Unexpected Recovery After Robotic Locomotor Training at Physiologic Stepping Speed: A Single-Case Design Martina R. Spiess, PT, MPTSc, Jeffrey P. Jaramillo,

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Unexpected Recovery After Robotic Locomotor Training at Physiologic Stepping Speed: A Single-Case Design Martina R. Spiess, PT, MPTSc, Jeffrey P. Jaramillo, PT, MS, Andrea L. Behrman, PT, PhD, Jeffrey K. Teraoka, MD, Carolynn Patten, PhD, PT Archives of Physical Medicine and Rehabilitation Volume 93, Issue 8, Pages 1476-1484 (August 2012) DOI: 10.1016/j.apmr.2012.02.030 Copyright © 2012 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 1 MR image (T1) of the spinal cord 6 months postsurgery. The marker identifies the lesion site, revealing near complete cord disruption with a residual rim of white matter continuity mostly on the ventral aspect. Archives of Physical Medicine and Rehabilitation 2012 93, 1476-1484DOI: (10.1016/j.apmr.2012.02.030) Copyright © 2012 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 2 Study design. Arrows on top indicate application of the experimental treatment during block B1, withdrawal of the experimental treatment during block A, and reintroduction of the treatment in block B2. Boxes below list testing that occurred during the different phases. Abbreviations: CHART, Craig Handicap Assessment and Reporting Technique; LEMS, lower extremity motor score; PT, physical therapy. Archives of Physical Medicine and Rehabilitation 2012 93, 1476-1484DOI: (10.1016/j.apmr.2012.02.030) Copyright © 2012 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 3 LT parameters used over each 24-session training block. Data reflect weighted averages for training session to account for parameter adjustments and the amount of time spent training at each setting. Abbreviation: km/h, kilometers per hour. Archives of Physical Medicine and Rehabilitation 2012 93, 1476-1484DOI: (10.1016/j.apmr.2012.02.030) Copyright © 2012 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 4 Evolution of walking capacity, as measured by the WISCI-II during the first LT block (B1), the 16 weeks of experimental training withdrawal (A), and the second LT block (B2). Please note the different scales on the time axes between the 2 LT blocks B1 and B2 (daily measurements) and the 16 weeks of block A (weekly measurements). Asterisks in the first and second training block indicate days on which LT took place. Archives of Physical Medicine and Rehabilitation 2012 93, 1476-1484DOI: (10.1016/j.apmr.2012.02.030) Copyright © 2012 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 5 EMG responses elicited during the Lokomat speed experiment. Representative data from 1 assessment of the first and second training blocks are shown separately for the left and right legs. EMG amplitudes are expressed as percentage of the amplitude measured while walking at 1.5km/h within each experiment. Gray shaded areas >3.2km/h indicate typical walking speeds of individuals without disability. R2 values are presented for the third-order polynomial fit models of the mean of all muscles within 1 extremity. Red-shaded areas represent 95% confidence intervals of the mean per leg. Abbreviation: kph, kilometers per hour. Archives of Physical Medicine and Rehabilitation 2012 93, 1476-1484DOI: (10.1016/j.apmr.2012.02.030) Copyright © 2012 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 6 EMG activity during overground stepping. EMG “on time” (milliseconds [ms] of muscle activation) was normalized by distance (feet) to assess differences while stepping with varying levels of external support. For sake of illustration, EMG “on time” was collapsed over 7 muscles measured within each leg and averaged over the 4 assessments in the second LT block. Error bars represent 95% confidence intervals. Archives of Physical Medicine and Rehabilitation 2012 93, 1476-1484DOI: (10.1016/j.apmr.2012.02.030) Copyright © 2012 American Congress of Rehabilitation Medicine Terms and Conditions