The Evolution of Walking-Related Outcomes Over the First 12 Weeks of Rehabilitation for Incomplete Traumatic Spinal Cord Injury: The Multicenter Randomized Spinal Cord Injury Locomotor Trial

Abstract

Background. The Spinal Cord Injury Locomotor Trial (SCILT) compared 12 weeks of step training with body weight support on a treadmill (BWSTT) that included overground practice to a defined but more conventional overground mobility intervention (CONT) in patients with incomplete traumatic SCI within 8 weeks of onset. No previous studies have reported walking-related outcomes during rehabilitation. Methods. This single-blinded, randomized trial entered 107 American Spinal Injury Association (ASIA) C and D patients and 38 ASIA B patients with lesions between C5 and L3 who were unable to walk on admission for rehabilitation. The Functional Independence Measure (FIM-L) for walking, 15-m walking speed, and lower extremity motor score (LEMS) were collected every 2 weeks. Results. No significant differences were found at entry and during the treatment phase (12-week mean FIM-L = 5, velocity = 0.8 m/s, LEMS = 35, distance walked in 6 min = 250 m). Combining the 2 arms, a FIM-L ≥ 4 was achieved in < 10% of ASIA B patients, 92% of ASIA C patients, and all of ASIA D patients. Walking speed of ≥ 0.6 m/s correlated with a LEMS near 40 or higher. Conclusions. Few ASIA B and most ASIA C and D patients achieved functional walking ability by the end of 12 weeks of BWSTT and CONT, consistent with the primary outcome data at 6 months. Walking-related measures assessed at 2-week intervals reveal that time after SCI is an important variable for entering patients into a trial with mobility outcomes. By about 6 weeks after entry, most patients who will recover have improved their FIM-L to >3 and are improving in walking speed. Future trials may reduce the number needed to treat by entering patients with FIM-L < 4 at > 8 weeks after onset if still graded ASIA B and at > 12 weeks if still ASIA C.

Walking ability at discharge from inpatient rehabilitation in a cohort of non-traumatic spinal cord injury patients

“…The inclusion of two ASIA B patients in our results may explain the lower mean scores in our study. Interestingly, this same study 9 reported 6MWT scores of 250 m, which is comparable to our NTSCI group's mean result (220 m). Further research is required to clarify these differences and the long-term walking outcomes after NTSCI.…”

“…In contrast to this study and our results, a recent multicentre randomised trial, investigating the effects of overground training versus body-weight supported treadmill training (in addition to routine physical therapy) after TSCI, reported that 92% of ASIA C and 100% of ASIA D patients achieved minimal assisted ambulation at B16 weeks after SCI. 9 It is possible that the additional physical intervention in this trial accounted for the improved result in patients with ASIA C and D grades of SCI. An age of greater than 50 years has been reported to have a negative effect on the likelihood of walking in TSCI, 2 and one study 22 that included both TSCI and NTSCI patients also found that age affects the independence and performance of gait.…”

“…Our patients' results are lower compared with one study of mostly TSCI subjects in which their 10 mWT and 6MWT results at 12 weeks after injury were 8 s and 473 m, respectively. 26 Similarly, in a large multicentre study, 9 10 mWT speeds reported in subjects with ASIA C and D at B3 months after TSCI (B11 s or 0.85 m s…”

ZeroG: Overground gait and balance training system

“…The integration of body-weight support (BWS) systems into gait rehabilitation strategies following stroke, spinal cord injury, and other neurological disorders has continued to expand over the last two decades [1][2][3][4]. While the conceptual framework for utilizing BWS is beyond the scope of the present discussion, at its core, unloading the paretic lower limbs allows patients with gait impairments to practice a high number of steps in a safe, controlled manner (Hidler et al [5]).…”

Technology for mobility in SCI 10 years from now

“…A critical aspect of recovery of movement after SCI is central nervous system neuroplasticity. Neuroplastic changes can be influenced both by the environment and activity, which can be manipulated through interventions ranging from activity-based therapy 24,25 to electrical stimulation 26 to cellular implants, to local or systemic application of various substances. Here, we focus on neuromodulation via electrical stimulation and via chemical agents.…”