An Intensive Intervention for Improving Gait, Balance, and Mobility in Individuals With Chronic Incomplete Spinal Cord Injury: A Pilot Study of Activity Tolerance and Benefits

Abstract 

Fritz SL, Merlo-Rains AM, Rivers ED, Peters DM, Goodman A, Watson ET, Carmichael BM, McClenaghan BA. An intensive intervention for improving gait, balance, and mobility in individuals with chronic incomplete spinal cord injury: a pilot study of activity tolerance and benefits.

Objective

To determine the tolerance to and benefits of an intensive mobility training (IMT) approach for individuals with incomplete spinal cord injury (ISCI).

Design

Prospective pretest-posttest study with 6-month follow-up.

Setting

University research laboratory.

Participants

A volunteer sample of individuals with ISCI (N=15; >6mo postinjury and able to walk at least 3.05m with or without assistance). Follow-up data were collected for 10 of the participants.

Interventions

Participants received IMT for 3h/d for 10 weekdays, participating in activities that encouraged repetitive, task-specific training of their lower extremities in a massed practice schedule.

Main Outcome Measures

Amount of time spent in therapeutic activities and rest was used to assess participants' tolerance to the intervention. Treatment outcomes were assessed pretest, posttest, and 6 months after the intervention and included the Berg Balance Scale (BBS), Dynamic Gait Index (DGI), 6-minute walk test, gait speed, and Spinal Cord Injury Functional Ambulation Inventory.

Results

Individuals in the higher functioning ISCI group (BBS score ≥45 and gait speed ≥0.6m/s) spent more time in the intensive therapy on average than individuals in the lower functioning ISCI group. Effect sizes were comparable for changes in balance and mobility assessments between the lower and higher functioning groups, with the largest effect sizes observed for the DGI.

Conclusions

This dosage of IMT may be a more appropriate treatment approach for higher functioning ISCI individuals, as they were better able to tolerate the length of the session and demonstrated higher effect sizes postintervention.

Key Words: Gait, Mobility limitation, Postural balance, Rehabilitation, Spinal cord injuries

List of Abbreviations: ASIA, American Spinal Injury Association, BBS, Berg Balance Scale, BWSTT, body weight–supported treadmill training, CIMT, constraint-induced movement therapy, DGI, Dynamic Gait Index, IMT, intensive mobility training, ISCI, incomplete spinal cord injury, LE, lower extremity, MDC, minimal detectable change, SCI, spinal cord injury, SCI-FAI, Spinal Cord Injury Functional Ambulation Inventory, 6MWT, 6-minute walk test