Does Neurorehabilitation Play a Role in the Recovery of Walking in Neurological Populations?^a

Abstract

This review demonstrates that neurorehabilitation approaches, based on recent neuroscience findings, can enhance locomotor recovery after a spinal cord injury or stroke. Findings are presented from more than 20 clinical studies conducted by numerous research groups on the effect of locomotor training using either body weight support (BWS), functional electrical stimulation (FES), pharmacological approaches or a combination of them. Among the approaches, only BWS-assisted locomotor training has been demonstrated to have a greater effect than conventional or locomotor training alone. However, when study results were combined and weighted for the number of subjects, the results indicated that there is a gradient of effects from small changes with the immediate application of FES or BWS to larger changes when locomotor training is combined with FES or BWS or pharmacological approaches. The findings of these studies suggest that these neurorehabilitation approaches do play a role in the recovery of walking in subjects with spinal cord injury or stroke. Several factors contribute to the potential for recovery including the site, etiology, and chronicity of the injury, as well as the type, duration, and specificity of the intervention and whether interventions are combined. Furthermore, how these neurorehabilitation approaches may take advantage of the plasticity process following neurological lesion is also discussed.

Body weight-supported treadmill training in chronic incomplete spinal cord injury: a pilot study evaluating functional health status and quality of life

“…As in other studies, [3][4][5][6][7][8] all patients improved their walking capabilities on the treadmill during the 12-week period of TT. Positive changes were reported in the majority of the most important problematic activities in daily life (COPM scores).…”

“…This has prompted further studies of TT during rehabilitation or long thereafter, be it in quasi-or pre-experimental designs. [3][4][5][6][7][8] In most cases, the patient walks/steps on a treadmill while being suspended in a harness that provides a certain amount of body weight support (BWS). Most studies have reported restoration of patient's ability to walk (on the treadmill) and a gradual reduction of the need for BWS.…”

“…Most studies have reported restoration of patient's ability to walk (on the treadmill) and a gradual reduction of the need for BWS. [3][4][5][6][7][8] These encouraging results are generally attributed to the plasticity and adaptive capacity of the spinal cord below the lesion, in which the so-called 'Central Pattern Generator' plays a pivotal role. 9 Up to now, the effectiveness of TT combined with BWS in patients with an ISCI has been almost exclusively evaluated at the level of body functions, 10 mostly by electromyography or measuring speed and BWS on the treadmill.…”

“…9 Up to now, the effectiveness of TT combined with BWS in patients with an ISCI has been almost exclusively evaluated at the level of body functions, 10 mostly by electromyography or measuring speed and BWS on the treadmill. [3][4][5][6][7][8]11,12 A couple of studies have also measured walking over ground, 3,4,7,13 but only a few have measured walking-related activities. 3,13 While results are generally positive, 3,4,7,13 little is known about the effect of TT on the functional health status (FHS) and quality of life (QoL) of patients with an ISCI, even though changes of FHS are considered an important aspect of rehabilitation.…”

Treadmill walking in incomplete spinal-cord-injured subjects: 1. Adaptation to changes in speed

“…7 The walking ability of SCI subjects can be greatly improved quantitatively and qualitatively with appropriate interventions. [8][9][10] However, it is not known if this is also reflected in the capacity to adapt to changes in the mechanical demand of the task, as often observed in a changing environment. Thus, an important question remains: can SCI subjects adapt their walking pattern over a wide range of speeds?…”