Comparison of training methods to improve walking in persons with chronic spinal cord injury: a randomized clinical trial

Abstract

Objective: To compare two forms of device-specific training -body-weight-supported (BWS) ambulation on a fixed track (TRK) and BWS ambulation on a treadmill (TM) -to comprehensive physical therapy (PT) for improving walking speed in persons with chronic, motor-incomplete spinal cord injury (SCI). Methods: Thirty-five adult subjects with a history of chronic SCI (>1 year; AIS 'C' or 'D') participated in a 13-week (1 hour/day; 3 days per week) training program. Subjects were randomized into one of the three training groups. Subjects in the two BWS groups trained without the benefit of additional input from a physical therapist or gait expert. For each training session, performance values and heart rate were monitored. Pre-and post-training maximal 10-m walking speed, balance, muscle strength, fitness, and quality of life were assessed in each subject. Results: All three training groups showed significant improvement in maximal walking speed, muscle strength, and psychological well-being. A significant improvement in balance was seen for PT and TRK groups but not for subjects in the TM group. In all groups, post-training measures of fitness, functional independence, and perceived health and vitality were unchanged. Conclusions: Our results demonstrate that persons with chronic, motor-incomplete SCI can improve walking ability and psychological well-being following a concentrated period of ambulation therapy, regardless of training method. Improvement in walking speed was associated with improved balance and muscle strength. In spite of the fact that we withheld any formal input of a physical therapist or gait expert from subjects in the device-specific training groups, these subjects did just as well as subjects receiving comprehensive PT for improving walking speed and strength. It is likely that further modest benefits would accrue to those subjects receiving a combination of device-specific training with input from a physical therapist or gait expert to guide that training.

Ambulation and Spinal Cord Injury

“…2 Walking speed can be improved in those with chronic iSCI with activity-based therapies. 45 Walking ability and psychological well-being improved in 35 adults with chronic iSCI for more than 1 year (AIS C and AIS D), both with BWSTT and walking in a fixed track device with body-weight support. Improved walking speed was associated with increased balance and muscle strength.…”

Frequency and age effects of secondary health conditions in individuals with spinal cord injury: a scoping review

“…Many of the most common conditions identified, such as cardiovascular disease, diabetes, BMD loss, fatigue, obstructive sleep apnea appear to be related to a sedentary lifestyle, obesity or both. Significant effort may be needed to develop and evaluate the efficacy of ways for individuals with SCI to (1) increase weight-bearing and both improve and maintain cardiovascular fitness 34 and (2) help individuals with SCI avoid gaining weight as they age. Treatments that successfully address these factors may prevent or ameliorate a large number of the secondary conditions that in our review were associated with increasing age.…”

How well do randomised controlled trials of physical interventions for people with spinal cord injury adhere to the CONSORT guidelines? An analysis of trials published over a 10-year period

“…The median (IQR) number of CONSORT items per trial that was 'fully reported' was 11/37 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The median (IQR) number of CONSORT items per trial that was either 'fully reported' or 'not relevant' or 'not reported but unable to determine if relevant/done' was 20/37 items (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27).…”