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Possible Deleterious Effects of Therapy Solely Directed at Neural Plasticity and Walking in People With Serious Spinal Cord Injury

      We read with interest the recent article by Riggins and colleagues.
      • Riggins M.S.
      • Kankipati P.
      • Oyster M.L.
      • Cooper R.A.
      • Boninger M.L.
      The relationship between quality of life and change in mobility 1 year post injury in individuals with spinal cord injury.
      The authors highlight a contentious but important issue which needs to be openly addressed. At issue are the risks of focusing on neural plasticity and walking through locomotor training and recovery programs in patients with serious spinal cord injury and very little lower-limb strength. The authors provide some evidence that when walking is not achieved 1 year later, these patients have high levels of depression and pain, and a low quality of life. Of course as the authors state, one cannot assume a cause-effect relationship, because the study is retrospective and does not capture an inception cohort. However, it does provide preliminary evidence of a possible detrimental effect of locomotor training and recovery programs for patients with limited or no lower-limb strength. The authors argue that therapy for these types of patients is currently focusing on walking and not the training of functional mobility from a seated position. Consequently, at 1-year postinjury, when walking does not eventuate and patients have not learned to adequately mobilize in a wheelchair, they are experiencing the detrimental effects associated with false hope, limited mobility, and restricted community participation.
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      Reference

        • Riggins M.S.
        • Kankipati P.
        • Oyster M.L.
        • Cooper R.A.
        • Boninger M.L.
        The relationship between quality of life and change in mobility 1 year post injury in individuals with spinal cord injury.
        Arch Phys Med Rehabil. 2011; 92: 1027-1033

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