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Uvod: Ocenjevanje funkcijske sposobnosti za hojo je eden od ključnih ocenjevalnih postopkov v fizioterapevtski obravnavi pacientov z okvaro hrbtenjače. Funkcijska ocena hoje za paciente z okvaro hrbtenjače (angl. spinal cord injury functional ambulation inventory – SCI-FAI) je standardizirano merilno orodje, ki vključuje oceno kinematike, pripomočkov in premičnosti, specifično za to skupino pacientov. Namen: Oceniti zanesljivost posameznega preiskovalca, zanesljivost med preiskovalci, sočasno veljavnost in učinek stropa slovenskega prevoda SCI-FAI. Metode dela: V raziskavi je sodelovalo 30 pacientov z nepopolno okvaro hrbtenjače. Zanesljivost smo ugotavljali za del SCI-FAI, s katerim ocenjujemo kinematiko hoje. Veljavnost in učinek stropa smo ugotavljali za dela SCI-FAI, s katerima ocenjujemo uporabo pripomočkov in premičnost. Zanesljivosti posameznega preiskovalca smo izračunali za pet preiskovalcev. En preiskovalec je hojo preiskovancev prvič ocenil v živo, drugič z video posnetka. Ostali štirje preiskovalci, med katerimi smo ugotavljali tudi zanesljivost med preiskovalci, so dvakrat ocenjevali z video posnetka. Za obe obliki zanesljivosti smo izračunali intraklasne korelacijske koeficiente (ICC). Za oceno veljavnosti smo izračunali vrednosti Pearsonovih (r) in Spearmanovih (ro) korelacijskih koeficientov med omenjenimi deli SCI-FAI in testom hoje na 10 metrov, indeksom hoje za paciente z okvaro hrbtenjače (angl. Walking index for spinal cord injury – WISCI) ter 6-minutnim testom hoje. Učinek stropa smo izrazili v odstotkih preiskovancev, ki so dosegli največje možno število točk. Rezultati: Povprečna vrednost pri ocenjevanju SCI-FAI kinematike je bila 18,8 točk, SCI-FAI pripomočkov 11,9 točke, SCI-FAI premičnosti 4,5 točke, na 2-minutnem testu hoje 138,3 metre, testu hitre hoje na 10 metrov 1,3 m/s, na WISCI 17,6 točke in na 6-minutnem testu hoje 403,6 metra. Ugotovili smo visoko zanesljivost posameznega preiskovalca (ICC = 0,821&#8722 0,860) in nizko (ICC = 0,463) do srednjo (ICC = 0,611) zanesljivost med preiskovalci. Sočasna veljavnost je bila dobra (ro = 0,608&#8722 0,621) do zelo dobra (r = 0,976&#8722 0,996 ro = 0,794&#8722 0,922) odvisno od primerjanih merilnih orodij. 46,6 % preiskovancev je doseglo največje število točk pri oceni pripomočkov, 73,3 % pri oceni premičnosti. Zaključek: Ugotovitve naše raziskave so skladne z avtorji SCI-FAI, ki so prav tako ugotovili visoko zanesljivost posameznega preiskovalca. Zaradi nizke do srednje zanesljivosti med preiskovalci, priporočamo, da s SCI-FAI hojo ocenjuje isti fizioterapevt pred in po obravnavi. Tudi rezultati sočasne veljavnosti in učinka stropa so v skladu s predhodnimi raziskavami. Nadaljnje raziskovanje bi morali usmeriti v razjasnitev razlogov za nizko do srednjo zanesljivost med preiskovalci. Smiselno bi bilo ugotoviti usklajenost med preiskovalci po posameznih s SCI-FAI kinematiko ocenjenih spremenljivkah hoje. Introduction: Assessment of functional gait ability is one of the key assessment procedures in physiotherapeutic treatment of patients with spinal cord injury. Spinal cord injury functional ambulation inventory (SCI-FAI) is a standardized outcome measure, which includes assessment of kinematics, assistive devices and mobility, specific for this patient group. Purpose: To evaluate intra-, interrater reliability, concurrent validity and ceiling effect of Slovenian translation of SCI-FAI. Methods: 30 patients with incomplete spinal cord injury participated in the study. Reliabiliy was assessed for the part of the instrument with which we assess gait kinematics. Validity and ceiling effect were assessed for part of the instrument with which we assess assistive devices and mobility. We calculated intrarater reliability for five raters. One rater assessed participants on-site for the first evaluation and from the video record for the second one. Other four raters, between which we also evaluated interrater reliability, assessed participants from the video record. We calculated intraclass correlation coefficients (ICC) for both reliability measures. For validity evaluation we calculated Pearsons (r) and Spearmans (ro) correlation coefficients between parts of the instrument and 10 meter walk test, Walking index for spinal cord injury (WISCI) and 6-minute walk test. Ceiling effect was reported as percentage of participants that achieved maximal possible score. Results: Average values on assessments of SCI-FAI kinematics was 18,8 points, SCI-FAI assistive devices 11,9 points, SCI-FAI mobility 4,5 points, on 2-minute walk test 138,3 meters, on fast 10 meter walk test 1,3 m/s, on WISCI 17,6 points and on 6-minute walk test 403,6 meters. We evaluated good intrarater reliability (ICC = 0,821– 0,860) and low (ICC = 0,463) to moderate (ICC = 0,611) interrater reliability. Concurrent validity was good (ro = 0,608–0,621) to excellent (r = 0,976–0,996 ro = 0,794–0,922) depending on the compared outcome measures. 46,6 % participants achieved maximal possible score for assistive devices assessment, 73,3 % for mobility assessment. Conclusion: Our findings are in concordance with authors of the SCI-FAI, that also evaluated good intrarater reliability. Due to low to moderate interrater reliability, we recommend, that gait assessment with SCI-FAI is done by the same physiotherapist before and after treatment. Results of validity and ceiling effect are also in concordance with previous research. Further research should point out the reasons for low to moderate interrater reliability. It would be meaningful to investigate consistency between raters regarding all SCI-FAI kinematics evaluated parameters.

Background: Treadmill training in patients with incomplete spinal cord injury is based on research and evidence about existence of central pattern generators within the spinal cord. This approach is one of the established approaches in rehabilitation and has been a part of everyday practice for many years. Training is time-limited because of inconvenient ergonomic position of the physiotherapists and their fatigue. Besides, it does not enable patients to learn an optimal gait pattern. That is why development of medical devices for robotic gait training has taken place all over the world. Lokomat is the most common one. Methods: We gathered the data about patients who were included in the therapy with the Lokomat from November 2010 to December 2013 at the University Rehabilitation Institute in Ljubljana: data about the number of included patients, gender, age, cause of injury, injury consequences, time from injury onset to inclusion in the therapy, total number of training sessions, average number of training sessions per patient, average body-weight support during therapy, average duration of a training session and average gait velocity. Data about the number of physiotherapists needed for therapy, gait velocity, body weight support and duration of training sessions were compared to the data gathered from assisted treadmill training. The latter were gathered from the literature. Results: Fourty-three males (average age 54 years) and six females (average age 58 years) with spinal cord injury were included in the treatment with the Lokomat. Three fourths of the patients were included in the treatment within the first year after injury. In total they had 805 training sessions, 16.4 sessions per hospitalised patient on average. The training session lasted for 30.3 minutes on average. The average body weight support was 31.1 kilograms; the average gait velocity was 1.5 km/h. In the studies of assisted treadmill training two to three physiotherapists were needed for the therapy, gait velocity was 0.19 m/s to 0.54 m/s, body weight support ranged from 30 % to more than 60 %, training duration was between 20 and 45 minutes. Conclusions: The comparison between the approaches shows advantages of the Lokomat in terms of fewer physiotherapists needed for the therapy, higher gait velocity and longer duration of training units. Izhodišča: Vadba hoje na tekočem traku pri pacientih z nepopolno okvaro hrbtenjače temelji na raziskavah in dokazih o obstoju centralnih generatorjev vzorcev hoje v hrbtenjači. Ta način vadbe je pri nas eden izmed uveljavljenih pristopov v rehabilitaciji in kot tak del vsakdanje prakse vrsto let. Vadba je zaradi neudobnega ergonomskega položaja in utrujanja fizioterapevtov časovno omejena. Poleg tega ne zagotavlja pacientom učenja optimalnega vzorca hoje, zato so po svetu začeli razvijati medicinske naprave za robotizirano vadbo hoje. Lokomat je v svetovnem merilu najbolj razširjena tovrstna naprava. Metode: Zbrali smo podatke o pacientih, ki so bili v vadbo na lokomatu vključeni od novembra 2010 do decembra 2013 na URI % Soča v Ljubljani: podatke o številu vključenih pacientov, spolu, starosti, vzroku okvare, posledicah okvare, času, ki je pretekel od okvare hrb - tenjače do vključitve v vadbo na lokomatu, o številu vseh opravljenih vadbenih enot, povprečnem številu vadbenih enot na pacienta, o povprečni razbremenitvi telesne teže med vadbo, povprečnem času vadbene enote in povprečni hitrosti hoje. Podatke o številu za vadbo potrebnih fizioterapevtov, o hitrosti hoje med vadbo, o razbremenitvi telesne teže in trajanju vadbenih enot smo primerjali s podatki vadbe na tekočem traku s pomočjo fizioterapevtov. Te podatke smo pridobili iz domače in tuje literature. Rezultati: V vadbo na lokomatu je bilo vključenih 43 moških (povprečna starost 54,4 leta) in šest žensk (povprečna starost 41 58 let) z okvaro hrbtenjače. Tri četrtine pacientov je bilo vključenih v obravnavo v prvem letu od začetka okvare, drugi kasneje. Skupaj so opravili 805 vadbenih enot, v okviru bolnišničnega programa v povprečju 16,4 vadbene enote na pacienta. Vadbene enote so v povprečju trajale 30,3 minute. Povprečna razbremenitev telesne teže je bila 31,1 kilograma. Povprečna hitrost hoje je bila 1,5 km/h. Pri študijah na tekočem traku sta bila za vadbo potrebna dva ali trije fizioterapevti, hitrosti hoje so se gibale od 0,19 m/s do 0,54 m/s, razbremenitev telesne teže je bila med 30 % in več kot 60 %, časi obravnave so bili od 20 do 45 minut. Zaključki: Primerjava obeh pristopov kaže prednosti lokomata v smislu manjšega števila za vadbo potrebnih fiziotera - pevtov, višjih hitrosti vadbe in daljših vadbenih enot.

Robot assisted gait training can present an alternative to manual assisted treadmill training. The purpose of this literature review is to find out which variables did researchers investigate in the field of training with the Lokomat system in people with incomplete spinal cord impairments and with what protocols did they measure them. The reviewed articles were retrieved using Medline, Cochrane and Pedro database. The studies either explore the effects of walking on the Lokomat or compare walking on the Lokomat with other rehabilitation strategies. The effect of walking training was evaluated using different protocols. The results have shown reduced heart rate, increase of oxygen consumption and reduced breathing frequency after training with the Lokomat system. Training has caused improvement in muscular coordination and contributed to nerve plasticity in the spinal cord level and higher nerve centres. There is no proof that Lokomat training has a better influence on the rehabilitation outcome in comparison with other methods for relearning walking. Robotizirana vadba hoje je lahko alternativni pristop k vadbi hoje na tekočem traku, pri kateri fizioterapevt pacientu pomaga pri izvedbi koraka. S pregledom razpoložljive literature smo želeli ugotoviti, katere spremenljivke so raziskovalci preučevali pri vadbi hoje s sistemom Lokomat pri ljudeh z nepopolno okvaro hrbtenjače in s katerimi merilnimi protokoli so jih ocenjevali. Pregledali smo članke, zbrane iz podatkovnih zbirk Medline, Cochrane in Pedro. Opravljene študije po eni strani raziskujejo učinke vadbe hoje s pomočjo naprave Lokomat, po drugi pa primerjajo učenje hoje na napravi Lokomat z drugimi postopki. Učinke vadbe hoje so v različnih prispevkih merili z vrsto različnih merilnih protokolov. Rezultati študij so pokazali, da se po taki vodeni vadbi pri posamezniku zniža srčni utrip, poveča se poraba kisika in zniža frekvenca dihanja. Vadba je pacientom omogočila izboljšanje mišične koordinacije in prispevala k plastičnosti živčevja na ravni hrbtenjače in v višjih centrih živčevja. Ni dokazov, da bi vadba z robotsko napravo Lokomat vplivala na boljši izid rehabilitacije v primerjavi z drugimi metodami učenja hoje.