Recovery of walking in nonambulatory children with chronic spinal cord injuries: Case series

Abstract

The immature central nervous system is recognized as having substantial neuroplastic capacity. In this study, we explored the hypothesis that rehabilitation can exploit that potential and elicit reciprocal walking in nonambulatory children with chronic, severe (i.e., lower extremity motor score < 10/50) spinal cord injuries (SCIs). Seven male subjects (3–12 years of age) who were at least 1‐year post‐SCI and incapable of discrete leg movements believed to be required for walking, enrolled in activity‐based locomotor training (ABLT; http://clinicaltrials.gov NCT00488280). Six children completed the study. Following a minimum of 49 sessions of ABLT, three of the six children achieved walking with reverse rolling walkers. Stepping development, however, was not accompanied by improvement in discrete leg movements as underscored by the persistence of synergistic movements and little change in lower extremity motor scores. Interestingly, acoustic startle responses exhibited by the three responding children suggested preserved reticulospinal inputs to circuitry below the level of injury capable of mediating leg movements. On the other hand, no indication of corticospinal integrity was obtained with transcranial magnetic stimulation evoked responses in the same individuals. These findings suggest some children who are not predicted to improve motor and locomotor function may have a reserve of adaptive plasticity that can emerge in response to rehabilitative strategies such as ABLT. Further studies are warranted to determine whether a critical need exists to re‐examine rehabilitation approaches for pediatric SCI with poor prognosis for any ambulatory recovery.

Activity-Based Restorative Therapy Promotes Progression from Asymmetry to Symmetry in Posture and Gait in a Child with Chronic, Incomplete Spinal Cord Injury

“…Children, adolescents, and adults with incomplete spinal cord injuries have displayed the potential for neurorecovery for the initiation of ambulation and increased neurological capacity through ABRT interventions [ 17 , 18 , 19 , 20 , 21 , 24 , 36 , 37 ]; however, this case exemplifies the possibility for recovery of symmetry of posture and gait in a child who is ambulatory. ABRT [ 14 , 21 ] targets the inherent biological response of activity-dependent plasticity [ 37 ] via task-specific, intense practice to activate more typical sensorimotor patterns of muscle activation above, across, and below the lesion. This therapeutic approach activates a more efficient, age-appropriate neuromuscular pattern and decreases habitual maladaptive patterns in gait.…”