogenous sample sizes. Further high-powered, randomised controlled trials, with homogenous samples, are required to investigate these effects. If widespread adoption of these new technologies is to occur, sound evidence demonstrating efficacy and long-term cost saving is required. This dissertation aimed to explore some of these under-researched areas in a sample of sixteen persons with incomplete tetraplegia. Areas of focus included, 1) rehabilitation feasibility, adherence, and research challenges in an under-resourced environment 2) cardiovascular functioning and adaptation to a rehabilitation programme, and 3) psychological well-being. We implemented two interventions, robotic locomotor training (RLT) and activity-based training (ABT), over a 24-week pilot randomised control trial. Adherence to the interventions was high (93.9 ± 6.2%). Challenges to the study's feasibility included: ethical approval, medical clearance, transport and limited human/financial resources. Cardiovascular parameters demonstrated that efficiency of exoskeleton walking improved during the intervention. RLT may be more effective than ABT in improving cardiac responses to orthostatic stress, with standing heart rate at 24-weeks being significantly lower in the RLT group (75.1 ± 15.0 beats/min) compared to the ABT group (95.6 ± 12.6 beats/min). Standing and RLT had similar effects on the parasympathetic nervous system, whilst both interventions were limited in their effect on brachial and ankle blood pressure. Despite experiencing past trauma, participants possessed psychological resources including resilience, self-efficacy and post-traumatic growth which contributed to high perceptions of quality of life. The use of an exoskeleton may have had a greater positive impact on subjective psychological well-being. Expectations of participants entering the study centred around regaining the ability to walk again, despite past experiences and medical advice suggesting otherwise. Hope aids in buffering against negative emotions, however, a thin line exists between supporting high expectations and confronting unrealistic hope. Initial high expectations of recovery decreased and became more realistic during the intervention. This dissertation demonstrates potential physiological and psychological benefits that RLT provides. Despite this potential, barriers exist in the use of RLT in low- and middle-income countries such as South Africa, primarily due to a lack of financial and human resources. The development of lower-cost exoskeletons would lessen the burden of conducting large-scale trials and increase the likelihood of adopting these innovative rehabilitation tools into current standard of care practices. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/35613 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:32:12.136Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2022 |
| publishDateRange | 2022 |
| publishDateSort | 2022 |
| publisher | Division of Exercise Science and Sports Medicine |
| publisherStr | Division of Exercise Science and Sports Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/35613 Innovative spinal cord injury rehabilitation in the context of a middle-income country: a pilot randomised control study investigating physiological and psychological effects Evans, Robert William Albertus, Yumna West, Sacha Derman, Wayne Exercise Science & Sports Medicine A spinal cord injury (SCI) is life-altering, resulting in neurological deficits and a multitude of secondary complications. South Africa holds one of the highest traumatic SCI incidence rates in the world, where the social need for SCI prevention and rehabilitation is immense. Robotic locomotor training (RLT) is a novel rehabilitation technique that may improve health and wellbeing after SCI. A systematic review was conducted across 27 studies and 308 participants to explore the systemic effects of RLT. This review demonstrated that RLT shows promise as a tool for improving neurological rehabilitation outcomes; providing individuals with a SCI the ability to walk safely while improving their walking performance, as well as potentially improving cardiovascular outcomes and psychosocial factors. However, the studies reviewed were non-controlled with small, heterogenous sample sizes. Further high-powered, randomised controlled trials, with homogenous samples, are required to investigate these effects. If widespread adoption of these new technologies is to occur, sound evidence demonstrating efficacy and long-term cost saving is required. This dissertation aimed to explore some of these under-researched areas in a sample of sixteen persons with incomplete tetraplegia. Areas of focus included, 1) rehabilitation feasibility, adherence, and research challenges in an under-resourced environment 2) cardiovascular functioning and adaptation to a rehabilitation programme, and 3) psychological well-being. We implemented two interventions, robotic locomotor training (RLT) and activity-based training (ABT), over a 24-week pilot randomised control trial. Adherence to the interventions was high (93.9 ± 6.2%). Challenges to the study's feasibility included: ethical approval, medical clearance, transport and limited human/financial resources. Cardiovascular parameters demonstrated that efficiency of exoskeleton walking improved during the intervention. RLT may be more effective than ABT in improving cardiac responses to orthostatic stress, with standing heart rate at 24-weeks being significantly lower in the RLT group (75.1 ± 15.0 beats/min) compared to the ABT group (95.6 ± 12.6 beats/min). Standing and RLT had similar effects on the parasympathetic nervous system, whilst both interventions were limited in their effect on brachial and ankle blood pressure. Despite experiencing past trauma, participants possessed psychological resources including resilience, self-efficacy and post-traumatic growth which contributed to high perceptions of quality of life. The use of an exoskeleton may have had a greater positive impact on subjective psychological well-being. Expectations of participants entering the study centred around regaining the ability to walk again, despite past experiences and medical advice suggesting otherwise. Hope aids in buffering against negative emotions, however, a thin line exists between supporting high expectations and confronting unrealistic hope. Initial high expectations of recovery decreased and became more realistic during the intervention. This dissertation demonstrates potential physiological and psychological benefits that RLT provides. Despite this potential, barriers exist in the use of RLT in low- and middle-income countries such as South Africa, primarily due to a lack of financial and human resources. The development of lower-cost exoskeletons would lessen the burden of conducting large-scale trials and increase the likelihood of adopting these innovative rehabilitation tools into current standard of care practices. 2022-01-31T07:56:08Z 2022-01-31T07:56:08Z 2021 2022-01-26T12:57:00Z Doctoral Thesis Doctoral PhD http://hdl.handle.net/11427/35613 eng application/pdf Division of Exercise Science and Sports Medicine Faculty of Health Sciences |
| spellingShingle | Exercise Science & Sports Medicine Evans, Robert William Innovative spinal cord injury rehabilitation in the context of a middle-income country: a pilot randomised control study investigating physiological and psychological effects |
| thesis_degree_str | Doctoral |
| title | Innovative spinal cord injury rehabilitation in the context of a middle-income country: a pilot randomised control study investigating physiological and psychological effects |
| title_full | Innovative spinal cord injury rehabilitation in the context of a middle-income country: a pilot randomised control study investigating physiological and psychological effects |
| title_fullStr | Innovative spinal cord injury rehabilitation in the context of a middle-income country: a pilot randomised control study investigating physiological and psychological effects |
| title_full_unstemmed | Innovative spinal cord injury rehabilitation in the context of a middle-income country: a pilot randomised control study investigating physiological and psychological effects |
| title_short | Innovative spinal cord injury rehabilitation in the context of a middle-income country: a pilot randomised control study investigating physiological and psychological effects |
| title_sort | innovative spinal cord injury rehabilitation in the context of a middle income country a pilot randomised control study investigating physiological and psychological effects |
| topic | Exercise Science & Sports Medicine |
| url | http://hdl.handle.net/11427/35613 |
| work_keys_str_mv | AT evansrobertwilliam innovativespinalcordinjuryrehabilitationinthecontextofamiddleincomecountryapilotrandomisedcontrolstudyinvestigatingphysiologicalandpsychologicaleffects |