Effects of Robot-Assisted Gait Therapy on Urodynamic Changes in the Subacute Phase After Spinal Cord Injury: A Prospective Study

BACKGROUND Approximately 70% to 84% of patients with spinal cord injury (SCI) have varying degrees of bladder dysfunction, which can lead to upper urinary tract complications. Urodynamics is the standard method for evaluating bladder function after SCI. The effect of robot-assisted gait therapy (RAGT) on urinary function is rarely reported in the literature. The aim of this study was to evaluate the changes in urodynamics in SCI patients undergoing RAGT. MATERIAL AND METHODS The study included 35 SCI patients (26 males and 9 females) with neurological impairment at between 3 months and 2 years after injury. Simple randomization was used by tossing a coin. The rehabilitation program was performed for 7 weeks in 30-minute sessions with exoskeleton EKSO-GT or Locomat Pro; while in the control group, a dynamic parapodium was used instead of RAGT. In all patients, at the beginning and the end of therapy, urodynamics were assessed. The parameters, including cystometric bladder capacity (CBC), the first, normal, and strong desire to void (FD, ND, SD), maximum and average flow rate, post-void residual volume (PRV) and compliance, and external urethral sphincter function were analyzed. RESULTS A decreasing trend in micturition time was observed in all patients undergoing RAGT. Compliance in patients with complete SCI did not change, or in some cases decreased (up to 3 ml/cm). In patients with incomplete SCI, flow rates (average and maximum) increased while micturition time decreased. In patients with incomplete injury in the RAGT group, the lowest increases or decreases in CBC, FD, ND, and SD were observed in patients with L-level SCI lesions. CONCLUSIONS The improvement in bladder parameters observed in the study indicates that RAGT should be considered as an option in neurogenic bladder treatment.