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Activity-Based Therapy for Recovery of Walking in Chronic Spinal Cord Injury: Results From a Secondary Analysis to Determine Responsiveness to Therapy

Published:August 04, 2014DOI:https://doi.org/10.1016/j.apmr.2014.07.401

      Abstract

      Objective

      To gain insight into who is likely to benefit from activity-based therapy (ABT), as assessed by secondary analysis of data obtained from a clinical trial.

      Design

      Secondary analysis of results from a randomized controlled trial with delayed treatment design.

      Setting

      Outpatient program in a private, nonprofit rehabilitation hospital.

      Participants

      Volunteer sample of adults (N=38; 27 men; 11 women; age, 22–63y) with chronic (≥12mo postinjury), motor-incomplete (American Spinal Injury Association [ASIA] Impairment Scale [AIS] grade C or D) spinal cord injury (SCI).

      Interventions

      A total of 9h/wk of ABT for 24 weeks including developmental sequencing; resistance training; repetitive, patterned motor activity; and task-specific locomotor training. Algorithms were used to guide group allocation, functional electrical stimulation utilization, and locomotor training progression.

      Main Outcome Measures

      Walking speed and endurance (10-meter walk test and 6-minute walk test) and functional ambulation (timed Up and Go test).

      Results

      This secondary analysis identified likely responders to ABT on the basis of injury characteristics: AIS classification, time since injury, and initial walking ability. Training effects were the most clinically significant in AIS grade D participants with injuries <3 years in duration. This information, along with information about preliminary responsiveness to therapy (gains after 12wk), can help predict the degree of recovery likely from participation in an ABT program.

      Conclusions

      ABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motor-incomplete SCI. However, not everyone with goals of walking recovery will benefit. Individuals with SCI should be advised of the time, effort, and resources required to undertake ABT. Practitioners are encouraged to use the findings from this trial to assist prospective participants in establishing realistic expectations for recovery.

      Keywords

      List of Abbreviations:

      6MWT (6-minute walk test), 10MWT (10-meter walk test), ABT (activity-based therapy), AIS (ASIA Impairment Scale), RCT (randomized controlled trial), SCI (spinal cord injury), TUG (timed Up and Go)
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