Effect of Locomotor Training on Motor Recovery and Walking Ability in Patients with Incomplete Spinal Cord Injury: A Case Series

Abstract

[Purpose] The aim of this study was to describe the effect of locomotor training on a treadmill for three individuals who have an incomplete spinal cord injury (SCI). [Subjects and Methods] Three indivduals (2 males, 1 female) with incomplete paraplegia participated in this prospective case series. All subjects participated in locomotor training for a maximum of 20 minutes on a motorized treadmill without elevation at a comfortable walking speed three days a week for four weeks as an adjunct to a conventional physiotherapy program. The lower extremity strength and walking capabilities were used as the outcome measures of this study. Lower extremity strength was measured by lower extremity motor score (LEMS). Walking capability was assessed using the Walking Index for Spinal Cord Injury (WISCI II). [Results] An increase in lower extremity motor score and walking capabilities at the end of training program was found. [Conclusion] Gait training on a treadmill can enhance motor recovery and walking capabilities in subjects with incomplete SCI. Further research is needed to generalize these findings and to identify which patients might benefit from locomotor training.

Spinal cord injury: overview of experimental approaches used to restore locomotor activity

“…A conventional training program primarily provides compensatory strategies to regain motor activity and recover from damages to the spinal cord. Functional recovery after locomotor training is mostly due to strengthening of the cortical input and adaptation of spinal neuronal networks to physiological proprioceptive inputs ( Anwer et al, 2014 ). It has been shown that treadmill training following SCI leads to cortical reorganization and plastic changes that significantly improve the coordination of movements ( Martinez et al, 2012 ).…”

Energetic and cardiovascular responses to treadmill walking and stationary cycling in subjects with incomplete spinal cord injury

“…In contrast to the SCI group, the healthy control subjects exhibited a significantly higher peak VO 2 during the treadmill test compared with the cycle test (P = 0.007) and a nearsignificant higher peak HR (P = 0.059; Table 2). In the control group, no significant difference in perceived exertion between treadmill walking and cycling was found (Borg scale; median (min-max); 19 (17)(18)(19)(20) versus 20 (18)(19)(20), P = 0.73).…”

“…In contrast to cycle exercise, there is no linear relationship between workload and oxygen uptake during treadmill exercise at higher speeds. 18 Several studies 19,20 have found that gait training improves walking ability in subjects with incomplete SCI. Uphill walking at high intensity might likewise have a positive effect on the walking ability in this population.…”

“…General exhaustion was the reason for termination for all subjects in this study. The perceived exertion was rated somewhat higher during cycling compared with walking (Borg scale; median (min-max); 20 (15)(16)(17)(18)(19)(20) versus 18 (13)(14)(15)(16)(17)(18)(19)(20), P = 0.06). In contrast to the SCI group, the healthy control subjects exhibited a significantly higher peak VO 2 during the treadmill test compared with the cycle test (P = 0.007) and a nearsignificant higher peak HR (P = 0.059; Table 2).…”

“…Perceived exertion was measured instantly after the maximal exercise test with the Borg Scale (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”